Prescription antibiotic
Bacteria, viruses and fungi are constantly trying to invade our bodies. If the immune system is intact, the pathogens are usually quickly rendered harmless. However, if the immune system is weakened, they can multiply in the body and cause an infection. If the pathogens are bacteria, they can be fought with an antibiotic.
Ciprofloxacin is a prescription antibiotic from the group of fluoroquinolones – also called gyrase inhibitors. This name derives from the way the substance works: Ciprofloxacin blocks the protein gyrase in the body, which bacteria need in order to multiply. If the bacteria can no longer multiply, the inflammation heals.
Ciprofloxacin als Reserveantibiotikum
Due to some significant side effects, ciprofloxacin is now used as a so-called reserve antibiotic. Such antibiotics are only used for infections where no other antibiotic has worked. In such cases, it is an infection with resistant pathogens.
In the therapy of a simple infection, reserve antibiotics are usually avoided in order to avoid the development of resistance. As in the case of ciprofloxacin, reserve antibiotics are often associated with serious side effects.
When is ciprofloxacin used?
Ciprofloxacin can be used to treat the following bacterial infections:
- the airways
- in the ear, nose and throat area
- the sex organs
- of the gastrointestinal tract
- the kidneys and the urinary tract
- of bones and joints
In addition, ciprofloxacin is also used in blood poisoning , in cystic fibrosis  and prophylactically in contact with anthrax pathogens.
Side Effects of Ciprofloxacin
The most common side effects of ciprofloxacin include gastrointestinal symptoms such as diarrhea, indigestion, nausea and vomiting.
Uncommonly  (in one to ten out of every 1,000 people treated) the following side effects may also occur:
- headache
- rash on the skin
- fatigue
- insomnia
- drowsiness
- Fever
- taste disorders
- Blood count changes (changed bilirubin levels)
- feeling weak
- Pain, swelling or tears in the area of ​​the tendons, muscles or joints
- functional disorders of the kidneys
- loss of appetite
Rare and very rare side effects
In rare cases  (affecting 1 to 10 users in 10,000) taking ciprofloxacin can cause the following side effects:
- allergic reactions
- visual disturbances
- seizures
- anxiety states
- hallucinations
- depressions
- hearing impairment
- deafness
- Hepatic impairments
- shortness of breath
 Side effects such as anemia, liver failure, ruptured tendons, bleeding into the skin (petechiae), psychotic reactions and inflammation of the pancreas are very rare  . On average, fewer than one in 10,000 people treated are affected.
More side effects
If ciprofloxacin is applied externally to the ear, itching often occurs there  . Serious side effects such as tinnitus  or skin inflammation, on the other hand, are rare.  Itching can also occur during the treatment of eye inflammation .
In addition, eyelid swelling, a foreign body sensation in the eye, sensitivity to light, red eyes, lid edge crusting, corneal changes and visual impairment are among the possible side effects of ciprofloxacin.
Dosage of Ciprofloxacin
The dose of ciprofloxacin depends on the infection and its severity. Unless otherwise directed, adults can take between 500 and 700 milligrams twice a day.
For mild urinary tract infections, a lower dose is sufficient. Basically, ciprofloxacin is available in dosages of 100 mg, 200 mg, 500 mg and 750 mg.
duration of use
The treatment usually lasts between seven and 14 days. In the case of particularly severe infections, the antibiotic can also be used over a longer period of time.
If there is only an uncomplicated infection such as a mild urinary tract infection, it may be sufficient to take ciprofloxacin for a period of one to three days.
Instructions for taking Ciprofloxacin
You should note the following when taking ciprofloxacin:
- Ciprofloxacin must be taken exactly as directed by your doctor. Under no circumstances should ciprofloxacin be discontinued independently. Otherwise it may happen after weaning that the disease does not heal completely or that resistance to ciprofloxacin develops.
- Ingestion can impair the ability to react and thus the ability to drive and use machines. This is especially true in connection with alcohol.
- Taking the antibiotic can lower the number of white blood cells and make the body more susceptible to infections. If you experience symptoms of infection, seek medical advice. This also applies if there are signs that indicate a tendon rupture.
- Avoid going to solariums and extensive sunbathing while taking ciprofloxacin. The antibiotic can increase the skin’s sensitivity to light.
- Be sure to drink enough fluids.
Contraindications of Ciprofloxacin
Ciprofloxacin should not be used in:
- hypersensitivity to the active substance
- Patients prone to seizures
- concomitant use of tizanidine
- a deficiency in the enzyme glucose-6-phosphate dehydrogenase, as otherwise blood formation disorders can occur.
- impaired liver or kidney function
- mental illnesses
- Heart diseases, such as cardiac arrhythmia
- Tendon disorders or muscle weakness (myasthenia gravis)
- disturbances in salt balance
- previous seizures
If an allergic reaction occurs, medical advice must be sought immediately. In addition, growing children and adolescents should generally not take ciprofloxacin.
Ciprofloxacin during pregnancy and lactation
Ciprofloxacin should not be taken during pregnancy, as there is currently insufficient knowledge about the consequences of its use. In animal experiments, however, cartilage damage was found in newborn animals. If ciprofloxacin is used locally – for example to treat infections of the eyes or ears – the doctor must weigh up the costs and benefits.
Ciprofloxacin passes into breast milk. So far, no severe side effects have been found in infants whose mothers had to take ciprofloxacin while breastfeeding. In individual cases, diluted stools up to diarrhea have been observed in infants. However, the use of ciprofloxacin by the mother during breastfeeding should always be carefully checked and weighed up.
Interactions of Ciprofloxacin
If ciprofloxacin is taken at the same time as certain other active ingredients, interactions can occur. Used internally, the antibiotic inhibits the  breakdown of active ingredients  such as clozapine, ropinirole, tizanidine, methotrexate , pentoxifylline and theophylline. This increases the effects and side effects of the substances. For most medications, it is sufficient to have the dosage adjusted after consultation. Only tizanidine should not be taken at all.
There are also active ingredients that increase the concentration of ciprofloxacin in the body. These include, for example, the gout remedy probenecid. Simultaneous use of phenytoin can both increase and decrease the concentration of ciprofloxacin in the body.
Drugs that reduce the effect of ciprofloxacin in the body include antacids, the active ingredients sucralfate and sevelamer, and drugs containing calcium, magnesium, iron ,  or aluminum. If one of these drugs must be taken, ciprofloxacin should be administered at least two hours before or four hours later.
Interactions with food
Dairy products can impair the absorption of ciprofloxacin in the body. Therefore, there should be at least four hours between taking the antibiotic and consuming dairy products.
In addition, caffeinated beverages such as coffee , caffeinated painkillers and medicines for colds  – which also often contain caffeine – should be avoided during treatment. Because taking ciprofloxacin inhibits the breakdown of caffeine in the body. This restriction is especially true for people who have problems with seizures or heart rhythm problems.
Alcohol should also be avoided when taking ciprofloxacin, as this combination can have a strong influence on the ability to react.
The pill and ciprofloxacin
By taking antibiotics, the intestinal flora is  damaged and certain active ingredients can be poorly absorbed by the body. Among other things, the effectiveness of the pill can decrease.
However, it has not yet been possible to prove that ciprofloxacin reduces the protective effect of the pill. Studies seem to indicate that the effect is not affected by the antibiotic. In order to be protected against pregnancy, you should still use additional contraceptives.
Critic or Ciprofloxacin
Antibiotics from the group of fluoroquinolones such as ciprofloxacin have been heavily criticized for several years due to serious and momentous side effects. Sometimes permanent damage is the result of taking ciprofloxacin.
The drug can cause tendon damage such as inflammation or tears in the tendons. A tear in the Achilles tendon  is particularly common. The risk of this is particularly high in older people over the age of 60.
Mental disorders such as depression and anxiety and nerve damage are also among the long-lasting side effects. Possible damage to the DNA of mitochondria by ciprofloxacin is discussed as the cause of these undesired effects. Mitochondria are responsible for generating energy in human cells. They also influence the formation of new cells.
Due to the severe side effects described, the Federal Institute for Drugs and Medical Devices (BfArM) is also calling for more restrictive use of fluoroquinolones such as ciprofloxacin. In a Red Hand Letter 1 published in 2019, Â the use of ciprofloxacin is therefore restricted and the prescription recommended after a careful risk/benefit assessment. 2Â For example, ciprofloxacin should not be prescribed for infections that are not serious, nonbacterial, or infections that resolve without treatment.
