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CIPROFLOXACIN (CIPROFLOXACINUM)
INSTRUCTION TO PREPARATION

PHARMACOLOGICAL PROPERTY Antimicrobial wide spectrum preparation which belongs to a group of fluoroquinolones with antibacterial effect. Inhibits DNA-gyrase of bacteria.  Active towards micro-organisms in the period of fission and tranquility. Highly active towards many gramnegative and grampositive bacteria (including  stocks resistant to penicillins, cephalosporins and  aminoglycosides): Pseudomonas aeruginosa, Haemophilus influenzae, Escherichia coli, Shigella spp., Salmonella spp., Neisseria meningitidis, N.gonorrhoeae, many stocks Staphylococcus spp. (penicillinase productive and non-productive, methicillin-resistant), some stocks of Enterococcus spp., as well as ╤ampylobacter spp., Legionella spp., Mycoplasma spp., Chlamydia spp., Mycobacterium spp. Ciprofloxacinum is active towards beta-lactamase-productive bacteria.
 Ureaplasma urealyticum, Clostridium difficile, Nocardia asteroides are resistant towards Ciprofloxacinum. Activity towards Streptococcus faecium and Treponema pallidum is not sufficiently researched yet.

INDICATION TO ADMINISTRATION Infusion form of preparation is used mostly towards medium-heavy and heavy forms of infections. Infections of  ENT (ear, nose, throat ) organs (otitis media, sinuitis, mastoiditis, tonsilitis, pharyngitis), lower respiratory tract (chronic bronchitis at the recrudescence stage, pneumonia, but as to  streptococcal and pneumococcal pneumonias is not a medicament for choice), organs of small pelvis (cystitis, pyelonephritis, prostatitis, adnexitis, endometritis, pelvioperitonitis), skin and soft parts (infected chancres, injuries, burns, infections of outer acoustic meatus), bones and articulations (osteomyelitis, septic arthritis), venerial infections (gonorrhea, clamidiosis), infections of  abdominal space (cholecystis and bile passages, peritonotis, salmonellosis, dothienenteria, cholera), heavy infections while  immune deficiency and neutropenia. Medicament is used as preventive measures against infection complications during surgical interference.

ROUT Medicament is prescribed intravenously and dropwise for adults and children older than 15 without dilution. Dosage is set individually depending on localization and course of infection, as well as sensitivity of microorganisms.  Single doze composes 100 - 400 mg twice per 24 hours. Course of treatment -7 - 10 days, in the time of heavy and mixed infections course of treatment increases. When infections of urinary track, ENT-organs, bones and articulations 200 - 400 mg twice per 24 hours are inserted; when abdominal space infections and septicemia, skin and soft parts diseases - 400 mg twice 24 hours per day. Duration of infusion is 30 minutes when inserting medicine in the doze of  200 mg and 60 minutes - when inserting  400 mg. When nephros dysfunction Ciprofloxacinum is inserted first in the doze of  200 mg, and then taking into account  clearance creatinine (if clearance less than 20 ml/min, single doze must be 50 % of average doze when frequency of prescription is twice per 24 hours or a usual single doze is inserted once per 24 hours. For patients of declining years the doze should be decreased (usually to 1/3).

SIDE EFFECT Digestive tract: nausea, emesis, diarrheastomach ache, meteorism, increasing activity of hepatic transamenases, of bilirubin.
 Central nervous system: headache, faintness, destruction of sleep, hallucinations (at such reactions the preparation should be immediately canceled), loss of consciousness, destruction of sight (reduplication in the eyes), entonic sound, temporarily diminished hearing at high-frequency band.
  Uriniferous system: crystallaria, dysuria, polyuria, albuminuria, haematuria, transient increase of creatinine in blood serum.
 Blood formation: eozinophilia, leukopenia, neutropenia, decreasing amount of thrombocytes, anaemia.
 Cardiovascular system: tachycardia, destruction of heart rythmarterial hypertension.
 Allergic reactions: cutaneous eruption, urticaria fever, Quincke's disease, Stereos-Johnson syndrome, arthralgia, photoallergy.
 Other: at intravenous infusion - ache in veins direction, phlebitis; vasculitis; candidiasis.

CONTRAINDICATION High sensibility to ciprofloxacinum and other preparations of quinolones, period of pregnancy and breast-feeding, age under 15, epilepsy, central nervous system diseases with decrease of vascular boundary.

CORRELATION WITH OTHER PHARMARMACEUTICALS Activity of preparation increases at correlation with beta-lactam antibiotics, aminoglycosides, vancomycin, clindamycin, metronidasol.
 Ciprofloxacinum increases effect of warfarin and of other peroral anticoagulants (prolongs time of bloodflow).
 Ciprofloxacinum increases nephrotoxcoty of cyclosporine and risk of excitement of central nervous system and of paroxysm reactions while consumption of on the backgroung of consumption of nonsteroid anti-inflammatory preparations.
 Preparations which, increase level of alkaline in the urine (citrates, sodium bicarbonate, dissociable inhibitor of carbonic anhydrase), decrease solvability of ciprofloxacinum (probability of crystallaria increases).
 Correlated with infusion solutions: 0,9% natrium-chloride, Ringer's solution, Ringer-lackam solution, 5 or 10% glucose, 10% fructose, as well as 5% glucose, which contains 0,225% or 0,45% natrium-chloride.
 Not correlated with solutions with р═ higher than 7.
 Simultaneous consumption of large doses of ciprofloxacinum and of theophylline may cause the increase of theophylline in the blood plasma.

OVERDOSAGE Symptoms: no specific symptoms.
 Treatment. Preparation may be excreted by means of haemodialysis and peritoneal dialysis. It is preferable to take measures towards acidification of urine and symptomatic therapy. All measures are taken on the background of supporting vitally important functions of the organism.

SPECIFICS OF ADMINISTRATION Preparation is prescribed with carefulness for patients with pathematology of the central nervous system: mental illnesses, epilepsy, decrease of  myoclonic threshold, heavy cerebral (risk of cerebral crisis development).
 Preparation is prescribed with carefulness to persons of declining age as well as to patients with nephros and liver destruction of functions (control over the level of creatine in the blood plasma, liver ferments and timely decrease the doze of the preparation). In the course of treatment it is necessary to avoid sun and UV-light, heavy physical activity, control water schedule, р═ of urine. The speed of  psychomotor ability may decrease, especially at simultaneous consumption of alcohol. This must be taken into account by the patients who work with potentiaaly dangerous mechanisms or while driving a car.
  Simultaneous consumption of preparation with intravenous infusion of barbiturates needs control over functions of cardiovascular system (arterial pressure, indications of electrocardiogram).
 Children under 18 the preparation is prescribed only in case of resistance of a causative agent towards other  chemotherapeutic preparations.
 In the course of treatment the patients must get enough amount of liquid. Pregnancy and lactation period. Ciprofloxacinum is contraindicated at pregnancy in the lactation period (breast-feeding) because results of tests show that it causes arthropathia.

STORAGE CONDITIONS Keep in dark place at temperature from +10C to +25C.