Antibiotics for inflammation of the appendages 5/5 (2)

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Antibiotics for inflammation of the appendages should be given to the patient immediately after an accurate diagnosis is established. At this time, studies can be carried out to determine the type of pathogen, but this is not reflected in the initial treatment. Antibacterial drugs are relevant if the inflammatory process proceeds in an acute form. In some cases, antibiotics are given to patients with an exacerbation of a chronic disease.

  • Types of antibiotics for inflammation of the appendages;
  • Indications for the use of antibiotics;
  • Pharmacodynamics of antibiotics;
  • Pharmacokinetics of antibiotics;
  • Treatment of inflammation of the appendages during pregnancy;
  • Contraindications to the use of antibiotics;
  • Side effects of antibiotics;
  • How to take antibiotics for inflammation of the appendages;
  • Overdose of antibiotics;
  • Interactions of antibiotics with other drugs.

For the treatment of inflammation of the appendages, drugs with a wide spectrum of action are relevant, that is, they kill a number of bacteria that usually lead to diseases of the genitourinary system. Doctors need to remember that the antibiotics chosen for the treatment of the patient must be active against ureaplasma, chlamydia and mycoplasma, because most often it is these organisms that cause the inflammatory process.

The treatment is adjusted after the result of the study, if it is found that another drug is better suited to destroy the identified pathogen. The drug and / or dosage should be changed if the patient’s condition has not improved in a few days, that is, there has been no progress in symptoms and laboratory data.

Types of antibiotics for inflammation of the appendages

In recent years, a number of pathogens have acquired resistance to popular antibacterial drugs of the tetracycline series. It is also worth considering that drugs in this group have a large number of side effects. Specialists in most cases treat inflammation of the appendages with doxycycline (which has minimal side effects and is excreted by the body in a short time).

Another group of effective drugs for the problems under consideration are macrolides. They are not destroyed in the stomach, have a long half-life, therefore they accumulate in the body and thus speed up recovery. The effectiveness of sumamed and klacid has been proven in practice today. Antibacterial drugs from the macrolide group destroy, among other things, organisms that settle inside cells, leading to inflammation.

Fluoroquinolines are the next group that is relevant in the treatment of inflammation of the appendages. The “addiction” of pathogens to these drugs is very, very slow, so there will be no need to change the drug often. If the patient has no contraindications to taking fluoroquinolines, one of these drugs is prescribed:

For the treatment of diseases of the genitourinary system, two or more drugs are used, monotherapy is not indicated. The reason is that the pathogens are often two or more microorganisms, both anaerobes and aerobes. For the destruction of the latter, drugs such as metronidazole and tinidazole are relevant.

Indications for the use of antibiotics

Infectious inflammation of the ovarian appendages is known as adnexitis. For therapy, the use of antibacterial drugs of various forms of release is mandatory. Injectable forms are mostly relevant (into a muscle, into a vein, as well as drugs are available in the form of powders for dilution or ready-made solutions). After a course of injections, the doctor prescribes tablet forms of drugs. Also, in some cases, suppositories or suspensions of antibacterial agents may be prescribed.

The main antibiotics that are prescribed for the inflammatory process in the appendages:

Effective drugs from the group of nitromidazoles:

The doctor prescribes aminoglycosides only if the disease is very severe, or if the infection has spread throughout the body, moving to other organs.

Pharmacodynamics of antibiotics

Antibiotics, which are classified as tetracyclines, kill the ability of the pathogen to multiply. They are effective against such flora:

  • gonococci;
  • streptococci;
  • staphylococci;
  • enterobacteria;
  • whooping cough;
  • salmonella;
  • klebsiella;
  • spirochetes;
  • mycoplasmas;
  • chlamydia;

Antibacterial drugs from the group of fluoroquinols inhibit DNA gyrase and topoisomerase, disrupt DNA synthesis, and through these mechanisms they help to cope with the disease. If the pathogen is resistant to 1st generation quinolines (which is detected during therapy), then the doctor prescribes one of the fluoroquinolones. Kill mycobacteria, mycoplasma and pneumococci drugs of this group, but the 3rd and 4th generation, and the 2nd generation is less effective. Some enterococci can also be destroyed by fluoroquinolones.

Pharmacokinetics of antibiotics

Approximately seventy percent of the taken drug from a number of tetracyclines, which are prescribed by physicians in the diagnosis of inflammation of the appendages, is absorbed in the gastrointestinal tract. The active substance “disperses” through tissues and fluids, and during pregnancy it enters both the placenta and the fetus. Tetracycline antibiotics are excreted unchanged from the body in the urine and feces.

Absorption can be greater or lesser, depending on the type of drug and its form, as well as whether it is taken before, during or after a meal. This point should be indicated by the attending physician when developing a treatment regimen. Especially carefully you need to calculate the time of eating and taking ezithromycin. Josamycin and clarithromycin can be taken without regard to lunch/dinner hours.

Macrolides are collected in large quantities in the blood serum and tissues of the body. During inflammation in the body, macrolides spread well in the air, getting inside the cells and concentrating there. These drugs do not cross the hematoophthalmic barrier. Macrolides break down into simpler elements in the human liver, and are excreted through the gallbladder. The half-life is different for all drugs in the group, but the period is at least 1 hour, maximum 55 hours. Renal failure when taking drugs from the macrolide group does not change the above half-life figures.

The absorption of drugs from the fluoroquinolone group occurs to a large extent in the gastrointestinal tract after the patient drinks the pill. 2 hours after ingestion, the highest concentration of the drug in the patient’s blood occurs. These antibiotics can also affect the fetus, so pregnancy is a contraindication for taking. These drugs are excreted mainly by the kidneys, the gallbladder also plays a small role.

Fluoroquinolones, with the exception of norfloxacin, accumulate in the organs and tissues of the human body. Different drugs from this group have different degrees of disintegration into smaller particles, pefloxacin disintegrates the most. Drugs are excreted by 50% in 3-14 hours, the maximum half-life in some cases is twenty hours. If the patient’s kidney function is impaired, then the drugs are excreted longer, this issue should be clarified with the attending physician and be sure to inform him of all diseases, in addition to inflammation of the appendages. When determining the desired therapeutic dose, one must take into account severe renal failure, if it is present in a patient with inflammation of the appendages.

Treatment of inflammation of the appendages during pregnancy

Pregnancy is a contraindication for the appointment of tetracycline drugs, because these drugs pass through the placenta into the fetus, can be collected in its organs and tissues. Because of this, the unborn child will develop the skeleton incorrectly. Some macrolides are also not used during pregnancy. Clarithromycin has been shown to be harmful to the fetus. And the action of roxithromycin and midecamycin has not been sufficiently studied today.

Relatively safe for the treatment of inflammation of the appendages of pregnant women are such drugs:

If no other treatment is possible, and inflammation of the appendages in a pregnant woman is severe, doctors may resort to prescribing azithromycin. Preparations from the group of fluoroquinolones during pregnancy are prohibited.

Contraindications to the use of antibiotics

Contraindications to the appointment of tetracyclines are:

  • kidney failure
  • hypersensitivity to this drug
  • diagnosis of leukopenia
  • if the patient is less than 8 years old
  • when breastfeeding
  • when carrying a child

Contraindications for treatment with macrolides:

  • pregnancy (only part of the drugs)
  • breastfeeding (clarithromycin and others)

Contraindications for fluoroquinolone therapy:

  • gestation
  • lactation
  • lack of glucose-6-phosphate dehydrogenase
  • the appearance of allergic manifestations in response to taking the drug
  • not suitable for children

Side effects of antibiotics

Tetracycline antibiotics can lead to an increase in pressure inside the skull, to dizziness. In the blood, the number of neutrophils, platelets, and hemoglobin changes. Other side effects of these drugs include:

  • nausea;
  • loss of appetite;
  • inflammation in the gastrointestinal tract;
  • diarrhea or constipation;
  • violation of the functioning of the kidneys;
  • allergic manifestations;
  • anaphylactic shock.

Some of these antibiotics, prescribed for inflammation of the appendages, lead to candidiasis, the development of excessive susceptibility to ultraviolet rays. Tetracyclines in babies can disrupt the formation of bones, including teeth, the shade of enamel changes.

Macrolides can lead to such side effects:

  • allergic manifestations;
  • reinfection with pathogen resistance to erifomycin;
  • pain in the gastrointestinal tract;
  • nausea;
  • drooping of the upper eyelid;
  • vision problems;
  • a significant expansion of the pupil;
  • paralysis of the oculomotor muscles.

Fluoroquinolones also cause a number of side effects, one or some of which may be noted in the patient:

  • loss of appetite;
  • pain in the gastrointestinal tract;
  • diarrhea or constipation;
  • nausea;
  • poor sleep, or awakenings in the middle of the night;
  • headache;
  • convulsions;
  • trembling in the body;
  • decreased vision;
  • Allergy manifestations.

Rare side effects of taking fluoroquinolones include:

  • inflammation in the tendons, joints;
  • negative impact on the functioning of the kidneys;
  • tendon ruptures;
  • problems with heart rhythm;
  • diseases of the large intestine;
  • oral candidiasis;
  • thrush in female patients.

How to take antibiotics for inflammation of the appendages

Medicines classified as tetracyclines should be taken after meals or with meals. For adult patients, the doctor prescribes 100 mg of the drug, the dose is divided into three or four doses. If the child is over 8 years old, the dose for him is calculated according to the formula for a maximum of 25 mg / kg. The course of treatment with drugs of this group is 5-7 days, no more. But this should be indicated directly by your attending physician, self-medication with antibiotics is life threatening!

Treatment with tetracycline antibacterial drugs is canceled if a person develops such manifestations of allergies as burning, itching, redness of the skin. It is better not to take these drugs with milk or products based on it (kefir, fermented baked milk), otherwise the product will be absorbed much worse.

A number of macrolide antibiotics should be taken 2 hours after or 60 minutes before a meal. Erythromycin is recorded with water in an amount of more than two hundred milligrams. Suspensions for internal use must be diluted, before use, read the instructions, which indicate the features of administration and dosage. The doctor prescribes a specific treatment regimen that must be strictly followed. The medicine is taken at certain time intervals, and this plan cannot be deviated from, only in this way the desired concentration of the medicine in the blood and tissues is achieved.

Macrolides are not taken with antacids. The latter are prescribed in the presence of acid-dependent diseases of the gastrointestinal tract. Fluoroquinolones are also washed down with water in large quantities, taken 2 hours before meals. When treating with antibiotics, you need to drink one and a half liters of water or more per day.

Antibiotic overdose

If an overdose of tetracyclines occurs, the side effects of the drugs become stronger. Side effects are listed above. Treatment consists of taking medications to relieve symptoms. An overdose of antibiotics from a number of macrolides is not life-threatening. There are stool disorders, nausea, the heart rhythm changes.

Fluoroquinols in excessive dosage for the life of the patient do not pose a threat. The resulting symptoms are treated outside the hospital. Very rarely, epileptic seizures can occur. An overdose of these drugs affects the joints, liver, cardiovascular system and tendons.

Interactions of antibiotics with other drugs
Tetracyclines should not be combined with therapy with drugs containing such substances:

  • calcium;
  • magnesium;
  • iron;
  • zinc;
  • other metal ions.

The effect of tetracycline drugs is adversely affected by concurrent therapy with barbiturates and carbamazepine. It should be borne in mind that antibiotics from this series reduce the effectiveness of oral contraceptive pills. It is impossible to combine treatment with macrolides and aminoglycosides. Tetracyclines and chloramphenicol or lincomycin are not prescribed together. There are a number of other features of the interaction of antibiotics and other drugs that the attending physician should talk about, given the patient’s medical history and current diseases, in addition to inflammation of the appendages.

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Other names for this medication :
Baycip, Cifran, Ciloxan, Ciprofloksacin, Ciprofloxacina, Ciprofloxacinum,  Ciprofloxin, Ciproxin, Ciproxina, Ciriax, Floxelena, Kensoflex, Lucipro,  Novidat.

Active Ingredient: Ciprofloxacin

Form of issue

Eye and ear drops 0,3%.
Concentrate for infusion therapy 2 mg / ml.
Pills coated with a film coat 250 mg, 500 mg, 1000mg and 750 mg.
Ointment ophthalmic 0,3%.


Ear and eye drops of Ciprofloxin contain Ciprofloxin hydrochloride at a concentration of 3 mg / ml (in terms of a pure substance), Trilon B, benzalkonium chloride, sodium chloride, purified water.

In the ophthalmic ointment, the active substance is also contained in a concentration of 3 mg / ml.

Pills Ciprofloxin: 250, 500,  and 750 mg 1000mg mg Ciprofloxin, MCC, potato starch, corn starch, hypromellose, croscarmellose sodium, talc, magnesium stearate, colloidal anhydrous silica, macrogol 6000, additive E171 (titanium dioxide), polysorbate 80.

The infusion solution contains the active substance at a concentration of 2 mg / ml. Excipients: sodium chloride, edetate disodium, lactic acid, dilute hydrochloric acid, water d / u.

 Pharmachologic effect


↘ Pharmacodynamics and pharmacokinetics ↙

Ciprofloxin is an anti-biotics or not?
Antibiotic Ciprofloxin is an early fluoroquinolone (1st generation drug) and is used primarily for hospital infections. The agent penetrates well into cells and tissues (including cells of bacteria and macroorganisms) and has good pharmacokinetic parameters.

➡ Pharmacodynamics

The mechanism of action of the drug is due to the ability to inhibit DNA-gyrase (enzyme of bacterial cells) with a violation of DNA synthesis, division and growth of microorganisms.

Wikipedia indicates that against the background of the use of the drug, resistance to other non-group inhibitors of gyrase, antibiotics is not developed. This makes Ciprofloxin highly effective against bacteria resistant to the action of penicillins, kaminoglikozidov, tetracyclines, cephalosporins and a number of other antibiotics.

The most active activity is with Gram (-) and Gram (+) aerobes: 

H. influenzae, N. gonorrhoeae, Salmonella spp., P. aeruginosa, N. meningitidis, E. coli, Shigella spp.

Effective in infections caused by: strains of staphylococci (including those producing penicillinase), individual strains of enterococci, legionella, campylobacteria, chlamydia, mycoplasmas, mycobacteria.

It is active against the producing beta-lactamase microflora.

Anaerobes are moderately sensitive or resistant to the drug. Therefore, in patients with mixed anaerobic and aerobic infections, Ciprofloxin treatment should be supplemented with the administration of lincosamides or metronidazole.

Resistant to the antibiotic are: Ureaplasma urealyticum, Streptococcus faecium, Treponema pallidum, Nocardia asteroides.

➡ Pharmacokinetics

After taking the pill, the drug is quickly and completely absorbed in the digestive tract.

Main pharmacokinetic parameters:

▶ bioavailability – 70%;
▶ TSmax in blood plasma – 1-2 hours after administration;
▶ T½ – 4 hours.

Plasma proteins bind from 20 to 40% of the substance. Ciprofloxin is well distributed in body fluids and tissues, and its concentration in tissues and liquids can significantly exceed the plasma one.

Through the placenta penetrates the cerebrospinal fluid, excreted into breast milk, high concentrations are fixed in the bile. Up to 40% of the dose taken is eliminated within 24 hours in unchanged form by the kidneys, part of the dose is excreted with bile.

➡Indications for use Ciprofloxin

Ciprofloxin – from what these pills / solution?

Ciprofloxin is prescribed for the treatment of infectious diseases of the ENT organs, pelvic organs, bones, skin, joints, abdominal cavity, respiratory tract, urogenital and postoperative infections caused by a flora sensitive to the drug.

The drug can be used in patients with immunodeficiency states (including in conditions that develop with neutropenia, or due to the use of immunosuppressors).

Ciprofloxin (like other early fluoroquinolones) is the preferred drug in the treatment of UTI, including, among others, hospital infections.

Due to the ability to penetrate well into tissues and, in particular, into prostate tissue, fluoroquinolones have practically no alternative in the treatment of bacterial prostatitis.

Being highly active against the most likely pathogens of hospital pneumonia (Staphylococcus aureus, enterobacteria and Pseudomonas aeruginosa), it is important for pneumonia associated with the need for artificial ventilation.

If the causative agent of the disease is P. aeruginosa, before prescribing the drug, its sensitivity to Ciprofloxin should be established. This is due to the fact that in intensive care units more than a third of the Pseudomonas aeruginosa strains are resistant to the drug.

Importance of the drug has with intra-abdominal surgical infections and infections of the hepatobiliary system. To prevent infection, he can be assigned to a patient with pancreatic necrosis.

Fluoroquinolones are not used for CNS infections. This is due to their low penetration (penetration) into the cerebrospinal fluid. In this case, they are effective in meningitis, the causative agents of which are resistant to cephalosplorins of the third generation of Gram (-) bacteria.

The presence of several dosage forms allows the use of the drug for the stepwise therapy. When switching from Ciprofloxin IV administration to oral intake in order to maintain therapeutic concentration, the dose for oral administration should be increased.

So, if the patient was prescribed the administration of 100 mg intravenously, then he should take 250 mg inside, and if 200 mg was administered to the vein, then 500 mg.

What is the medicine in the form of eye / ear drops?
In ophthalmology it is used for superficial bacterial infections of the eye (eye) and its appendages, as well as for ulcerative keratitis.

Indications for use Ciprofloxin in otology: acute bacterial otitis of the external ear and acute bacterial otitis of the middle ear in patients with a tympanostomy tube.

Contraindications in systemic application:

➲ hypersensitivity;
➲ pregnancy;
➲ lactation;
➲ severe renal / hepatic dysfunction;
➲ indications of a history of chronic tendonitis caused by the use of  quinolones.

Drops for eyes and ears are contraindicated in fungal and viral infections of the eyes / ears, with intolerance to Ciprofloxin (or other quinolones), during pregnancy and lactation.

For children, pills and a solution for intravenous administration can be prescribed from the age of 12, eye and ear drops from 15 years.

▶ Side effects
The drug is good tolerability.

The most common side effects with intravenous administration and ingestion:

➲ dizziness;
➲ fatigue;
➲ headache;
➲ tremor;
➲ excitation.

In Vidal’s handbook it is reported that in single cases the patients were recorded:

➲ sweating;
➲ violation of gait;
➲ peripheral sensory disorders;
➲ tides;
➲ intracranial hypertension;
➲ depression;
➲ feeling of fear;
➲ visual impairment;
➲ flatulence;
➲ stomach ache;
➲ indigestion;
➲ nausea, vomiting;
➲ diarrhea;
➲ hepatitis;
➲ necrosis of hepatocytes;
➲ tachycardia;
➲ arterial hypertension (rarely);
➲ itching;
➲ the appearance of rashes on the skin.

Exceptionally rare side effects: bronchospasm, anaphylactic shock, Quincke’s edema, arthralgia, petechiae, malignant erythema exudative, vasculitis, Lyell’s syndrome, leuko- and thrombocytopenia, eosinophilia, anemia, hemolytic anemia, thrombotic or leukocytosis, increased plasma LDH concentration, bilirubin, LF, transaminase of the liver, creatinine.

Application in ophthalmology is accompanied by:

⓵. often – a sense of discomfort and / or foreign body presence in the eye, the appearance of white plaque (usually in patients with ulcerative keratitis and with frequent use of drops), the formation of crystallites / scales, supergiosis and conjunctival hyperemia, tingling and burning;

⓶. in isolated cases – keratitis / keratopathy, eyelid edema, corneal staining, hypersensitivity reactions, lacrimation, decreased visual acuity, photophobia, corneal infiltration.

Side effects that are associated with or possibly related to the use of the drug are usually mild, do not pose a threat and go untreated.

In patients with ulcerative keratitis, the emerging white coating does not adversely affect the treatment of the disease and the parameters of vision and disappears on its own. As a rule, it appears in the period from 1-7 days after the beginning of the course of application of the drug and disappears immediately or within 13 days after its termination.

Neofthalmological disorders when using drops: the appearance of an unpleasant aftertaste in the mouth, in rare cases – nausea, dermatitis.

When used in otology, the following are possible:

  • often – a run-off in the ear;
  • in some cases – ringing in the ears, headache, dermatitis.

Pills Ciprofloxin: instructions for use

The daily dose for an adult varies from 500 mg to 1.5 g / day.  It should be divided into 2 receptions with an interval of 12 hours.
To prevent the crystallization of salts in the urine, the antibiotic should be taken with a large volume of liquid.

A single dose is selected depending on the diagnosis:

☞ urogenital infections – from 2 * 250 to 2 * 500 mg with uncomplicated acute, from 2 * 500 to 2 * 750 mg with complicated;
☞ cystitis in women before menopause – 500 mg (once);
☞ infection of the respiratory tract (depending on the pathogen and severity of the disease) – from 2 * 500 to 2 * 750 mg;
☞ gonorrhea – 500 mg once for acute uncomplicated and from 2 * 500 to 2 * 750 mg mg, if the patient is diagnosed with an extragenital form of the disease, and also in cases when the disease occurs with complications;
☞ joint and bone lesions, severe, life-threatening patients, infections, septicemia, peritonitis (in particular, in the presence of Pseudomonas,   Streptococcus or Staphylococcus) – 2 * 750 mg;
☞ gastrointestinal infections – from 2 * 250 to 2 * 500 mg;
Inhalation form of anthrax – 2 * 500 mg;
prevention of invasive infections caused by N. meningitidis – 1 * 500 mg.

The treatment continues until clinical symptoms stop, and a few more days after their disappearance and the normalization of body temperature. In most cases, the course lasts from 5 to 15 days, with lesions of joints and bone tissue it is prolonged to 4-6 weeks, with osteomyelitis – up to 2 months.

Patients with renal dysfunction require a dose adjustment and / or duration of the interval.

Application of ampoules
Ciprofloxin in ampoules is recommended to be administered intravenously in the form of a drop infusion. The dose for an adult is 200-800 mg / day. The duration of the course is on average from 1 week to 10 days.

With urogenital infections, joints and bones or ENT disorders, a patient is administered 200-400 mg twice a day during the day. With infections of the respiratory tract, intra-abdominal infections, septicemia, soft tissue and skin lesions, a single dose at the same multiplicity of applications is 400 mg.

With kidney dysfunction, the starting dose is 200 mg, and subsequently it is adjusted for Clcr.

In the case of the use of ampoules in a dose of 200 mg, the duration of the infusion is 30 minutes, with the administration of the drug at a dose of 400 mg – 1 hour.

Ciprofloxin injections are not prescribed.

Ear and Eye Drops Ciprofloxin: Instructions for Use
With ulcerative keratitis, the treatment is carried out according to the following scheme:

✹ ➊ day – during the first 6 hours of the conjunctival cavity is administered 2 drops of the solution every 15 minutes, then the interval between instillation increased to half (a single dose of the same – 2 drops);
✹ ➋ days – 2 drops with an interval between instillations of 60 minutes;
3-14 days – 2 drops with an interval between instillations of 4 hours.
Treatment for ulcerative keratitis can last longer than 14 days. The treatment plan is selected individually by the attending physician.

With superficial bacterial infections of the eye and its appendages, the standard dose is 1-2 drops with a multiplicity of applications of 4 r. / Day. In especially severe cases, in the first 48 hours the patient is instilled with 1-2 drops every 2 hours.

Treatment lasts from 7 to 14 days.

After instillation, a nasolacrimal occlusion is recommended to reduce systemic absorption of the drug administered into the eye.

In the case of concomitant treatment with other drugs for ophthalmic topical use should withstand 15-minute time intervals between their administration and administration of Ciprofloxin.

In otology, the standard dose of the drug is 4 drops in the previously cleared auditory canal of the affected ear 2 r. / Day.

Patients who use ear pads, the dose is increased only with the first use of the drug: children are administered 6, adults – 8 drops.

The course should not last more than 10 days. If it is necessary to extend it, determine the sensitivity of the local flora.

In case of using other agents for topical application between their administration and administration of Ciprofloxin, it is necessary to maintain an interval of 10-15 minutes.

Dosage for children from 15 years: 3 drops twice a day.

The effect of renal / hepatic dysfunction on the pharmacokinetic parameters of the drug in the form of ear and eye drops has not been studied.

To avoid vestibular stimulation, the solution is warmed to body temperature before insertion into the auditory canal.

The patient should lie on the opposite side of the affected ear. In this position, it is recommended to stay for 5-10 minutes after instillation of the solution.

It is also permissible after local cleaning to insert for 1-2 days in the ear canal a tampon moistened with a solution of hygroscopic cotton wool or gauze. To saturate the drug, it should be moistened twice a day.

To avoid contamination of the tip of the dropper bottle and the solution, do not touch the dropper to the eyelids, the pinna, the external auditory canal, outdoor areas and any other surfaces.


Fundamental difference in how to take drugs from different manufacturers, no:    instructions for use Ciprofloxin-Akos similar to the instructions on the Ciprofloxin-FPO, Ciprofloxin, Promed, Vero Ciprofloxin or Ciprofloxin-Teva.

For children and adolescents under the age of 18, the drug should be prescribed only if the pathogen is resistant to other chemotherapeutic agents.

▶ Overdose
Specific symptoms with an overdose of Ciprofloxin not. The patient is shown gastric lavage, taking emetic drugs, creating an acidic urine reaction, introducing a large volume of fluid. All activities should be conducted against the backdrop of maintaining the function of vital systems and organs.

Peritoneal dialysis and hemodialysis contribute to the elimination of 10% of the dose.

There is no specific antidote for the drug.

▶  Interaction
The use in combination with Teofillinum promotes an increase in plasma concentration and an increase in T1 / 2 of the latter.

Al / Mg-containing antacids help to slow the absorption of Ciprofloxin and thereby reduce its concentration in urine and blood. Between the methods of these drugs should be maintained intervals of at least 4 hours.

Probenecid delayed excretion of the drug.

Ciprofloxin increases the effect of coumarin anticoagulants.

The interaction of Ciprofloxin for use in otology and ophthalmology with other drugs has not been studied.

▶ Storage conditions

Store the drug at room temperature, in a place inaccessible to children.

▶ Shelf life

For solution, ear and eye drops – 2 g (the contents of the opened vial should be used for 28 days), for pills – 3 g.

▶ Special instructions

Because of the possibility of occurrence of side effects from the side of the central nervous system in patients with a history of its pathology, the drug can be used exclusively for life indications.

Ciprofloxin is cautiously prescribed when lowering the threshold of convulsive readiness, epilepsy, brain damage, severe cerebrosclerosis (increased risk of blood flow and stroke), serious violations of the liver / kidney function, in old age.

During treatment it is recommended to avoid UV and solar irradiation and increased physical activity, to control urine acidity and drinking regimen.

In patients with an alkaline urine reaction, cases of crystalluria were recorded. To avoid its development, it is inadmissible to exceed the therapeutic dose of the drug. In addition, the patient requires a lot of drinking and maintaining an acid reaction of urine.

Pain in the tendons and the appearance of signs of tendovaginitis are a signal to stop treatment, as the possibility of inflammation / rupture of the tendon is not ruled out.

Ciprofloxin can inhibit the rate of psychomotor reactions (especially against the background of alcohol), which should be remembered for patients working with potentially dangerous devices.

With the development of severe diarrhea, pseudomembranous colitis should be ruled out. this disease is a contraindication to the use of the drug.

If necessary, simultaneous in / in the introduction of barbiturates should monitor the function of SSS: in particular, the parameters of ECG, heart rate, blood pressure.

The liquid ophthalmic form of the drug is not intended for intraocular injections.

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