Ciprofloxacin

INTRODUCTION

Indications

PO, IV: Treatment of the following bacterial infections: Urinary tract and gynecologic infections, including cystitis, gonorrhea, and prostatitis; Respiratory tract infections, including acute sinusitis, acute exacerbations of chronic bronchitis, and pneumonia; Skin and skin structure infections: Bone and joint infections; Infectious diarrhea; Complicated intra-abdominal infections (with metronidazole); Typhoid fever. Postexposure prophylaxis of inhalational anthrax. Cutaneous anthrax. Unlabeled Use: Febrile neutropenia.

Action

Inhibits bacterial DNA synthesis by inhibiting DNA gyrase enzyme. Therapeutic Effects: Death of susceptible bacteria. Spectrum: Active against gram-positive pathogens, including Staphylococcus aureus, S. epidermidis, S. saprophyticus, Streptococcus pyogenes, S. pneumoniae, Enterococcus faecalis, Bacillus anthracis (anthrax). Gram-negative spectrum notable for activity against Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Salmonella typhi, Shigella spp., Proteus mirabilis, P. vulgaris, Providencia stuartii, P. rettgeri, Morganella morganii, Pseudomonas aeruginosa, Serratia marcescens, Haemophilus influenzae, Neisseria gonorrhoeae, Moraxella catarrhalis, Campylobacter jejuni.

Adverse Reactions/Side Effects

CNS: SEIZURES, dizziness, drowsiness, headache, insomnia, agitation, confusion. GI: PSEUDOMEMBRANOUS COLITIS, abdominal pain, diarrhea, abnormal liver enzymes, nausea. GU: vaginitis. Derm: photosensitivity, rash. Endo: hyperglycemia, hypoglycemia. Hemat: eosinophilia. Local: phlebitis at IV site. MS: tendinitis, tendon rupture. Neuro: peripheral neuropathy. Misc: hypersensitivity reactions, including ANAPHYLAXIS.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings immediately to the physician or nursing staff.

• Monitor signs of hypersensitivity reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Watch for signs of pseudomembranous colitis, including diarrhea, abdominal pain, fever, pus or mucus in stools, or other severe or prolonged GI problems (nausea, cramps, vomiting). Report these signs to the physician or nursing staff immediately.

• Assess any tendon pain. Tendinopathy and rupture can occur, especially in large, weight-bearing tendons (Achilles', patellar tendons). Risk of tendon damage is greater in patients >65 yr old, transplant recipients (i.e., kidney, heart, lung), patients with preexisting tendon damage, and patients taking corticosteroids concurrently.

• Assess signs of peripheral neuropathy such as numbness, tingling, and decreased muscle strength. Establish baseline electroneuromyographic values using EMG and nerve conduction at the beginning of drug treatment whenever possible, and reexamine these values periodically to document drug-induced changes in peripheral nerve function.

• Assess dizziness and drowsiness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

• Be alert for confusion, agitation, or other alterations in ...