CIPROFLOXACIN - AN UPDATED REVIEW OF ITS PHARMACOLOGY, THERAPEUTIC EFFICACY AND TOLERABILITY

Ciprofloxacin is a broad spectrum fluoroquinolone antibacterial agent. Since its introduction in the 1980s, most cram-negative bacteria have remained highly susceptible to this agent in vitro; Gram-positive bac teria are generally susceptible ol model ately susceptible. Ciprofloxa cin attains therapeutic concentrations in most tissues and body fluids . The results of clinical trials with ciprofloxacin have confirmed its clinical efficacy and low potential for adverse effects. Ciprofloxaci n is effective in the treatment of a wide variety of infections, parti cularly those caused by Gram-negative pathogens. These include complic ated urinary tract infections, sexually transmitted diseases (gonorrho ea and chancroid), skin and bone infections, gastrointestinal infectio ns caused by multiresistant organisms, lower respiratory tract infecti ons (including those inpatients with cystic fibrosis), febrile neutrop enia (combined with an agent, which possesses good activity against cr am-positive bacteria), intra-abdominal infections (combined w ith an a ntiananerobic agent) find malignant external otitis. Ciprofloxacin sho uld not be considered a first-line empirical therapy for respiratory t ract infections if penicillin-susceptible Streptococcus pneumoniae is the primary pathogen; however it is an appropriate treatment option in patients with mixed infections (where S. pneumoniae may or may not be present) or in patients with predisposing factors for Gram-negative i nfections. Clinically important drug interactions involving ciprofloxa cin are well documented and avoidable with conscientious prescribing. Recommended dosage adjustments in patients with impaired renal functio n vary between countries; major adjustments are not required until the estimated creatinine clearance is <30 ml/min/1.73m(2) (or when the se rum creatinine level is greater than or equal to 2 mg/dl). Ciprofloxac in is one of the few broad spectrum antibacterials available in both i ntravenous and oral formulations. In this respect, it offers the poten tial for cost savings with sequential intravenous and oral therapy in appropriately selected patients and may allow early discharge from hos pital in some instances. In conclusion, ciprofloxacin has retained its excellent activity against most Gram-negative bacteria, and fulfilled its potential as an important antibacterial drug in the treatment of a wide range of infections. Rational prescribing will help to ensure t he continued clinical usefulness of this valuable antimicrobial drug.