Ciprofloxacin (INN) is a synthetic antibiotic, originally manufactured and sold by Bayer A.G.. Generic versions are now available, but Bayer continues sale under the brand names Cipro, Ciproxin and Ciprobay (and other brand names in other markets, e.g. Veterinary medicine), belonging to a group called fluoroquinolones. Ciprofloxacin is bactericidal. Its mode of action depends upon blocking bacterial DNA replication by binding itself to an enzyme called DNA gyrase, thereby inhibiting the unwinding of bacterial chromosomal DNA during and after the replication.
Ciprofloxacin is available for oral, parenteral and topical use. It has a variety of indications, including lower respiratory tract infections (such as pneumonia and acute bronchitis), urinary tract infections, several STDs, skin and soft tissue infections, septicemia, legionellosis, and anthrax.
Weak activity against:
No activity against:
Use against chlamydia and mycoplasma infections is now contraindicated; ciprofloxacin appears to be ineffective against these organisms, merely stopping their growth (and allowing them to resume growth after the antibiotic is withdrawn) rather than killing them.
Heavy exercise is discouraged, as achilles tendon rupture has been reported in patients taking ciprofloxacin. Achilles tendon rupture due to ciprofloxacin use is typically associated with renal failure.
Fluoroquinolones are increasingly contraindicated for patients who have been to S.E. Asia due to the growing prevalence of antibiotic resistance to the class of antibiotics in that region.
Ciprofloxacin is also contraindicated in children (except for serious infections and anthrax post-exposure), pregnancy, and in patients with epilepsy. Dose adjustment or avoidance may be necessary with liver or renal failure.
Ciprofloxacin can cause photosensitivity reactions and can elevate plasma theophylline levels to toxic values. It can also cause constipation and sensitivity to caffeine. Ciprofloxacin is also known to cause swelling of joints and cartilage, and cause tendon rupture and chronic pain.
In 2005 the U.S. Food and Drug Administration (FDA) changed the package insert for Cipro to acknowledge the tendon ruptures and the development of irreversible neurological conditions. On 8 July 2008, as the result of a lawsuit filed by Public Citizen, the FDA upgraded the warning to a "black box" for fluoroquinolones, including ciprofloxacin.
The incidence of side effects for ciprofloxacin is widely believed by physicians to be acceptable and relatively safe. However, the safety of Cipro has been increasingly challenged with a large number of patients suffering serious adverse effects with disabling effects lasting months or years with higher doses and/or longer duration of administration.
See also quinolone#Adverse effects.
Due to its elimination half-life, ciprofloxacin is administered twice daily. No dose adjustments are generally required for mild to moderate renal impairment.
Bayer Pharmaceutical embarked on a plan to remake itself from a pharmaceutical manufacturer into a player in the international pharmaceutical business, with a lock on the antibiotic field. Unfortunately, a combination of the tendency for antibiotics to be viewed as a commodity and prescribed on the basis of lowest cost, Bayer's inability to follow up with another "blockbuster" discovery, and a general downturn in the international pharmaceutical business forced Bayer into a major downsizing in 2000-2001. Faced with the imminent expiry of its patent rights to ciprofloxacin in the early 2000s and the loss of market share to generic ciprofloxacin, Bayer has focused on the development and patenting of new variations of the existing drug, i.e., pediatric ciprofloxacin, intravenous ciprofloxacin, once-a-day ciprofloxacin, etc., which will provide new patents and new sources of revenue as patients move to these newer versions of ciprofloxacin.
"Cipro" became a household word during the 2001 anthrax attacks.
Generic ciprofloxacin is now available in many markets around the world including the USA. In the Philippines, a leading brand is Xenoflox by Xeno Pharmaceuticals.
In addition two new once daily formulations have been launched in the USA. Bayer have marketed Cipro XR which is an extended release formulation. Meanwhile Depomed have developed ProQuin XR another once daily formulation of ciprofloxacin which uses a gastric retention polymer technology to slow the release of ciprofloxacin into the blood.