Ciflo

250 mg: Each pill contains Ciprofloxacin 250 mg.
500 mg: Active ingredients in 1 tablet include Ciprofloxacin hydrochloride equivalent to Ciprofloxacin 500 mg.

Pharmacology: 250 mg: Ciprofloxacin belongs to the fluoroquinolone class of antibiotics. It exhibits broad-spectrum antibacterial activity by inhibiting bacterial DNA gyrase and topoisomerase IV, enzymes essential for bacterial DNA replication, transcription, repair, and recombination. This mechanism disrupts bacterial cell division, ultimately leading to cell death. Even though they are resistant to other antibiotics that are not in the quinoline carboxylic acid derivatives, such as aminoglycosides, penicillins, cephalosporins and tetracyclines.
Ciprofloxacin is active against a wide range of gram-positive and gram-negative pathogens including Escherichia coli (E. coli), Neisseria gonorrhoeae, Klebsiella pneumoniae, Salmonella, Shigella, and others.
Ciprofloxacin demonstrates efficacy against resistant bacterial strains such as E. coli, Klebsiella, Enterobacter, Pseudomonas aeruginosa, Staphylococcus aureus (including methicillin-resistant Staphylococcus aureus, MRSA), and others. It is also effective against organisms like Haemophilus influenzae, Moraxella catarrhalis, Proteus mirabilis, and Bacteroides fragilis. This agent acts against gram-negative bacteria such as Salmonella typhi, Yersinia pestis, Vibrio cholerae, and gram-positive bacteria like Staphylococcus aureus and Streptococcus pneumoniae.
Ciprofloxacin is rapidly absorbed following oral administration, with peak plasma concentrations typically achieved within 60-90 minutes. Approximately 70-80% of the drug is bioavailable, and high concentrations are achieved in tissues and fluids, making it effective for treating a variety of systemic infections.
500 mg: Mechanism of action: Ciprofloxacin is a broad-spectrum fluoroquinolones antimicrobial that kills a wide range of gram-negative and some gram-positive bacteria by inhibiting the enzyme DNA gyrase, which is essential for bacterial DNA synthesis, repair, and transcription.
Quinolone drugs have a similar mechanism of action, so bacteria that are resistant to one quinolone will also be resistant to other quinolone drugs.
Scope of action against microorganisms: Ciprofloxacin has a broad spectrum of action and is active against both gram-positive and gram-negative aerobic bacteria. Anaerobic bacteria are often resistant to this drug.
Gram-negative organisms are susceptible to this drug include Enterobacteriaceae such as Citrobacter sp., Enterobacter sp., Escherichia coli, Klebsiella sp., Morganella morganii, Proteus sp. (P. mirabilis and P. vulgaris), Salmonella sp., Shigella sp., Vibrio sp., and Yersinia enterocolitica. This drug is active against other drug-resistant gram-negative rods such as penicillin-resistant Neisseria gonorrhoeae, beta-lactamase-produced by Haemophilus influenzae, and Moraxella catarrhalis. Normally, this drug does not kill Pseudomonas such as Ps. maltophila and Ps. cepacia, but it is very active against to Ps. aeruginosa.
Gram-positive organisms are susceptible to this drug including Staphylococci such as S. aureus, S. saprophyticus, and S. epidermidis. But Streptococci such as S. pneumoniae, S. pyogenes, and Enterococcus faecalis are moderately susceptible to this drug, like Ofloxacin, and should not be used as first-line therapy for pneumococcal pneumoniae.
The drug is also active against Chlamydia trachomatis, Mycoplasma sp., Legionella sp., Mycobacterium tuberculosis and atypical mycobacteria.
Pharmacokinetics: Ciprofloxacin is well absorbed from the gastrointestinal tract (50-84%). Food slows the absorption of ciprofloxacin from the gastrointestinal tract. Antacids, medications containing calcium, iron, and zinc reduce the absorption of ciprofloxacin. Ciprofloxacin levels are highest in the blood after drug is administered orally for 60-75 minutes. If a dose of 500 mg is administered orally, the maximum drug level is 2.5 mg/L. The drug is distributed throughout the body with a Vd of 2-3.5 L/kg, but in the elderly (64-91 years), the Vd is higher to 3.5-3.6 L/kg. Under normal conditions, the drug enters the cerebrospinal fluid very little. The drug level in the cerebrospinal fluid is only 6-10% of the blood level. However, if there is inflammation of the meninges, the drug can enter the brain more and the drug level is high enough to kill the disease. The drug is bound to plasma proteins by 20-40%, a half-life of 3-4 hours in normal people, but is longer in patients with kidney disease. The drug is metabolized in the liver and enters the enterohepatic circulation. Therefore, the drug is found in the feces in both the original form (20-40%) and metabolites (10-15%). These substances still have antibacterial activity. The remaining 15-50% is excreted in the urine in the original form. Most of the drug is excreted in the urine by tubular secretion, so co-administration with probenecid will increase drug levels and half-life. The drug crosses the placenta and is also excreted in breast milk. The drug is eliminated only slightly by hemodialysis or peritoneal dialysis.

250 mg: Urinary tract infections: Including cystitis, urethritis, and pyelonephritis.
Respiratory tract infections: Including sinusitis, bronchitis, and pneumonia, as well as prevention of lower respiratory infections in immuno-compromised patients.
Gastrointestinal tract infections: Including diarrhea caused by bacterial pathogens such as Shigella and Salmonella.
Bone and joint infections: Including osteomyelitis caused by susceptible bacteria.
Skin and soft tissue infections.
Other infectious diseases such as infected wounds, soft tissue infections, septicemia, meningitis, peritonitis, infectious diseases, or prevention of infections in neutropenic or immunosuppressed patients (lower than normal white blood cells).
500 mg: Treatment of bacterial infections sensitive to this drug, including respiratory tract infections such as bronchitis and pneumonia caused by gram-negative bacteria, urinary tract or genital infections such as gonorrhea, Chlamydia, chancroid, gastrointestinal infections such as Salmonella, Shigella, Vibrio parahemolytica, skin and soft tissue, bone and joint infections.

250 mg: Ciflo should be taken twice a day, in the morning and evening.
Cystitis: Take ½-1 tablet twice a day.
Respiratory tract, urinary tract, kidney and gastrointestinal infections (including typhoid fever): Take ½ tablet twice a day.
Other infections: Take 2 tablets twice a day.
Severe infections: The dosage can be increased to 3 tablets twice a day.
Acute gonorrhea in both men and women, including uncomplicated acute cystitis: Take only 1 tablet once.
Take medicine with water on an empty stomach. The drug will be absorbed more quickly.
The duration of treatment depends on the severity of the disease. It is usually given for 5-10 days. After the fever subsides or the symptoms of the disease disappear, the drug should be continued for at least 3 days.
In uncomplicated urinary tract infections, a treatment period of 3 days should be sufficient.
In patients with abnormal blood function, the creatinine clearance is less than 20 ml/min. Use the normal dosage. It may be given only once daily, or if twice daily is desired, reduce the dosage by half.
500 mg: Recommended dose: Adults: Take 250-750 mg twice daily, every 12 hours. The maximum dose per day is not more than 1.5 grams. The duration of treatment depends on the site of infection and the severity of the disease, as follows: Urinary tract infections: Take 250-500 mg twice daily, every 12 hours, for at least 7-14 days. Longer doses may be needed if the infection is severe or has complications.
Gonorrhea caused by Neisseria gonorrhoeae: Take 250-500 mg once.
Infectious diseases of the digestive tract: Take 500 milligrams twice daily, every 12 hours, for 5-7 days.
Typhoid fever: Take 500 milligrams twice daily, every 12 hours, for 10 consecutive days.
Lower respiratory tract infections, skin and soft tissue infections, bones and joints: Take 500-750 mg twice daily, every 12 hours for 7-14 days. Bone infections may require longer-term medication for 4-6 weeks.
Patients with impaired kidney function: The dosage should be reduced according to creatinine clearance (Cr_Cl), with the infusion interval adjusted from every 12 hours (Cr_Cl 30-50 mL/min) to every 18-24 hours when Cr_Cl is between 5-29 mL/min. For those undergoing hemodialysis or peritoneal dialysis, the infusion should be given every 24 hours after dialysis.
Children: This drug is not recommended for use in children as it has been shown to cause osteoarthritis in laboratory animals. However, if necessary, it might be given in doses of 10-20 mg/kg every 12 hours and as directed by a physician.
Notations: Should be taken with at least 1 glass of water (240 ml).
Take the medication continuously until the required treatment period is complete.
Do not drink milk or take antacids, sucralfate, iron or zinc-containing drugs, such as multivitamin products, within 2 hours before or after taking this medication, as this will reduce the absorption of the drug.
Do not take drugs that cause alkaline urine, such as citrates, bicarbonate of soda, or drugs that inhibit the action of the carbonic anhydrase enzyme, as this may cause kidney stones.
If the patient forgets to take the medicine, take it as soon as the patient remembers. However, do not take a double dose.
Sun exposure should be avoided during the period of treatment with this medicine.

500 mg: One patient who took 21 g of ciprofloxacin reported an acute renal failure.
Treatment: If there is still food in the stomach, flush the stomach or induce vomiting.
Give intravenous fluid to keep the body well hydrated.
Provide supportive treatment according to the symptoms. If there are psychotic symptoms, consult a psychiatrist.

250 mg: Hypersensitivity to ciprofloxacin or other fluoroquinolones. Should not be used in children and adolescents who are still growing. Pregnancy and lactation women.
500 mg: Do not use in patients with a history of hypersensitivity to quinolones.

If a patient experience a rash, joint pain, muscle pain, or pain in the tendons of the wrists or ankles after using this medicine, stop taking it immediately and consult a doctor.
This medicine may cause harm to the liver and kidneys.
Use cautiously in patients taking drugs metabolized by cytochrome P450 1A2 (e.g., theophylline, methylxanthine, caffeine), as ciprofloxacin may interfere with drug metabolism and increase plasma levels, leading to toxicity.
Blood disorders, including bone marrow suppression, may occur. If found, the drug should be stopped immediately. Using this drug together with warfarin may increase the effect of warfarin.
Avoid prolonged exposure to sunlight or ultraviolet (UV) light, as ciprofloxacin may cause phototoxicity. Rare but serious adverse reactions include Stevens-Johnson syndrome, toxic epidermal necrolysis, and erythema multiforme.
This drug may affect blood sugar level changes. Caution should be exercised in diabetic patients.
250 mg: History of allergic reactions to other quinolone antibiotics.
Pregnancy and lactation, unless the potential benefits outweigh the risks.
Avoid patients with a history of epilepsy or other central nervous system (CNS) disorders prone to seizures.
Ciprofloxacin should be administered to patients with a history of seizures only if appropriate and proven seizure prevention or treatment is available. Ciprofloxacin absorption is reduced when given with antacids containing aluminum and magnesium hydroxide; therefore, the two drugs should not be taken together. Ciprofloxacin should be given 1 to 2 hours before or after antacids. Co-administration of Ciprofloxacin (1500 mg or more per day) and theophylline may result in higher than desired blood theophylline concentrations.
500 mg: Do not use in people who are allergic to this drug or other quinolone drugs.
Pregnant and breastfeeding women should avoid using this drug.
This drug should not be used, or if necessary, should be used with caution in patients with central nervous system disorders who are prone to seizures, in relation to the dose given.

250 mg: Ciprofloxacin should only be administered to patients with a history of seizures if appropriate and effective seizure prevention or treatment measures are available. The absorption of Ciflo is reduced when co-administered with antacids containing aluminum or magnesium hydroxide; therefore, these medications should not be taken simultaneously. Ciflo should be taken 1 to 2 hours before or after antacids. Additionally, coadministration of Ciprofloxacin (1,500 mg or more per day) with theophylline may lead to elevated blood concentrations of theophylline, exceeding the desired therapeutic levels.
500 mg: Use with caution in patients with a history of epilepsy or other neurological disorders and patients with kidney disease.
This drug may cause nausea, vomiting, dizziness, headache, nervous system stimulation (causing insomnia, confusion, hallucinations and seizures), kidney inflammation, tendonitis or tendon rupture, skin sensitivity to sunlight and severe allergic reactions.
After using this medicine, if the patient experiences joint pain or tendonitis, stop taking the medicine and consult a doctor immediately.
This drug should not be taken with didanosine, sucralfate, antacids containing aluminum, magnesium, vitamins containing iron, zinc, and calcium because these drugs reduce the absorption of ciprofloxacin. If necessary, take at least 2 hours after taking ciprofloxacin.
This drug should not be used together with theophylline, caffeine, aminophylline, digoxin, cyclosporin, and the anticoagulant warfarin because ciprofloxacin inhibits the breakdown of these drugs, causing dangerously high levels of the drug.
Use in Pregnancy & Lactation: See USE IN PREGNANCY & LACTATION section for further information.
Use in Children: 500 mg: This medicine should not be used in people under the age of 18 years.

500 mg: This medicine should not be used in pregnant women and lactating women.

250 mg: Common: Nausea, vomiting, diarrhea, abdominal pain, headache, dizziness, and rash.
Rare: Tendon rupture, severe hypersensitivity reactions, peripheral neuropathy, or psychiatric effects such as anxiety and confusion. The liver may increase temporarily, especially in patients with a history of liver disease.

250 mg: Store at a temperature below 30 degrees Celsius.
Protect from light and moisture.
500 mg: Store in a tightly closed container, protected from light, at a temperature below 30 degrees Celsius.

Quinolones

J01MA02 - ciprofloxacin ; Belongs to the class of fluoroquinolones. Used in the systemic treatment of infections.

D