Ciprofloxacin

What is Ciprofloxacin?

Ciprofloxacin is an antibiotic of the fluoroquinolone family, which are broad-spectrum antibiotics used to treat a wide range of bacterial infections. It is most commonly used to treat bacterial traveller’s diarrhoea, but can also be used to treat other bacterial infections of the respiratory tract, ears, sinuses, urinary tract, genital tract, gastrointestinal tract, skin and soft tissue, and bones and joints.

How effective is Ciprofloxacin?

Ciprofloxacin can be used to treat a wide variety of bacterial infections and as such is an effective treatment for most cases of traveller’s diarrhoea. 

How long does it take to see the benefits of Ciprofloxacin?

For traveller’s diarrhoea, Ciprofloxacin starts working immediately once taken orally, and most people experience significant relief of their symptoms within 24-48 hours. In the cases of other bacterial infections, treatment with Ciprofloxacin can range from 5 - 21 days. The benefits are usually seen early on, but it is important to continue taking the antibiotic for the period of time recommended by your doctor.

How does Ciprofloxacin work?

Ciprofloxacin is an antibiotic and can therefore only be used to treat bacterial infections. It works by attacking the enzyme involved in the replication and repair of the bacteria’s DNA, preventing infection from spreading and allowing your body’s immune system to kill off the bacteria. 

Active ingredients

Ciprofloxacin contains the active ingredient ciprofloxacin hydrochloride which kills the bacteria that has caused the infection.

Inactive ingredients

The inactive ingredients of Ciprofloxacin are cellulose microcrystalline, crospovidone, magnesium stearate, maize starch, silica colloidal anhydrous, hypromellose, macrogol 4000, and titanium dioxide (E171).

Please Note: Different brands of generic medications can contain different inactive ingredients.

Ciprofloxacin dosage

Ciprofloxacin dosage and duration of treatment depends on the type of infection it is being used to treat. The recommended dosage for treatment of traveller’s diarrhoea is 500mg twice daily at 12-hour intervals for up to 3 days.

How to take Ciprofloxacin

Ciprofloxacin tablets should be swallowed with plenty of fluid, with or without food. The tablets should not be chewed or crushed and should not be taken directly with milk, yoghurt or calcium-fortified fruit juices. 

At what time should you take Ciprofloxacin?

You can take Ciprofloxacin at any time of the day as long as you maintain regular intervals between doses. Scheduling your dose for the same time or times each day will also help you remember to take your medication. 

Will I need to finish the course of Ciprofloxacin?

You should always continue taking Ciprofloxacin for the duration of time recommended by your doctor, regardless of whether your symptoms have already improved.

Can you eat dairy when taking Ciprofloxacin?

Ciprofloxacin should not be swallowed with milk alone, as there is evidence to suggest that direct contact with dairy products lessens the effectiveness of the medication. It is perfectly fine to eat or drink dairy products with your meals or as a part of your daily routine other than at the time you take your medication.

Ciprofloxacin and pregnancy

It is best to avoid taking Ciprofloxacin if you are pregnant, and you should seek the advice of your doctor. Do not take Ciprofloxacin whilst breastfeeding, as it is be passed on through breast milk and can be harmful to your child.

Ciprofloxacin and alcohol

It is best to avoid drinking alcohol altogether whilst taking Ciprofloxacin, as this may cause you to feel dizzy or tired.

Contraindications

You should not take Ciprofloxacin if:

• You are allergic to any of the ingredients of this medication, or to other quinolone drugs.
• You are taking Tizanidine

Before taking Ciprofloxacin, consult your doctor if:

• You have ever had kidney problems.
• You suffer from epilepsy or other neurological conditions.
• You have a history of tendon problems during previous problems with antibiotics.
• You are diabetic.
• You have myasthenia gravis (a type of muscle weakness).
• You have heart problems or a family history of heart problems,
• You or a member of your family is known to have a deficiency in glucose-6-phosphate dehydrogenase (G6PD).  

Drug interactions

Before taking Ciprofloxacin, tell your doctor if you are taking or have recently taken any other medication. In particular, alert your doctor if you are taking:

• Vitamin K antagonists or any other oral anticoagulants
• Probenecid
• Methotrexate
• Theophylline
• Tizanidine
• Olanzapine
• Clozapine
• Ropinirole
• Phenytoin
• Metoclopramide
• Cyclosporin
• Zolpidem
• Other medication that can alter your heart rhythm: arrhythmics (quinidine, hydroquinidine, disopyramide, amiodarone, sotalol, dofetilide, ibutilide), tricyclic antidepressants, some antimicrobials, some antipsychotics
• Pentoxifylline
• Duloxetine
• Lidocaine
• Sildenafil
• Agomelatine
• Antacids
• Omeprazole
• Mineral supplicants
• Caffeine
• Sucralfate
• A polymeric phosphate binder
• Medicines or supplements containing calcium, magnesium, aluminium or iron

Ciprofloxacin side Effects

Like all medications, Ciprofloxacin can cause side effects in some patients. Common side effects (affecting up to 1 in 10 people) include:

• Nausea and/or diarrhoea
• Joint pain and joint inflammation in children

Uncommon side effects can affect up to 1 in 100 people and include:

• Joint pain in adults
• Fungal superinfections
• High concentration of a type of white blood cell called eosinophils, of blood alkaline phosphatase, or of other substances in the blood
• Decrease in appetite
• Hyperactivity, agitation and trouble sleeping.
• Headache or dizziness
• Rash, itching or hives
• Poor kidney function
• Aching of bones and muscles, general feeling of unwell or fever.

Rare side effects, which may affect up to 1 in 1,000 people, include:

• Muscle pain, increased muscle tone, inflammation of the joints and cramping
• Inflammation of the bowel (colitis)
• Changes to the blood count and increased or decreased amount of thrombocytes (blood clotting factor)
• Allergic reaction, swelling of the skin and mucus membranes
• Hyperglycaemia (increased blood sugar)
• Hypoglycaemia (decreased blood sugar)
• Confusion, disorientation, anxiety, strange dreams, depression, or hallucinations
• Pins and needles, decreased skin sensitivity, tremors, or giddiness
• Eyesight issues
• Tinnitus, loss of hearing, impaired hearing
• Tachycardia (rapid heartbeat)
• Vasodilation (expansion of blood vessels), low blood pressure or fainting
• Shortness of breath
• Jaundice, liver disorders or hepatitis
• Sensitivity to light
• Kidney failure, Urinary Tract Infection, blood in the urine
• Fluid retention or excessive sweating
• Increased levels of amylase

Extremely rarely (around 1 in 10,000) the patient may experience the following:

• Haemolytic Anaemia (a type of reduced red blood cell count), agranulocytosis (a dangerous drop in a type of white blood cells) pancytopenia (a drop in the number of red and white blood cells and number of platelets), or bone marrow depression
• Serum sickness-like reaction or mental disturbances
• Migraines, disturbed coordination, gait disturbance, olfactory disorders, pressure on the brain, or visual colour distortions
• Vasculitis (inflammation of the wall of the blood vessels)
• Pancreatitis
• Liver necrosis
• Pin-point bleeding under the skin, skin eruptions or rashes

If you notice any of the following serious side effects, you should stop taking ciprofloxacin and contact your doctor immediately:

• Seizure
• Severe, sudden allergic reaction (characterised by a tightening of the chest and feeling dizzy, sick or faint)
• Muscle weakness, inflammation of the tendons which could lead to rupture of the tendons
• A serious rash in the form of blisters or ulcers in the mouth, throat, nose, eyes and other mucus membranes such as genitals
• Unusual feelings of pain, burning tingling, numbness or muscle weakness in the extremities
• Reaction that causes rash, fever or inflammation of the internal organs, hematologic abnormalities and systemic illness  

Ciprofloxacin vs Azithromycin for traveller's diarrhoea

Ciprofloxacin is the most commonly used antibiotic for treating traveller’s diarrhoea, and can be taken at 12 hour intervals until symptoms subside. It is used to treat a broad spectrum of bacterial infections, which unfortunately means that bacteria are becoming increasingly resistant to Ciprofloxacin. In this case, Azithromycin is the antibiotic of choice for treating traveller’s diarrhoea. Azithromycin can be taken at 24 hour intervals for up to 3 days, and although it has a narrower spectrum of usage than Ciprofloxacin, is sufficient treatment for most cases of traveller’s diarrhoea. 

How to avoid traveller's diarrhoea

The best way to avoid traveller’s diarrhoea is to be especially attentive to hygiene while travelling. The following tips are advisable when travelling to high-risk areas:

• Wash your hands often with soap and hot water and carry hand sanitizer with you at all times.
• Do not drink from the tap in areas where it is not safe, and avoid ice in your drinks unless you know it is made from bottled water. 
• When buying bottled water, make sure it is in a factory-sealed container. For extra caution, clean the rim before drinking.
• If you are unable to make sure raw fruit and vegetables are washed in clean water, you may choose to only eat varieties with a removable outer peel.
• Ensure that your meals are fully cooked and served hot, and avoid foods that have been left sitting. 

It is best to always be prepared for traveller’s diarrhoea by staying well-hydrated at all times. I is also possible to order a private prescription of Ciprofloxacin in advance of your travels if you are expecting to have limited access to a doctor.  

Is Ciprofloxacin an antibiotic?

Ciprofloxacin is an antibiotic belonging to the fluoroquinolone family, which are broad-spectrum antibiotics used to treat a wide range of bacterial infections.

Which countries is Ciprofloxacin suitable for?

Intermediate-risk areas include Eastern Europe, South Africa and Caribbean Islands, while the high-risk areas are most of Asia, the Middle East, Africa Mexico, and Central and South America. It may be worth ordering a private prescription of Ciprofloxacin in advance of travelling to high-risk areas. Ciprofloxacin works against the most common bacterial causes of traveller’s diarrhoea, most notably E. Coli, and is suitable treatment in cases of mild to severe traveller’s diarrhoea. 

However, the global rise in resistance of E. Coil to fluoroquinolone antibiotics such as Ciprofloxacin is particularly problematic in India and South-East Asia, where other antibiotic treatments may be preferable.  

Do I need to keep taking Ciprofloxacin after my symptoms have resolved?

Even if your symptoms appeared to have resolved, it is vital that you continue to take Ciprofloxacin for the period of time recommended by your doctor. This can range from between 5 to 21 days.

What should you do if Ciprofloxacin doesn't work for your infection?

Unless you have reached the end of your dose, you should not stop taking Ciprofloxacin without consulting your doctor. If your symptoms fail to improve or worsen, speak to your doctor. It may be that your infection is caused by a bacteria that is resistant to Ciprofloxacin.

Is Ciprofloxacin Penicillin?

Ciprofloxacin is not related to Penicillin and is safe to use in individuals who are allergic to Penicillin.

How long does it take for Ciprofloxacin to leave your system?

The time taken for Ciprofloxacin to leave your system varies from person to person, but usually takes 2-3 days. 

How long does it take for Ciprofloxacin to treat a UTI?

While Ciprofloxacin can clear up a UTI in a matter of a few days, this is dependent on the severity of the infection and on the patient as an individual. Treatment may continue to be administered for up to 2 weeks. It is important to keep taking Ciprofloxacin for the period of time recommended by your doctor. 

Sources

• Patient Information Leaflet
• Centres for Disease Control and Prevention > Traveller’s Diarrhoea
• NHS > Antibiotics
• WebMD > Ciprofloxacin
• ResistanceMap
• Drugs.com > Comparing Ciprofloxacin and Azithromycin