Ciprofloxacin (most common) Norfloxacin FLUOROQUINOLONES Ciprofloxacin (most common) Norfloxacin Ofloxacin Pefloxacin All these dugs are given oral except ciprofloxacin is given oral & injection CIPROFLOXACIN Mechanism of action Inhibit DNA synthesis by inhibiting DNA gyrase(topoisomerase II). It’s the only injected quinolone

It doesn’t work against anerobes CIPROFLOXACIN ( CONT. ) Antibacterial spectrum Mainly effective against G – bacteria : Enterobacteriacae H. influenzae M. catarrhalis Campylobacter Pseudomonas N. gonorrheae Intracellular pathogens M. Tuberculosis Mycoplasma Chlamydia Legionella Brucella It doesn’t work against anerobes

Ciprofloxacin ( Cont. ) Pharmacokinetics Well absorbed orally ( available i.v. ) Di & tri- valent cations interfere with its absorption (milk, Mg, Al, Ca, antacid) Concentrates in many tissues, esp. kidney, prostate, lung & bones/ joints Do not cross BBB Excreted mainly through the kidney (tubular & glomerular) (probencid interferes with tubular secretion) Accumulate in renal insufficiency Up to 20% metabolized by liver t1/2 = 3.3 hrs

CIPROFLOXACIN ( CONT. ) Clinical uses 1. Urinary tract infections (P.aeruginosae,E.coli,Klebsiella) 2. Osteomyelitis due to P. aeruginosa 3. Gonorrhea 4. Travellers’ diarrhea- ciprofloxacin commonly used (if there’s a bloody diarrhea) 5. Prostatitis 6. Legionnaires’ disease 7. Brucellosis 8. Diabetic foot infections 9. Anthrax 10. Eradication of menengiococci from carriers For P.aeruginosa infection outside urinary tract or the bones use AGS, penicillin

CIPROFLOXACIN ( CONT. ) Side effects Contraindications Nausea , vomiting & diarrhea CNS effects : confusion, insomnia, headache, dizziness & anxiety.(indirectly by modifying GAPA transmitter in the CNS) May damage growing cartilage Tendinitis ( rare but more serious ) (irreversible) (may lead to tendon rupture) Phototoxicity  avoid excessive sunlight Contraindications Children / adolescents (under 18), pregnancy and lactation (secreted in milk) It’s not contraindicated in adolescents it’s not preferred so u have to measure benfits vs. risks Drug interaction Iron or antacids containing Mg, Ca, or Al  reduce oral absorption Elevates serum levels of theophylline, warfarin & glibenclamide