Instructions for use CIPROFLOXACIN

Antibiotics are substances of biological or semi-synthetic origin. They are used in medical practice to combat pathogenic microbes and viruses. Before the advent of these medications, typhoid fever, dysentery, pneumonia, and tuberculosis had the status of incurable diseases. Today, treatment of infectious diseases is possible with the use of 1-6 generations of antibiotics.

At this moment, the pharmacological industry produces more than 2000 varieties of drugs of this type. Doctors have described the effects of about 600 positions, and about 120-160 drugs are used in medical practice.

Important! For any disease, it is recommended to take antibiotics after consulting a doctor. Otherwise, antibiotic resistance may develop (decreased sensitivity of pathogenic microorganisms to antibacterial agents).

Pharmacological properties

Ciprfloxacin solution is an antimicrobial agent with a broad spectrum of action. The antibiotic included in its composition is a fluoroquinolone derivative. Its action is based on the mechanism of suppression of bacterial DNA gyrase and disruption of DNA synthesis, affecting the growth and division of bacterial microflora, which causes the rapid death of bacterial cells.

The use of ciprofloxacin does not cause resistance to other actibiotics: aminoglycosides, penicillins, tetracyclines, cephalosporins, etc. Most gram-positive and gram-negative aerobic bacteria are sensitive to ciprofloxacin. Resistant to the drug: Pseudomonas cepacia, Bacteroides fragilis, Pseudomonas maltophilia, Clostridium difficile Nocardia asteroides, Ureaplasma urealyticum. It is ineffective against Treponema pallidum.

Classification of antibiotics

All antibacterial agents can be divided into 5 categories according to their characteristics and range of application. Let's take a closer look at this classification:

Mechanism of action:

• Bactericidal - the active substances of the drugs completely destroy bacteria and viruses. After taking such strong drugs, all pathogenic microflora in the human body dies.
• Bacteriostatic – inhibits the growth or spread of viruses. Thus, the cells remain “alive” without forming pathogenic flora.

Directions for use and doses

In ophthalmic practice, for mild to moderately severe eye infections, it is prescribed to instill 1 or 2 drops of Ciprofloxacin solution conjunctivally into the affected eye every 4 hours.

Cases of severe infection require instillation of 2 drops every hour. As the condition improves, the frequency of instillations is reduced.

When treating a bacterial corneal ulcer, it is recommended to apply a solution of Ciprfloxacin: on the first day, 1 drop every 15 minutes, for six hours, then, in the same dosage, every 30 minutes. On day 2, a drop of the drug is added every hour. Starting from day 3, a drop of Ciprfloxacin solution is added to the affected eye every 4 hours. The duration of such therapy is 14 days.

A sore throat

Roza Ismailovna Yagudina, Ph.D.
Sc., prof., head. Department of Organization of Drug Supply and Pharmacoeconomics and Head. laboratory of pharmacoeconomic research of the First Moscow State Medical University named after. I. M. Sechenov. Evgenia Evgenievna Arinina, Ph.D., leading researcher at the laboratory of pharmacoeconomic studies of the First Moscow State Medical University named after. I. M. Sechenov.

One of the most common complaints in the autumn-winter and, oddly enough, in the summer periods is a sore throat. The causes of painful sensations can be various pathogenetic processes occurring in the human body, and in the summer - also a violation of the environmental situation (humid, dusty air, air conditioners). The most common types of throat lesions are laryngitis, pharyngitis and tonsillitis. The last of these diseases is inflammation of the tonsils. Tonsillitis is the most common cause of sore throat; moreover, the inflammation often has a chronic course.

Causes and mechanism of tonsillitis

Sore throat, according to patients themselves, is always associated with hypothermia. However, the etiology of the development of oropharyngeal lesions is very diverse: from bacteria to viruses. The occurrence of pain in these cases is almost always associated with damage to the palatine tonsils, located on the side walls of the oropharynx - the junction of the respiratory and digestive tracts. The tonsils have many lacunae into which crypts or sacs open, having a dichotomous division and immersed in the depths of the tonsils. This structure of the tonsils contributes to the accumulation of various exudates in them. The palatine tonsils do not have afferent lymphatic vessels, since they themselves actively produce lymphocytes. Also, the palatine tonsils take an active part in the formation of local and general immunity.

NB ! A sore throat should not be confused with chronic tonsillitis (more precisely, its exacerbation, which, with similar symptoms, requires different treatment).

Sore throat is a general infectious disease with acute inflammation of the components of the lymphadenoid pharyngeal ring (usually the palatine tonsils). Sore throats are divided into: primary, secondary and specific.

• Primary - ordinary, simple, or banal sore throats. They manifest themselves as acute inflammatory diseases that have signs of damage only to the lymphadenoid ring of the pharynx.
• Secondary - symptomatic tonsillitis. Damage to the tonsils with scarlet fever, diphtheria, infectious mononucleosis, etc., as well as with blood diseases - leukemia, agranulocytosis, acute infectious diseases.
• Specific - sore throats caused by specific infections (fungal tonsillitis, Simanovsky-Plaut-Vincent tonsillitis).

Chronic tonsillitis is a chronic inflammatory, periodically exacerbating focus of infection in the palatine tonsils with a general infectious-allergic reaction.

The mechanism of infection spread is airborne, mainly occurs when coughing, sneezing, kissing, sharing dishes, towels, etc. The most common cause of chronic tonsillitis is group A β-hemolytic streptococcus, other pathogens are St. Aureus, H. influenzae, M. Catarrhalis, N. Gonorrhoeae, C. haemolyticum, M. Pneumoniae, C. pneumoniae, Toxoplasma, anaerobes, adenoviruses, cytomegaloviruses, herpes viruses, etc. Chronic tonsillitis is not always a consequence of previous tonsillitis. In most cases, it develops unnoticed, masquerading as other diseases (ARVI, stomatitis, etc.). As tonsillitis progresses, the parenchyma of the tonsils is slowly replaced by connective tissue, encapsulated foci of necrosis are formed, and regional lymph nodes are involved in inflammation. There are several forms and types of chronic tonsillitis with different symptoms.

The presence of only local signs characterizes simple tonsillitis (initial stage)

• liquid pus or caseous-purulent plugs in the lacunae of the tonsils (sometimes with an odor);
• tonsils are small, sometimes smooth or with a loose surface;
• persistent hyperemia of the edges of the palatine arches (Gise's sign);
• swelling of the edges of the upper parts of the palatine arches (Zach's sign);
• thickened, roller-shaped edges of the anterior palatine arches (Preobrazhensky sign);
• fusion and adhesions of the tonsils with the arches and triangular fold;
• enlargement of individual regional lymph nodes, sometimes painful on palpation (in the absence of other foci of infection in this region).

Also at this stage, other diseases not related to tonsillitis may worsen, which can have serious consequences.

Toxic-allergic form I (TAF I ) - is caused by repeated previous sore throats. In addition to local symptoms (the same as at the initial stage), general toxic-allergic phenomena develop:

• low-grade body temperature (occasionally);
• weakness, malaise;
• increased fatigue, decreased ability to work;
• periodic joint pain;
• enlargement and pain on palpation of regional lymph nodes (in the absence of other foci of infection);
• functional disorders of cardiac activity (can manifest themselves during exercise and at rest, but only during exacerbation);
• Abnormalities in laboratory data are variable.

Concomitant diseases in this case are the same as in the simple form, but they do not have a common infectious basis with chronic tonsillitis.

Toxic-allergic form II (TAF II ) - characterized by local symptoms inherent in the simple form and general toxic-allergic reactions:

• periodic functional disorders of cardiac activity (disturbances in heart rhythm are recorded on the ECG, pain in the heart area occurs both at the latent stage and at the acute stage);
• joint pain (both at the latent stage and at the acute stage);
• low-grade fever (may be prolonged);
• functional kidney disorders;
• deviations from laboratory data norms.

Concomitant diseases may be the same as in the simple form (not associated with infection). The course of this stage of chronic tonsillitis may be accompanied by the development of severe complications: peritonsillar abscess, tonsillogenic sepsis, etc.

Treatment of tonsillitis

How to get rid of tonsillitis? The palatine tonsils play a large role in the normal functioning of the immune system, so treatment of the disease should first of all include the restoration of the body's protective functions. Pharmacotherapy for chronic tonsillitis includes a set of measures aimed at eliminating the bacterial environment, relieving inflammation and eliminating purulent plugs from the pharyngeal mucosa. Treatment of chronic tonsillitis is carried out in accordance with the form and phase of the disease (acute tonsillitis, latent).

NB ! Conservative therapy is carried out at the initial stage of the disease and TAF I outside the period of exacerbation and not earlier than 1 month after it. Patients with TAF II are indicated for tonsillectomy!

Principles of pharmacotherapy of chronic tonsillitis:

• antibacterial drugs. To treat tonsillitis, various types of antibiotics are used: penicillins (mostly “protected”) or cephalosporins (2nd or 3rd generation), macrolides can be used, less often fluoroquinolones;
• desensitizing drugs that have an anti-edematous effect on tissues and help facilitate tolerance and improve the absorption of prescribed therapy;
• oral antiseptics: miramistin, octenisept at a dilution of 1:5, various gargles, etc. (how to gargle for tonsillitis is described below);
• homeopathic preparations that normalize and improve the trophism of the palatine tonsils;
• drugs that stimulate local immunity of the palatine tonsils.

Antibacterial therapy - what antibiotics are taken for tonsillitis

• Penicillins: preference in this group is given to amoxicillin in combination with clavulanic acid, since it is this combination that ensures the effectiveness of treatment in the event of penillinase-producing staphylococci joining the pathogenic flora. However, they are ineffective against methicillin-resistant strains of Staphylococcus aureus.
• Cephalosporins: cefepime (IV generation), ceftriaxone, cefoperazone, cefixime (III), cefuroxime (II). The first three drugs have only parenteral forms of release, while cefixime is produced only in oral form. Cefuroxime has both forms of release.
• Macrolides: azithromycin, clarithromycin, josamycin. The drugs are active against all pathogens, including penicillin-resistant strains.
• Aerosol forms of antibacterial drugs: fusafungine, active against hemolytic streptococcus, Staphylococcus aureus and Candida albicans.

Immunomodulators

Immunomodulators are prescribed as part of complex therapy. Among vaccine-like immunomodulators that activate both specific and nonspecific local immunity, preparations containing lysates of thirteen microorganisms are used (including lysates of hemolytic streptococcus, Staphylococcus aureus, Candida albicans). A similar mechanism of action (increased phagocytosis, increased lysozyme content, stimulation of immunoglobulin A production) is also characteristic of nasal sprays containing bacterial lysates: Streptococcus pneumoniae type I, II, III, V, VIII, XII, Staphylococcus aureus, Neisseria subflava, Neisseria perflava, Klebsiella Pneumoniae, Moraxella Catarrhalis, Haemophilus Influenzae Type B, Acinetobacter Calcoaceticus, Enterococcus Faecum, Enterococcus Faecalis, Streptococcus Pyogen ES Group A, Streptococcus Dysgalae Group C, Streptococcus Group G. Natural immunostimulating agents are also used: ginseng, leftze, echinacea, chamomile, garlic, garlic, garlic propolis, pantocrine. Peptides with immunoregulatory, detoxification, hepatoprotective, antioxidant effects are also used as an immunomodulator - arginyl-alpha-aspartyl-lysyl-valyl-tyrosyl-arginine, azoximer bromide, glucosaminyl muramyl dipeptide. Recently, herbal medicines such as tonsiral and tonsilgon have become widespread.

Antiseptics

Rinse solutions

An important stage in the treatment of sore throat is the sanitation of the oropharynx using a variety of antiseptics. The best option for sanitation is systematic (up to 8-10 times a day) gargling for tonsillitis with antiseptic and anti-inflammatory solutions of furatsilin, tinctures of eucalyptus leaves (have an antimicrobial effect), calendula, propolis (have an antiseptic and anti-inflammatory effect), preparations containing the NSAID agent benzydamine and so on.

Sprays and lozenges

The above-mentioned benzydamine is available not only in the form of a solution, but also in the form of a spray, which provides the so-called “spot” sanitation of the oropharynx. Other sprays used for sore throats contain hexethidine, povidone-iodine, mixtures of camphor, levomenthol, chlorobutanol and eucalyptus oils.

Another convenient local form of throat sanitation is lozenges and lozenges based on the same antiseptics (a combination of dry sage extract with essential oil, ambazone, chlorhexidine in combination with tetracaine and vitamin C). As a rule, in addition to the analgesic effect, tablets and lozenges have a bactericidal, local anesthetic and immunomodulatory effect. The basis for local drugs for resorption can also be drugs from the PNVP group: flurbiprofen, acetylaminonitropropoxybenzene, benzydamine.

Antioxidants

Antioxidants in the treatment of sore throat are used to improve metabolism, restore the functioning of enzyme systems and reduce the destructive effects of free radicals and peroxide compounds, as well as to improve immunity (rutin-containing complexes, vitamins A, E, C, microelements Zn, Mg, Si, Fe , Ca, dietary supplements, etc.).

Criteria for treatment effectiveness

Indicators that the treatment is sufficiently effective are:

• disappearance of pus and pathological contents in the tonsils;
• reduction of hyperemia and infiltration of the palatine arches and palatine tonsils;
• reduction or disappearance of regional lymph nodes.

But even in this case, it is better to carry out courses of treatment at least three times a year, especially during the off-season.

However, if a patient has a relapse even with a simple form of chronic tonsillitis or TAF I, then after the first course of treatment, pus remains in the palatine tonsils and caseous masses form, so it is necessary to discuss with the patient the possibility of tonsillectomy.

Thus, conservative treatment of chronic tonsillitis should to some extent be considered as a stage in preparing the patient for tonsillectomy for chronic tonsillitis TAF I, and in a simple form (if there is a positive result of treatment), the patient must be taught to maintain the tonsils in a satisfactory condition - that is, to carry out prevention chronic tonsillitis. Many people are interested in how to cure chronic tonsillitis once and for all. Unfortunately, there are no universal recipes for the treatment of chronic tonsillitis, since it is a focal infection that constantly reduces immunity and can at any time cause an exacerbation of the patient’s condition.

Table 1. List of drugs for the treatment of chronic tonsillitis in adults and children (group Rx)
Drugs for the treatment of chronic tonsillitis (exacerbation stage). Prescription group (Rx-drugs)*

* State register of medicines

The more appropriate form of release of the drug in this case is determined by the doctor.

Table 2. List of drugs for chronic tonsillitis at the acute stage (tablets, solutions, sprays)

* State register of medicines

special instructions

Ciprofloxacin eye drop solution is not intended for injection.

When using this drug in combination with other ophthalmic solutions, the interval between their applications should be up to 5 minutes.

If any signs of hypersensitivity appear, use of the solution should be discontinued.

During treatment with Ciprofloxacin solution, soft contact lenses are not recommended. Or they must be removed before each instillation.

Store Ciprofloxacin solution at room temperature, in a dark place. Keep away from children.

The shelf life of the bottle before opening is 3 years. After opening - 4 weeks.

Spectrum of action

There are antibacterial agents:

Release form

Tsiprolet is produced by many pharmaceutical companies, as it is one of the most popular antibacterial agents. It is produced in the following dosage forms:

• infusion solution - in polyethylene bottles of 100 ml, where the content of ciprofloxacin does not exceed 2 mg per ml;
• tablets - each containing 250 mg or 500 mg of the main active ingredient, they are packaged in blisters of 10 pieces;
• eye drops - sold in bottles with a dropper of 5-10 ml, which contain 3 mg of ciprofloxacin per 1 ml of solution.

According to the instructions for use of Tsiprolet 500, these tablets contain the maximum dose of the active substance. They are used to treat severe bacterial lesions in advanced infections.