Ciprofloxacin

What is Ciprofloxacin?

Ciprofloxacin is a broad-spectrum antibiotic that belongs to the fluoroquinolone family. Ciprofloxacin 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 range of bacterial infections. Ciprofloxacin is used to treat traveller’s diarrhoea. However, due to resistance, sometimes Azithromycin is the preferred treatment.

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

Ciprofloxacin helps relieve the symptoms of traveller’s diarrhoea within 24 to 48 hours. Treatment with Ciprofloxacin can take a number of days depending on the type and severity of the infection. You must complete the full course of antibiotics your doctor has prescribed to prevent your bacterial infection from recurring and the potential development of resistance.

How does Ciprofloxacin work?

Ciprofloxacin is an antibiotic and is only used to treat bacterial infections. Ciprofloxacin works by attacking two enzymes involved in the replication and repair of bacterial DNA. This stops bacteria from multiplying and they die, preventing the infection from spreading and allowing your body’s immune system to remove the bacteria.

Active ingredients

Ciprofloxacin contains the active ingredient ciprofloxacin hydrochloride.

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. Please read the Patient Information Leaflet provided for further details

Ciprofloxacin dosage

Your dose of Ciprofloxacin and your duration of treatment depends upon the type of infection you are being treated for. A typical treatment course for traveller’s diarrhoea is one 500 mg Ciprofloxacin tablet twice a day, with a twelve-hour interval, for up to three 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 day, as long as you maintain regular intervals between doses. Scheduling your dose for the same time each day will also help you remember to take your medicine.

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.

Ciprofloxacin side effects

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

• Nausea 
• 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, a 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 mucous 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 (UTI)
• 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 cell), 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 (a tightening of the chest and feeling dizzy, sick or faint)
• Muscle weakness, inflammation of the tendons that 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 mucous membranes such as genitals
• Unusual feelings of pain, burning tingling, numbness or muscle weakness in the extremities
• A reaction that causes rash, fever or inflammation of the internal organs, hematologic abnormalities and systemic illness

Contraindications

You should not take Ciprofloxacin if:

• You are allergic to any of the ingredients in this medicine, or to other quinolone medicines.
• 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 medicine. In particular, tell 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 medicines 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 supplements
• Caffeine
• Sucralfate
• A polymeric phosphate binder
• Medicines or supplements containing calcium, magnesium, aluminium or iron

Ciprofloxacin and alcohol

You should avoid drinking alcohol whilst taking Ciprofloxacin, as it can make you feel dizzy or tired. You should not drive after drinking alcohol if you are taking Ciprofloxacin.

Ciprofloxacin and pregnancy

Speak to your doctor if you are pregnant or planning a baby before you take Ciprofloxacin. Do not take Ciprofloxacin if you are breastfeeding, as it can pass through breast milk and can be harmful to your child.

Can you eat dairy when taking Ciprofloxacin?

Ciprofloxacin should not be taken with milk, yoghurt or calcium-fortified juices, as it can reduce the absorption and effectiveness of the medicine. You can eat or drink dairy products with your meals or as a part of your daily routine other than at the time you take Ciprofloxacin.

How to avoid traveller's diarrhoea

The best way to avoid traveller’s diarrhoea is to maintain good hygiene standards while travelling. The following tips may help when travelling:

• Wash your hands often with soap and hot water. Especially before preparing or eating food.
• Carry hand sanitiser with you at all times.
• Do not drink tap water 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 and check if it has been tampered with. Ideally, clean the rim around the bottle cap before drinking.
• If you are unsure whether raw fruits and vegetables have been washed in clean water, you should only eat varieties with a removable outer peel.
• Ensure that your meals are fully cooked and served hot. Avoid foods that have been reheated or left sitting out for too long. 

Be prepared for traveller’s diarrhoea by staying well-hydrated at all times. It 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.

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 three days, and although it has a narrower spectrum of usage than Ciprofloxacin, it is sufficient treatment for most cases of traveller’s diarrhoea.

Is Ciprofloxacin an antibiotic?

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

Which countries is Ciprofloxacin suitable for?

Medium risk areas include Eastern Europe, South Africa and the Caribbean Islands. Higher risk areas are most of Asia, the Middle East, Africa, Mexico, Central America 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. Coli to fluoroquinolone antibiotics such as Ciprofloxacin is particularly problematic in India and South East Asia, where other antibiotic treatments, such as Azithromycin, may be preferable.

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

Even if your symptoms appear to have resolved and you feel better, it is vital that you continue to take Ciprofloxacin for the period of time prescribed by your doctor. Make sure to complete the course to prevent recurrent bacterial infections and reduce the chances of resistance.

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, or your infection may be caused by a virus or protozoa and requires a different treatment.

Is Ciprofloxacin Penicillin?

Ciprofloxacin is not related to Penicillin and is generally 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 two to three days.

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

While Ciprofloxacin can clear up a Urinary Tract Infection (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 be required for two weeks and beyond. It is important to keep taking Ciprofloxacin for the period of time recommended by your doctor.