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. 1994 Mar 1;150(5):669–676.

Ciprofloxacin: an oral quinolone for the treatment of infections with gram-negative pathogens. Committee on Antimicrobial Agents. Canadian Infectious Disease Society.

T J Louie 1
PMCID: PMC1486352  PMID: 8313286

Abstract

OBJECTIVE: To optimize the use of ciprofloxacin, a synthetic fluoroquinolone, in community and hospital practice, and to minimize overprescribing by providing an overview of the literature and recommendations for appropriate use. OPTIONS: First-line treatment for infections in which ciprofloxacin is shown to be effective, treatment with oral ciprofloxacin rather than parenteral therapy with another drug, and step-down therapy with oral ciprofloxacin after initial parenteral treatment. OUTCOMES: In order of importance: efficacy, side effects and cost. EVIDENCE: A MEDLINE search of articles concerning ciprofloxacin, including in-vitro and pharmacokinetic studies using recognized standard methods with appropriate controls and published in recognized peer-reviewed journals, and randomized, controlled, double-blind clinical trials. VALUES: The Committee on Antimicrobial Agents of the Canadian Infectious Disease Society (CIDS) and a recognized expert (T.J.L.) recommended use of ciprofloxacin to treat infections against which it has proved effective both in vitro and in randomized controlled trials. They took into account its value as an oral replacement for other drugs given parenterally and development of resistance. BENEFITS, HARMS AND COSTS: With more appropriate use of ciprofloxacin there will be less development of resistant pathogens. For certain infections patients who would otherwise require admission to hospital could be treated at home and patients initially admitted for parenteral therapy could be discharged sooner on oral therapy with ciprofloxacin. RECOMMENDATIONS: Ciprofloxacin may be considered as first-line treatment for a number of infections in which gram-negative pathogens are proven or strongly suspected, including complicated urinary tract infections, bacterial prostatitis, bacterial diarrhea, selected bone and joint infections, malignant otitis externa, bronchopulmonary infections in patients with cystic fibrosis and selected pneumonia cases. VALIDATION: The paper was prepared, reviewed and revised by the Committee on Antimicrobial Agents of the CIDS. It was then reviewed and revised further by the Council of the CIDS. SPONSOR: The CIDS is solely responsible for developing, funding and endorsing these guidelines.

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Selected References

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  1. Alfaham M., Holt M. E., Goodchild M. C. Arthropathy in a patient with cystic fibrosis taking ciprofloxacin. Br Med J (Clin Res Ed) 1987 Sep 19;295(6600):699–699. doi: 10.1136/bmj.295.6600.699. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Barry A. L., Jones R. N. In vitro activity of ciprofloxacin against gram-positive cocci. Am J Med. 1987 Apr 27;82(4A):27–32. [PubMed] [Google Scholar]
  3. Bellido F., Pechère J. C. Laboratory survey of fluoroquinolone activity. Rev Infect Dis. 1989 Jul-Aug;11 (Suppl 5):S917–S924. doi: 10.1093/clinids/11.supplement_5.s917. [DOI] [PubMed] [Google Scholar]
  4. Bergan T., Thorsteinsson S. B., Solberg R., Bjornskau L., Kolstad I. M., Johnsen S. Pharmacokinetics of ciprofloxacin: intravenous and increasing oral doses. Am J Med. 1987 Apr 27;82(4A):97–102. [PubMed] [Google Scholar]
  5. Campoli-Richards D. M., Monk J. P., Price A., Benfield P., Todd P. A., Ward A. Ciprofloxacin. A review of its antibacterial activity, pharmacokinetic properties and therapeutic use. Drugs. 1988 Apr;35(4):373–447. doi: 10.2165/00003495-198835040-00003. [DOI] [PubMed] [Google Scholar]
  6. Cooper B., Lawlor M. Pneumococcal bacteremia during ciprofloxacin therapy for pneumococcal pneumonia. Am J Med. 1989 Oct;87(4):475–475. doi: 10.1016/s0002-9343(89)80838-1. [DOI] [PubMed] [Google Scholar]
  7. Dekker A. W., Rozenberg-Arska M., Verhoef J. Infection prophylaxis in acute leukemia: a comparison of ciprofloxacin with trimethoprim-sulfamethoxazole and colistin. Ann Intern Med. 1987 Jan;106(1):7–11. doi: 10.7326/0003-4819-106-1-7. [DOI] [PubMed] [Google Scholar]
  8. DuPont H. L., Ericsson C. D., Robinson A., Johnson P. C. Current problems in antimicrobial therapy for bacterial enteric infection. Am J Med. 1987 Apr 27;82(4A):324–328. [PubMed] [Google Scholar]
  9. Easmon C. S., Crane J. P. Uptake of ciprofloxacin by human neutrophils. J Antimicrob Chemother. 1985 Jul;16(1):67–73. doi: 10.1093/jac/16.1.67. [DOI] [PubMed] [Google Scholar]
  10. Edelstein P. H. Legionnaires' disease. Clin Infect Dis. 1993 Jun;16(6):741–747. doi: 10.1093/clind/16.6.741. [DOI] [PubMed] [Google Scholar]
  11. Ericsson C. D., Johnson P. C., Dupont H. L., Morgan D. R., Bitsura J. A., de la Cabada F. J. Ciprofloxacin or trimethoprim-sulfamethoxazole as initial therapy for travelers' diarrhea. A placebo-controlled, randomized trial. Ann Intern Med. 1987 Feb;106(2):216–220. doi: 10.7326/0003-4819-106-2-216. [DOI] [PubMed] [Google Scholar]
  12. Fass R. J. Efficacy and safety of oral ciprofloxacin in the treatment of serious respiratory infections. Am J Med. 1987 Apr 27;82(4A):202–207. [PubMed] [Google Scholar]
  13. Ferreccio C., Morris J. G., Jr, Valdivieso C., Prenzel I., Sotomayor V., Drusano G. L., Levine M. M. Efficacy of ciprofloxacin in the treatment of chronic typhoid carriers. J Infect Dis. 1988 Jun;157(6):1235–1239. doi: 10.1093/infdis/157.6.1235. [DOI] [PubMed] [Google Scholar]
  14. Follath F., Bindschedler M., Wenk M., Frei R., Stalder H., Reber H. Use of ciprofloxacin in the treatment of Pseudomonas aeruginosa infections. Eur J Clin Microbiol. 1986 Apr;5(2):236–240. doi: 10.1007/BF02013997. [DOI] [PubMed] [Google Scholar]
  15. Fong I. W., Linton W., Simbul M., Thorup R., McLaughlin B., Rahm V., Quinn P. A. Treatment of nongonococcal urethritis with ciprofloxacin. Am J Med. 1987 Apr 27;82(4A):311–316. [PubMed] [Google Scholar]
  16. Gaunt P. N., Lambert B. E. Single dose ciprofloxacin for the eradication of pharyngeal carriage of Neisseria meningitidis. J Antimicrob Chemother. 1988 Apr;21(4):489–496. doi: 10.1093/jac/21.4.489. [DOI] [PubMed] [Google Scholar]
  17. Gentry L. O., Rodriguez G. G. Oral ciprofloxacin compared with parenteral antibiotics in the treatment of osteomyelitis. Antimicrob Agents Chemother. 1990 Jan;34(1):40–43. doi: 10.1128/aac.34.1.40. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Guibert J., Destrée D., Konopka C., Acar J. Ciprofloxacin in the treatment of urinary tract infection due to enterobacteria. Eur J Clin Microbiol. 1986 Apr;5(2):247–248. doi: 10.1007/BF02014000. [DOI] [PubMed] [Google Scholar]
  19. Haring J. I., Van Dis M. L. Odontogenic keratocysts: a clinical, radiographic, and histopathologic study. Oral Surg Oral Med Oral Pathol. 1988 Jul;66(1):145–153. doi: 10.1016/0030-4220(88)90082-5. [DOI] [PubMed] [Google Scholar]
  20. Henry N. K., Schultz H. J., Grubbs N. C., Muller S. M., Ilstrup D. M., Wilson W. R. Comparison of ciprofloxacin and co-trimoxazole in the treatment of uncomplicated urinary tract infection in women. J Antimicrob Chemother. 1986 Nov;18 (Suppl 500):103–106. doi: 10.1093/jac/18.supplement_d.103. [DOI] [PubMed] [Google Scholar]
  21. Khan F. A., Basir R. Sequential intravenous-oral administration of ciprofloxacin vs ceftazidime in serious bacterial respiratory tract infections. Chest. 1989 Sep;96(3):528–537. doi: 10.1378/chest.96.3.528. [DOI] [PubMed] [Google Scholar]
  22. Koga H. High-performance liquid chromatography measurement of antimicrobial concentrations in polymorphonuclear leukocytes. Antimicrob Agents Chemother. 1987 Dec;31(12):1904–1908. doi: 10.1128/aac.31.12.1904. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Lebel M., Bergeron M. G. Pharmacokinetics in the elderly. Studies on ciprofloxacin. Am J Med. 1987 Apr 27;82(4A):108–114. [PubMed] [Google Scholar]
  24. Lesse A. J., Freer C., Salata R. A., Francis J. B., Scheld W. M. Oral ciprofloxacin therapy for gram-negative bacillary osteomyelitis. Am J Med. 1987 Apr 27;82(4A):247–253. [PubMed] [Google Scholar]
  25. Naamara W., Plummer F. A., Greenblatt R. M., D'Costa L. J., Ndinya-Achola J. O., Ronald A. R. Treatment of chancroid with ciprofloxacin. A prospective, randomized clinical trial. Am J Med. 1987 Apr 27;82(4A):317–320. [PubMed] [Google Scholar]
  26. Naber K. G. Use of quinolones in urinary tract infections and prostatitis. Rev Infect Dis. 1989 Jul-Aug;11 (Suppl 5):S1321–S1337. doi: 10.1093/clinids/11.supplement_5.s1321. [DOI] [PubMed] [Google Scholar]
  27. Neu H. C. Ciprofloxacin: an overview and prospective appraisal. Am J Med. 1987 Apr 27;82(4A):395–404. [PubMed] [Google Scholar]
  28. Newsom S. W., Murphy P., Matthews J. A comparative study of ciprofloxacin and trimethoprim in the treatment of urinary tract infections in geriatric patients. J Antimicrob Chemother. 1986 Nov;18 (Suppl 500):111–115. doi: 10.1093/jac/18.supplement_d.111. [DOI] [PubMed] [Google Scholar]
  29. Peterson L. R., Lissack L. M., Canter K., Fasching C. E., Clabots C., Gerding D. N. Therapy of lower extremity infections with ciprofloxacin in patients with diabetes mellitus, peripheral vascular disease, or both. Am J Med. 1989 Jun;86(6 Pt 2):801–808. doi: 10.1016/0002-9343(89)90476-2. [DOI] [PubMed] [Google Scholar]
  30. Peterson P. K., Stein D., Guay D. R., Logan G., Obaid S., Gruninger R., Davies S., Breitenbucher R. Prospective study of lower respiratory tract infections in an extended-care nursing home program: potential role of oral ciprofloxacin. Am J Med. 1988 Aug;85(2):164–171. doi: 10.1016/s0002-9343(88)80336-x. [DOI] [PubMed] [Google Scholar]
  31. Renkonen O. V., Sivonen A., Visakorpi R. Effect of ciprofloxacin on carrier rate of Neisseria meningitidis in army recruits in Finland. Antimicrob Agents Chemother. 1987 Jun;31(6):962–963. doi: 10.1128/aac.31.6.962. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Righter J. Pneumococcal meningitis during intravenous ciprofloxacin therapy. Am J Med. 1990 May;88(5):548–548. doi: 10.1016/0002-9343(90)90442-g. [DOI] [PubMed] [Google Scholar]
  33. Rohwedder R., Bergan T., Thorsteinsson S. B., Scholl H. Transintestinal elimination of ciprofloxacin. Chemotherapy. 1990;36(2):77–84. doi: 10.1159/000238751. [DOI] [PubMed] [Google Scholar]
  34. Saito A., Koga H., Shigeno H., Watanabe K., Mori K., Kohno S., Shigeno Y., Suzuyama Y., Yamaguchi K., Hirota M. The antimicrobial activity of ciprofloxacin against Legionella species and the treatment of experimental Legionella pneumonia in guinea pigs. J Antimicrob Chemother. 1986 Aug;18(2):251–260. doi: 10.1093/jac/18.2.251. [DOI] [PubMed] [Google Scholar]
  35. Sanders C. C., Sanders W. E., Jr, Goering R. V. Overview of preclinical studies with ciprofloxacin. Am J Med. 1987 Apr 27;82(4A):2–11. [PubMed] [Google Scholar]
  36. Shen L. L., Pernet A. G. Mechanism of inhibition of DNA gyrase by analogues of nalidixic acid: the target of the drugs is DNA. Proc Natl Acad Sci U S A. 1985 Jan;82(2):307–311. doi: 10.1073/pnas.82.2.307. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Tolkoff-Rubin N. E., Rubin R. H. Ciprofloxacin in management of urinary tract infection. Urology. 1988 Apr;31(4):359–367. doi: 10.1016/0090-4295(88)90102-1. [DOI] [PubMed] [Google Scholar]
  38. Weidner W., Schiefer H. G., Dalhoff A. Treatment of chronic bacterial prostatitis with ciprofloxacin. Results of a one-year follow-up study. Am J Med. 1987 Apr 27;82(4A):280–283. [PubMed] [Google Scholar]

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