Talk:Ciprofloxacin

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[edit] Public Citizen Sues FDA over CIPRO labeling - Black Box Labeling Wanted

The consumer group went to federal court today to force the agency to act on a petition filed last summer seeking stronger warnings about the risks of tendon rupture associated with fluroquinolones, a class of antibiotics used to treat bacterial infections. These includes Levaquin, a Johnson & Johnson med, and Bayer’s Cipro, along with other brand name versions and various generics. (Here is the lawsuit). See full article and copy of lawsuit at: http://www.pharmalot.com/2008/01/public-citizen-sues-fda-over-antibiotic-risks/ Although the labels warn of tendon ruptures, Public Citizen wants the FDA to place Black Box warnings on the drugs. —Preceding unsigned comment added by 71.41.19.148 (talk) 12:04, 7 February 2008 (UTC)

[edit] Major side effects of ciprofloxin hidden but often severe and permanent

My daughter had a side effect to ciprofloxin. Her main side effect (drug taken about the first of August 2007) was severe, full body pain and weakness which may become chronic. She was a student, but the pain is so great that she does not have the strength to carry her text books. The cipro was given for "food poisoning" a disorder that rarely requires any drug treatment. My research since she became ill indicates that tendon damage to the point of tendon rupture is not "rare" but much more common than Bayer would have you believe. My research showed that chronic pain may continue for years after the cipro is given, and that there is massive internal damage to all tendons and damage to the microvessels that impacts the entire body and mind. For the few patients so affected, cipro is the drug from hell. The FDA has required strong warnings on the labels and inserts warning of severe side effcts, that are so severe that people have committed suicide to stop the pain. The research of fluorquinolone drugs such as cipro shows that many drugs in this class were so toxic and produced such severe side effects that many have been taken off the market. Cipro may be the most toxic of all legal drugs, and even though it is a potent and effective antibiotic, there are many victims, including my family, that believe that the potential side effects outweigh its benefits.

There are a number of websites that have documented in layman's words these horrible side effects, which those writers have taken from original peer reviewed medical journals. Two primary sites that cover these side effects are: http://fqresearch.com , http://www.fluoroquinolones.org/ , and several others that are listed on these two sites.

Following is a list of possible side effects from cipro taken from http://www.medications.com/se/cipro : Asthenia, Edema, Fever, Malaise, Rigors, Substernal Chest Pain, Syncope, Cardiovascular Disorders, Cardiac Failure, Circulatory Failure, Hypertension, Central and Peripheral Nervous System Disorders, Abnormal Coordination, Coma, Convulsions, Seizures, Hyperkinesia, Hypertonia, Hypoaesthesia, Involuntary Muscle Contractions, Paresthesia, Paralysis, Speech Disorders, Stupor, Tremor, Vertigo, Gastrointestinal System Disorders, Dry Mouth, Dysphagia, Gastroenteritis, G.I.Hemorrhage, Pancreatitis, Pseudomembranous Colitis, Tongue Edema, Hearing and Vestibular Disorders, Ear Disorders, Tinnitus, Heart Rate and Rhythm Disorders, Arrhythmia, Atrial Fibrillation, Bradycardia, Cardiac Arrest, Heart Block, Palpitation, Supraventricular Tachycardia, Tachycardia, Ventricular Fibrillation, Hematology, Decreased Lymphocytes, Liver and Biliary System Disorders, Abnormal Hepatic Function, Cholelithiasis, Hepatic Coma, Jaundice, Metabolic and Nutritional Disorders, Aggravated Diabetes, Mellitus, Decreased Glucose, Decreased Magnesium, Increased Calcium, Dehydration, Hyperglycemia, Hyperkalemia, Hypoglycemia, Hypokalemia, Increased LDH, Weight Loss, Musculo-Skeletal System Disorders, Arthralgia, Arthritis, Arthrosis, Muscle Weakness, Myalgia, Osteromyelitis, Rhabdomyolysis, Synovitis, Tendinitis, Myo, Endo, Pericardial and Valve Disorders, Angina, Pectoris, Coronary Thrombosis, Myocardial Infarction, Neoplasms, Carcinoma, Parosmia, Platelet, Bleeding and Clotting Disorders, Abnormal Platelets, Embolism, Epistaxis, Purpura, Thrombocytopenia, Psychiatric Disorders, Abnormal Dreaming, Aggressive Reaction, Agitation, Anorexia, Anxiety, Confusion, Delirium, Depression, Emotional Liability, Hallucination, Impaired Concentration, Impotence, Manic Reaction, Mental Deficiency, Nervousness, Paranoia, Sleep Disorders, Somnolence, Withdrawal Syndrome, Suicide, Red Blood Cell Disorders, Anemia, Reproductive Disorders, Ejaculation Failure, Resistance Mechanism Disorders, Fungal Infections, Genital Moniliasis, Respiratory System Disorders, ARDS, Asthma, Coughing, Dyspnea, Haemoptysis, Hypoxia, Pleural Effusion, Respiratory Insufficiency, Respiratory Failure, Skin and Appendages Disorders, Erythema Nodosum, Genital Pruritus, Increased Sweating, Skin Disorders, Skin Exfoliation, Skin Ulceration, Urticaria, Urinary System Disorders, Abnormal Renal Function, Acute Renal Failure, Face Edema, Crystalluria, Cylindruria, Hematuria, Vascular (Extracardiac) Disorders, Cerebrovascular Disorder, Phlebitis, Vision Disorders, Abnormal Vision, Conjunctivitis, Diplopia, Retina Damage, Cornea Damage, Ophthalmologic Abnormalities, Cataracts, Multiple Punctate Lenticular Opacities, White Cell and RES Disorders, Granulocytopenia, Leukocytosis, Leukopenia, Lymphadenopathy, WBC Abnormal Count, Allergic Pneumonitis, Anaphylactic Shock, Anaphylactoid Reaction, Dysphonia, Abnormal EEG, Encephalopathy, Eosinophilia, Erythema Multiforme, Hemolytic Anemia, Multi System Organ Failure (Death), Increased International Normalized Ratio (INR) Prothrombin Time, Stevens-Johnson Syndrome, Tendon Rupture, Torsades de Pointes, Vasodilation, This is but a small sampling of various adverse reactions associated with such therapy.

This list goes on and on and on and on and on. The physician has no clue as to what these drugs can and will do to a patient. The physician will likely prescribe steriods and other drugs which often have adverse interactions with the fluoroquinone drugs, sometimes resulting in unexpect outcomes such as death.

There is no known treatment for a majority of the severe reactions. Such reactions often DO NOT abate once therapy is discontinued in a subset of those so treated and the current research indicates that such events are to be considered permanent in nature.

Perhaps the wide range of actions and side effects is due to the ability of flourine in Cipro to substitute for hydrogen due to their very similar van der Waals radiuses. For a list and review of the role of flourine in drugs, see: http://www.halocarbon.com/halocarbon_media/swinson_109.pdf Obviously, this is an extremely basic change in our biochemistry!

Consequently, people should not use cipro or any of the fluoroquinone class of antibiotics without consideration of the risk of permanent adverse health as an outcome posibility. Physicians should prescribe these drugs only in cases of life threatening disease and then only as a third line of treatment after other drugs have failed. The patient must be informed that these side effects are not rare and that they can be life long in duration.

To the editors, may I post a short version of this on the main article? georgeeby 8/17/2007

Please read the section below, specifically the comments regarding how side effects are presented in the article. The websites you cite above are, unfortunately, not reliable sources. I am truly sorry for your daughter's experience, but I can't see how adding an indiscriminate list of all possible side effects is productive. I agree this article is currently unbalanced and quite lacking in information, but we must be careful not to simply shift bias instead of making it impartial. Fvasconcellos (t·c) 02:02, 19 August 2007 (UTC)

Perhaps you will acknowledge the "neutrality" of Walgreens Drug Store "CAUTIONS" and "SIDE EFFECTS", which are found in their article http://www.walgreens.com/library/finddrug/druginfo1.jsp?particularDrug=Cipro&id=9387 which read as follows:

<redacted, copyrighted text>

Perhaps my arguement is with the word "rarely" when descibing severe side effects. I do not know very many people well enough to discuss their health issues, but in mentioning my daughter's plight to my friends, I found that: (1) my own physician suffers from tendon issues and chronic pain from using cipro, (2) a nurse of a prominent research scientist in Detroit has the same issues that she attributes to cipro, (3) I too have unexplained shoulder pains which started several months after taking cipro, and a friend has had chronic pain and weakness for about 6 years after taking cipro during breast surgery.

I believe that the unreliable sources that you critisize may be right, in that these severe side effects are less "rare" than the totally unbiased, extremely reliable, highly scientific and undisputable reports of Bayer and the U.S. FDA would have one believe. What does the FDA say about cipro?

From the http://www.medscape.com/viewarticle/491176 page are these words about what the FDA says:

Moxifloxacin (Avelox) and Ciprofloxacin (Cipro) Linked to Peripheral Neuropathy and Tendon Effects

On July 14 and July 28, the FDA approved changes to the safety labeling for moxifloxacin hydrochloride tablets and moxifloxacin hydrochloride in sodium chloride injection (Avelox, Avelox IV, made by Bayer Pharmaceuticals) and ciprofloxacin hydrochloride tablets and oral suspension (Cipro, made by Bayer Pharmaceuticals), warning of the risks of peripheral neuropathy and tendon effects associated with their use.

The FDA has received rare postmarketing reports of sensory or sensorimotor axonal polyneuropathy affecting small and/or large axons and resulting in paresthesias, hypoesthesias, dysesthesias, and weakness in patients receiving quinolone therapy.

Ruptures of the shoulder, hand, Achilles tendon, and other tendons resulting in prolonged disability or requiring surgical repair have also been reported in patients receiving quinolone therapy, including moxifloxacin and ciprofloxacin.

Again, my arguement is with the notion that these severe side effects are "rare". The problem appears to be that the testing of side effects from the cipro class of drugs did not extend far enough in time after treatment was stopped. Classically, side effects occur during treatment, not 6 to 12 months afterwards. In the case of Cipro, the damage to tendons and nerves seems irreversible and these side effects seem to occur (start) up to a year after treatment is stopped (from what I have read in the "unreliable" reports above), which actually are layman's condensations of about 400 original medical research reports found on http://pubmed.gov , which is a primary research resource fom many physicians and the educatable public.

I am one of those "permanently poisoned by cipro" individuals. The permanent side effects are real. If these rare side effects hit you, your life is destroyed. Since I took a week of Cipro in 2006, I have permanent tinnitus, tendonitis, insomnia, anxiety, severe depression (loss of emotion), psychosis, other sensory disturbances, constipation, the list goes on, like the list of side effects on the warning labels... Rare permanent side effects for most individuals, maybe. None of these "side effects" have been treated or remediated by any of my physicians. The list of side effects given to patients should make clear than any or all could become permanent. I am expecting tendon ruptures in the future. The FDA should analyze the data it has via Medwatch and follow Public Citizen's reminder to publish the widely recognized tendon issues in a Black Box and send "Dear Doctor Letters" to let physicians know how toxic this drug is.

—Preceding unsigned comment added by 68.199.93.11 (talk) 03:12, 22 February 2008 (UTC)

How about the "ask a patient" website? Think they are biased? For many comments about cipro serious side effects including death, see http://www.askapatient.com/viewratings.asp?drug=19537&name=cipro&sort=age They have no axe to grind, and they simply offer the reports of many people. With the internet, the drug companies will be exposed for the side effects their drugs produce and the efficaciousnous or lack thereof of their products.

The Weston A. Price foundation at http://www.westonaprice.org/healthissues/cipro.html has what they report to be "The True Story of Cipro", which offers a fascinating review of the drug's history. Further, they report in part: "Achilles tendon rupture was shown to occur even after withdrawal of the drug with examination showing pathological ultrastructure alteration in tendinocytes. Just as in other cases of fluoride poisoning, studies in animals show that magnesium deficiency aggravates the induced tendinopathy.14,19

"Fatal Drug Interactions Just as with Baycol (NOTE: This drug was recalled by the FDA), drug interactions with ciprofloxacin have resulted in fatal outcomes due to potentiation of another drug’s effects including theophylline,4,20 methadone21 and warfarin.22"

"Just like Baycol and other fluorinated drugs, ciprofloxacin is a potent inhibitor of the thyroid hormone-regulated P 450 enzyme system in the liver. Of all fluoroquinolones, ciprofloxacin and enoxacin have shown the greatest inhibitory capacity.4"

"P450 IA2 prevents the metabolism and inactivation of methylxanthines, thereby causing increased serum concentrations of drugs like theophylline (found in tea) and caffeine (found in coffee and soft drinks), which in turn causes excess central nervous system and cardiac stimulation. As mentioned above, Cipro also elevates serum fluoride levels."

"The liver has been identified as a target organ of fluoroquinolone toxicity in animal studies.23 As early as the 1930s, scientists at Bayer and Knoll had discovered that all organic fluoride compounds tested (including those used for fluoroquinolone production) interfered with thyroid hormone activity in liver and muscle tissue. Meanwhile, they also showed "anti-bacterial" activity. This led to the development of many fluorinated medications, including the numerous compounds then used very successfully in the treatment of hyperthyroidism.24,25 A Dr. Kraft of the Knoll corporation invented many fluorinated "medications." When it was discovered that some of these organic compounds had the same detrimental effects on teeth and bone as inorganic fluoride (although much less actual F ion was involved) he even filed patents on behalf of Knoll for use of these compounds in dental preparations.26,27"

"pregnant women should never take ciprofloxacin. Cipro transfers through the placenta. It inhibits P450 1A2 which has been shown to be critical for neonatal survival as it influences the physiology of respiration in neonates. Mice lacking this cytochrome died shortly after birth and showed symptoms of severe respiratory distress.28 Respiratory distress is also a side-effect of ciprofloxacin in adults.9 Cipro also transfers through breastmilk."

An important point here (outside my family's disaster) is that drug side effects are damaging our trust in medicine and pharmaceuticals. We should not be required to voluntarily play "Russian Roulette" every time we go to our doctor for a tummy ache.

Here is the letter that the FDA sent out about Cipro found on the http://www.fluoroquinolones.org/ site , which is a depository of all things "cipro"

NDA 19-537/S-053, S-054 NDA 20-780/S-017, S-018 Bayer Corporation Pharmaceutical Division Attention: Andrew S. Verderame Director, Regulatory Affairs 400 Morgan Lane West Haven, CT 06516-4175

Dear Mr. Verderame:

Please refer to your supplemental new drug applications, which were submitted under section 505(b) of the Federal Food, Drug, and Cosmetic Act for the following: NDA # Drug Product Supplement Number Letter Date Receipt Date S-053 April 7, 2004 April 9, 2004 19-537 Cipro  (ciprofloxacin hydrochloride) Tablets, 100 mg, 250 mg, 500 mg, 750mg S-054 April 7, 2004 April 9, 2004 S-017 April 7, 2004 April 9, 2004 20-780 Cipro  (ciprofloxacin) Oral Suspension, 5% and 10% S-018 April 7, 2004 April 9, 2004 NDA 19-537/S-053 (tablets) and NDA 20-780/S-017 (oral solution) were submitted as Changes Being Effected (CBE) and provide for additional safety information in the label. Revisions are included in the PRECAUTIONS, Drug Interactions subsection of the package insert. NDA 19-537/SLR-054 (tablets) and NDA 20-780/SLR-018 (oral solution) were submitted as CBE and provide for the addition of quinolone class labeling in the WARNINGS section, PRECAUTIONS, Information for Patients subsection and ADVERSE REACTIONS, Post-Marketing Adverse Events subsection as was requested in the supplement request letter on November 26, 2003 and the facsimile from the Division dated March 10, 2004. These supplements provide for the following changes to the Cipro  Tablet and Oral Suspension label. Deleted text is noted by strikethrough and added text is noted by double underline:

1. The following revisions were made under the WARNINGS section: Peripheral neuropathy: Rare cases of sensory or sensorimotor axonal polyneuropathy affecting small and/or large axons resulting in paresthesias, hypoesthesias, dysesthesias and weakness have been reported in patients receiving quinolones, including ciprofloxacin. Ciprofloxacin should be discontinued if the patient experiences symptoms of neuropathy including pain, burning, tingling, numbness, and/or weakness, or is found to have deficits in light touch, pain, temperature, position sense, vibratory sensation, and/or motor strength in order to prevent the development of an irreversible condition.

Tendon Rupture: Effects: Ruptures of the shoulder, hand, and Achilles and other tendon ruptures tendon or other tendons that required surgical repair or resulted in prolonged disability have been reported in patients receiving quinolones, including ciprofloxacin. Post-marketing surveillance reports indicate that the this risk may be increased in patients receiving concomitant corticosteroids, especially in the elderly. Ciprofloxacin should be discontinued if the patient experiences pain, inflammation, or rupture of a tendon. Patients should rest and refrain from exercise until the diagnosis of tendonitis or tendon rupture has been excluded. Tendon rupture can occur during or after therapy with quinolones, including ciprofloxacin.

2. The following bullet was added to the PRECAUTIONS, Information for Patients subsection:• that peripheral neuropathies have been associated with ciprofloxacin use. If symptoms of peripheral neuropathy including pain, burning, tingling, numbness and/or weakness develop, they should discontinue treatment and contact their physicians.

3. The following revisions were made under the PRECAUTIONS, Drug Interactions subsection: Non-steroidal anti-inflammatory Animal studies have shown that the drugs (but not acetyl salicylic acid) in combination of very high doses of quinolones have been shown to provoke convulsions in pre-clinical studies.

4. The following revisions were made under the ADVERSE REACTIONS, Post-Marketing Adverse Events subsection: Post-Marketing Adverse Events: The following adverse events have been reported from worldwide marketing experience with quinolones, including ciprofloxacin. Because these events are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Decisions to include these events in labeling are typically based on one or more of the following factors: (1) seriousness of the event, (2) frequency of the reporting, or (3) strength of causal connection to the drug. Agitation, agranulocytosis, albuminuria, anaphylactic reactions, anosmia, candiduria, cholesterol elevation (serum), confusion, constipation, delirium, dyspepsia, dysphagia, erythema multiforme, exfoliative dermatitis, fixed eruption, flatulence, glucose elevation (blood), hemolytic anemia, hepatic failure, hepatic necrosis, hyperesthesia, hypertonia, hypesthesia, hypotension (postural), jaundice, marrow depression (life threatening), methemoglobinemia, monoliasis moniliasis (oral, gastrointestinal, vaginal), myalgia, myasthenia, myasthenia gravis (possible exacerbation), myoclonus, nystagmus, pancreatitis, pancytopenia (life threatening or fatal outcome), peripheral neuropathy, phenytoin alteration (serum), potassium elevation (serum), prothrombin time prolongation or decrease, pseudomembranous colitis (The onset of pseudomembranous colitis symptoms may occur during or after antimicrobial treatment.), psychosis (toxic), renal calculi, serum sickness like reaction, Stevens-Johnson syndrome, taste loss, tendonitis, tendon rupture, torsades de pointes, toxic epidermal necrolysis, triglyceride elevation (serum), twitching, vaginal candidiasis, and vasculitis. (See PRECAUTIONS.)

We completed our review of these applications and they are approved effective on the date of this letter. The final printed labeling (FPL) must be identical to the enclosed draft labeling (text for the package insert submitted April 7, 2004). The electronic labeling rule published December 11, 2003, (68 FR 69009) requires submission of labeling content in electronic format effective June 8, 2004. For additional information, consult the following guidances for industry regarding electronic submissions: Providing Regulatory Submissions in Electronic Format - NDAs (January 1999) and Providing Regulatory Submissions in Electronic Format – Content of Labeling (February 2004). The guidances specify that labeling is to be submitted in pdf format. To assist in our review, we request that labeling also be submitted in MS Word format. If formatted copies of all labeling pieces (i.e., package insert, patient package insert, container labels, and carton labels) are submitted electronically, labeling does not need to be submitted in paper. For administrative purposes, these submissions should be designated "FPL for approved supplements NDA 19-537/S-053, S-054 and NDA 20-780/S-017, S-018." Approval of these submissions by FDA is not required before the labeling is used.

If you issue a letter communicating important information about these drug products (i.e., a “Dear Health Care Professional” letter), we request that you submit a copy of the letter to each NDA and a copy to the following address: MEDWATCH, HFD-410 FDA 5600 Fishers Lane Rockville, MD 20857 We remind you that you must comply with the requirements for an approved NDA set forth under 21 CFR 314.80 and 314.81. NDA 19-537/ S-053, S-054 NDA 20-780/S-017, S-018 Page 4 If you have any questions, call Robin Anderson, R.N., M.B.A, Labeling Reviewer, at (301) 827-2127. Sincerely, {See appended electronic signature page} Renata Albrecht, M.D. Director Division of Special Pathogen and Immunologic Drug Products Office of Drug Evaluation IV Center for Drug Evaluation and Research


The FDA knows these facts, but patients may not be warned that the side effects of this class of drugs may be worse than the symptoms they are intended to treat. Elsewhere you will find that these drugs are to be a "third line" of defense, to be used after failure of other antibiotics. Yet, in my daughter's case of a "food posioning" event, cipro was given as a "first choice" drug with absolutely no mention of these severe side effects. I suspect that had she been warned properly, she would have used a safer alternative.

I SUGGEST RECALL CIPRO JUST LIKE BAYCOL!

There are many other flourine-containing drugs that produce adverse side effects, some in good proportion to their benefits and others with poorer risk benefits. The list includes: 5-fluorouracil (anticancer), flunitrazepam (Rohypnol) (the date rape drug) and nitrazepam (Mogadon) tranquilizers, fluoxetine (Prozac) and paroxetine (Seroxat/Paxil) antidepressants, the entire class of the fluoroquinolones antibiotics, fluconazole (Diflucan) and flutrimazole (Micetal) the antifungals, Mefloquine Lariam) the antiprotozoal, (diethylamido)sulfur trifluoride DAST, atorvastatin calcium (Lipitor) the anti-cholesterol agent, a variety of flourinated toothpastes and many more, best found through specific web searchs (with flourine).

Georgeeby 11:22, 20 August 2007 (UTC)

The article certainly needs to be expanded, particularly regarding side effects, but we can't add anecdotal reports (such as those from askapatient.com) to the article or use them as references. Again, if there is information regarding these effects which can be cited to a reliable source and written in an impartial manner (and I'm sure there is) there is no reason why it shouldn't be added. If you'd like to expand the article to this effect, please do. I'll just ask you to have a look at Wikipedia:Verifiability and Wikipedia:Neutral point of view, and don't take it personally if your edits are reverted: just come back to the Talk page and discuss. Fvasconcellos (t·c) 20:51, 19 August 2007 (UTC)
By the way, I've removed the Walgreens text you quoted above, not because it was unreliable—no need for scare quotes here—but simply because that was quite a hefty amount of copyrighted content. If I can help you or you have any questions, please feel free to contact me or leave them here. You may also want to get in touch with our Clinical medicine and Pharmacology projects; the editors at either can provide input or answer questions regarding additions to the article, what kinds of sources are appropriate etc. Best, Fvasconcellos (t·c) 20:51, 19 August 2007 (UTC)

[edit] 2004-2005 Ciprofloxacin talk

Also implicated in the rise of resistant bacteria is the use of lower-cost, less potent fluoroquinones, and the widespread addition of Cipro and other antibiotics to the feed of farm animals, which leads to greater and more rapid weight gain, for reasons which are not clear.

the word sould be fluoroquinolones, or is it correct?

quinolones JFW | T@lk 08:45, 21 Nov 2004 (UTC)


The relative safety of Fluoroquinolones? These drugs can cause kidney damage, liver damage, neurological problems, weakened cartilidge...

It seems like this was written by a shill for the drug companies. I've taken drugs penicillin type drugs and I've taken a course of Cipro (for orchitis.) Cipro was much much harsher.

--Wiserd 8 July 2005 20:02 (UTC)

But will you concede that your personal experience may not reflect statistical reality? Allergies are much rarer, and the side-effects you kindly inserted are rarer e.g. than those in macrolides (stomach upset, transient hearing loss). This was not written by a "shill for the drug companies". The side-effects are not mentioned because thankfully they are rarer than therapeutic successes. I reckon your orchitis improved. JFW | T@lk 12:08, 10 July 2005 (UTC)
I'm not convinced the cipro was 100% successful in my case, though residual symptoms may be due to trauma\autoimmune response\some other non-bacterial factor. I'm going to head back to the Doctor as soon as I have time. But certainly my personal experience is far from a controlled study.
My language was a bit harsh. The use of cipro certainly outweighs the side effects in certain instances. But you have a lot of people self-administering cipro such as with the anthrax scare, overproscription, etc. and doing a great deal of harm to themselves, outside of the normal issues of antibiotic resistance.
The article on Cipro came across as a bit unbalanced, defending Bayer, praising cipro and offering no list of side effects or warnings. I suppose the Macrolides you mentioned don't have a list of side effects either (I just looked up their formatting now) though the tetracyclines, which I was going off of, did.
--Wiserd 23:33, 10 July 2005 (UTC)

I totally agree that people should not be self-administering any prescription drugs, and I think due to selective resistance this is especially important in antibiotics, as it harms more people than just the "patient".

I have condensed the side-effect area a bit. One has to be jolly careful with the reporting of side-effects in the medical literature. Often one or two cases of a side-effect are described, and in many instances the link is really really tentative (e.g. they were also taking other drugs at the same time).

I've also changed the links to the PubMed abstracts into actual academic references. Unfortunately the Brouwers article was not accessible as fulltext, and I've had to time to check which CYP450 isoenzyme is inhibited by cipro. JFW | T@lk 11:51, 11 July 2005 (UTC)


Thanks for tightening\cleaning things up. Very nice summation. I do think the neurological problems, particularly insomnia, feelings of dread, and some other more serious problems are genuine characteristics of ciprofloxacin since they seem to be characteristics of most fluoroquinolones. Significant phototoxicity is also a characteristic of most fluoroquinolones, though ciprofloxacin seems to be mild in this regard relative to others in its class.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15738624&query_hl=23 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12740182&query_hl=23

Likewise, the fluoroquinolones are generally chondrotoxic as well as weakening tendons, and this can be demonstrated in vivo in rats.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15456526&query_hl=21 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12052667&query_hl=2


"and I've had to time to check which CYP450 isoenzyme is inhibited by cipro."

"Likewise, quinolone antibiotics such as ciprofloxacin inhibit the metabolism of CYP1A2 substrates."

from - http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15058617&query_hl=36

--Wiserd 12:31, 12 July 2005 (UTC)

Better: please see PMID 1510417. PMID 12052667 is a good review, but one of us may need to read the fulltext to see what is worth mentioning. I don't think we should extensively mention animal studies. The Japanese study is not a good choice - most readers do not understand Japanese :0(. JFW | T@lk 13:49, 12 July 2005 (UTC)


Hai. Nihongo ga wakarimasen, ne. (Translation, " I don't understand Japanese")

--210.213.157.108 15:13, 2 August 2005 (UTC)


Action against Enterococcus?

According to their website: http://www.ciproxr.com/PAT/Patient_index.asp Cipro XR is active against Enterococcus faecalis, but this Wiki entry contradicts this. Which is right?

Cipro resistance is increasing. JFW | T@lk 02:43, 14 October 2005 (UTC)
I think it's only an incomplete list. You can see it:Ciprofloxacina. --F. Cosoleto 00:12, 15 October 2005 (UTC)

I'm having serious problems with Enterococcus faecalis which I fought well with Medocyprin drug that uses Ciprofloxacin as main base. Problem is, that I've undertaken 2 treatments, but infection always came again. Now I'm in different country, fighting same problem again, 10 years to the date :) People don't give up! —Preceding unsigned comment added by 172.188.177.114 (talk) 12:18, 30 September 2007 (UTC)

[edit] "Unfortunately?"

Removing that from the line that read "Unfortunately, Bayer took a financial blow..." Not that it's not a heartbreaker or anything.

I agree that it was not NPOV, but your sarcasm is misplaced. Bayer responded to a demand, which was a shrewd business decision which appears to be legitimate in any other branch of business apart from pharmaceuticals. JFW | T@lk 18:24, 31 January 2006 (UTC)
And a qualification: the business decision turned out to have been a bad one. JFW | T@lk 18:25, 31 January 2006 (UTC)
"Unfortunately" is correct, but in another sense. It is really unfortunate how two-faced the USA proved themselves once again when the US government ruled out Bayer's patent after these presumed anthrax terror attacks (only one of which turned out to be real, and that one wasn't a terror attack) under the term "public health interest".

It is remarkable that a number of US companies hold and viciously defend (with aid from their government) the patents for nearly every significant treatment of AIDS. There is no consideration whatsoever that AIDS might possibly be an issue in regions like central Africa. Of course it's Africa, not the USA, and those people are not only black, they are also poor. Really, who cares if they can't afford treatement, and if a few million of them die. —Preceding unsigned comment added by 91.35.163.79 (talk) 07:53, 6 March 2008 (UTC)

[edit] Contradiction

The DNA gyrase article says gyrase is only found in bacteria, while this article says it's found in both but it acts more on bacterial. Which is correct? --zandperl 19:23, 26 April 2006 (UTC)

just bacteria. Well prokaryotes to be more accurate. I don't see where this is in the article though. SenorKristobbal 11:47, 9 November 2006 (UTC)

[edit] cipro and quercetin

This article may discuss the interaction between Cipro and quercetin. I can only get the abstract, which gives results but not specific antibiotics used. [1] There seems to be a very minor but positive interaction between the two.

[edit] Some other cipro / fluoroquinolone issues

I am currently researching cipro for treatment of a pneumococcus (streptococcus pneumoniae) infection for a loved one. Spent a lot of time reading original research articles in refereed journals. Some issues I'm wondering if you all would think are worth adding:

  • Central Nervous System (CNS) side effects: There are reported psychotic reactions (hallucinations, paranoia. The research I found indicated these are all temporary events that go away quickly upon cessation of treatment. But does seem important to know about.
  • Interaction with NSAID: Should this be moved and / or repeated in the "interactions" section and not just "contraindications" section? Also, should ibuprofen be specifically mentioned?
  • Fluoroquinolones for streptococcus pneumoniae infections: While ciprofloxacin is not idea for raging strep pneumo infections, it may be appropriate for "mop up" after treatment with vancomycin. Important parameters are MIC levels and drug uptake. There are good reports out there showing that some 3rd generation fluorquinolone may be have much higher efficacy against strep pneumo than cipro. For example moxifloxacin may be 20 times more effective (I am not sure of the technical way of defining "efficacy").
  • Arthropathic side effects in children: I found some good articles that (a) demonstrate undetectable risk in pediatric usage and (b) explanations for why human side effects are much dimished compared with puppy or bunny models.

Let me know if you think these would be good additions to the article. I did spend quite a bit of time doing my own research while in the hosptial at nights. (I am a very new wiki user, so you may want to send me an email with your thoughts, I am not sure how I will notice updates to this page.) I will also look to update information I found on vancomycin and side effects. Skoch3 14:14, 21 December 2006 (UTC)

[edit] Business aspects

I've tagged the whole "Business aspects" section for a neutrality check. It is completely uncited, and statements such as "with the other drugs developed by other pharmaceutical companies relegated to 'me-too' status and forced to compete on the basis of lower cost" are not at all encyclopedic. I'll see if I can get to this later. Fvasconcellos (t·c) 04:00, 3 June 2007 (UTC)


This might help http://www.managingip.com/?ISS=13068&PUBID=198&Page=9&SID=486721&SM=&SearchStr= ? Dnadiver

[edit] Information lacking citation

Ciprofloxin can cause neurological agaitation in health young adults. A State toxicology report indicates that ciprofloxin caused a toxic reaction, grand maul seizure, permanent loss of conciousness and subsequent death in a 28 year old in North Alabama in 1992.

I cut this paragraph Snafflekid 22:40, 7 August 2007 (UTC) 172.188.177.114 12:21, 30 September 2007 (UTC)