The empirical formula for roxithromycin is C41H76N2O15. Its structure is: Roxithromycin is a bacteriostatic drug acts by inhibiting protein synthesis. It binds reversibly to 50S ribosomal subunits of sensitive microorganism. Roxithromycin interferes with transpeptidation and translocation thus there is inhibition of protein synthesis and hence inhibition of cell growth. Food interferes with absorption of roxythromycin so it should be taken on empty stomach or atleast 15 minutes prior to or 3 hours after meal. Peak plasma concentrations occur about 2 hours after a single dose of 150 mg. Roxitromycin is effective against Streptococcus pyogenes, Streptococcus pneumoniae, Mycoplasma pneumoniae, Ureaplasma urealyticum, Chlamydia species, Moraxella catarrhalis, Gardenella vaginalis and Legionella. Roxithromycin is preferred for treating otitis media, sinusitis and pneumonia. TURB should be done with sterile urine, any infection should treated with a full course of antibiotics. A perioperative antibiotic prophylaxis may reduce postoperative urinary tract infections, fever and may reduce the likelihood for urethral strictures. Disinfect the external genitalia, the lower abdomen and the perineum and sterile draping. A perioperative antibiotic prophylaxis is often given, randomized studies for TURB are missing. Spinal anesthesia or general anesthesia is needed for TURB. Patients with risk factors for a urinary tract infection (diabetes, bladder stones and preoperative bladder catheter) benefit especially from an antibiotic prophylaxis. Spinal anesthesia offers theoretical advantages for the initial postoperative period: the patient is calm, the manipulation of the catheter is possible without pain, less pressing and coughing. General anesthesia with muscle relaxation eliminates the risk of an obturator reflex (see complications) and is preferable in lateral tumors. Check for the width of the urethra, search for urethral tumors. The mucosa of the bladder (and prostate) is examined to identify all flat and papillary tumors.
Members of the human herpesvirus (HHV) and human papillomavirus (HPV) families cause the most common primary viral infections of the oral cavity. HPV infections have received particular attention in recent years, as high-risk strains have been linked to some cases of oral squamous cell carcinoma. Nonetheless, many other viral infections can affect the oral cavity in humans, either as localized or systemic infections. This article discusses viral conditions of the oral cavity, including HHV infection, HPV infection, coxsackievirus infection, mumps, measles (rubeola), and rubella. See Cutaneous Manifestations of HIV Disease and Cutaneous Manifestations of Hepatitis C for information on these viral infections. For patient education resources, visit the Oral Health Center and Infections Center. Eight types of HHV have been linked with oral disease. Also, see the patient education articles Oral Herpes, Canker Sores, Measles, Mumps, Chemical Burns, and Allergic Reaction. These types have different disease patterns in their hosts. White to off white, capsule shaped, film coated tablets, with a score line on one side and debossed with 'F22' on the other side. The size is 18.2 mm x 8.1 mm Ciprofloxacin film-coated tablets are indicated for the treatment of the following infections (see sections 4.4 and 5.1). Special attention should be paid to available information on resistance to ciprofloxacin before commencing therapy. Consideration should be given to official guidance on the appropriate use of antibacterial agents. • Lower respiratory tract infections due to Gram-negative bacteria - pneumonia - exacerbations of chronic obstructive pulmonary disease - broncho-pulmonary infections in cystic fibrosis or in bronchiectasis • Chronic suppurative otitis media • Acute exacerbation of chronic sinusitis especially if these are caused by Gram-negative bacteria • Urinary tract infections • Genital tract infections - gonococcal uretritis and cervicitis due to susceptible Neisseria gonorrhoeae - epididymo-orchitis including cases due to susceptible Neisseria gonorrhoeae - pelvic inflammatory disease including cases due to susceptible Neisseria gonorrhoeae • Infections of the gastro-intestinal tract (e.g. travellers' diarrhoea) • Intra-abdominal infections • Infections of the skin and soft tissue caused by Gram-negative bacteria • Malignant external otitis • Infections of the bones and joints • Prophylaxis of invasive infections due to Neisseria meningitidis • Inhalation anthrax (post-exposure prophylaxis and curative treatment) Ciprofloxacin may be used in the management of neutropenic patients with fever that is suspected to be due to a bacterial infection. • Broncho-pulmonary infections in cystic fibrosis caused by Pseudomonas aeruginosa • Complicated urinary tract infections and pyelonephritis • Inhalation anthrax (post-exposure prophylaxis and curative treatment) Ciprofloxacin may also be used to treat severe infections in children and adolescents when this is considered to be necessary. Treatment should be initiated only by physicians who are experienced in the treatment of cystic fibrosis and/or severe infections in children and adolescents (see sections 4.4 and 5.1).
Mild/moderate: 500 mg PO q12hr or 400 mg IV q12hr for 7-14 days Severe/complicated: 750 mg PO q12hr or 400 mg IV q8hr for 7-14 days Limitations-of-use: Reserve fluoroquinolones for patients who do not have other available treatment options for acute bacterial exacerbation of chronic bronchitis Acute uncomplicated: Immediate-release, 250 mg PO q12hr for 3 days; extended-release, 500 mg PO q24hr for 3 days Mild/moderate: 250 mg PO q12hr or 200 mg IV q12hr for 7-14 days Severe/complicated: 500 mg PO q12hr or 400 mg IV q12hr for 7-14 days Limitations-of-use: Reserve fluoroquinolones for patients who do not have other available treatment options for uncomplicated urinary tract infections Dry powder for inhalation: Orphan designation for patients with NCFB who suffer from frequent severe acute pulmonary bacterial exacerbations which lead to further inflammation, airway, and lung parenchyma damage Indication for treatment and prophylaxis of plague due to Yersinia pestis in pediatric patients from birth to 17 years of age 15 mg/kg PO q8-12hr x10-21 days; not to exceed 500 mg/dose, OR 10 mg/kg IV q8-12hr x 10-21 days; not to exceed 400 mg/dose Postexposure therapy IV: 10 mg/kg q12hr for 60 days; individual dose not to exceed 400 mg PO: 15 mg/kg q12hr for 60 days; individual dose not to exceed 500 mg Change antibiotic to amoxicillin as soon as penicillin susceptibility confirmed Nausea (3%) Abdominal pain (2%) Diarrhea (2% adults; 5% children) Increased aminotransferase levels (2%) Vomiting (1% adults; 5% children) Headache (1%) Increased serum creatinine (1%) Rash (2%) Restlessness (1%) Acidosis Allergic reaction Angina pectoris Anorexia Arthralgia Ataxia Back pain Bad taste Blurred vision Breast pain Bronchospasm Diplopia Dizziness Drowsiness Dysphagia Dyspnea Flushing Foot pain Hallucinations Hiccups Hypertension Hypotension Insomnia Irritability Joint stiffness Lethargy Migraine Nephritis Nightmares Oral candidiasis Palpitation Photosensitivity Polyuria Syncope Tachycardia Tinnitus Tremor Urinary retention Vaginitis Acute generalized exanthematous pustulosis (AGEP), erythema multiforme, exfoliative dermatitis, fixed eruption, photosensitivity/phototoxicity reaction Agitation, confusion, delirium Agranulocytosis, albuminuria, serum cholesterol and TG elevations, blood glucose disturbances, hemolytic anemia, marrow depression (life threatening), pancytopenia (life threatening or fatal outcome), potassium elevation (serum) Anaphylactic reactions (including life-threatening anaphylactic shock), serum sickness like reaction, Stevens-Johnson syndrome Anosmia, hypesthesia Constipation, dyspepsia, dysphagia, flatulence, hepatic failure (including fatal cases), hepatic necrosis, jaundice, pancreatitis Hypertonia, hypotension (postural), increased INR (in patients treated with Vitamin K antagonists), QT prolongation, torsade de pointes, ventricular arrhythmia Methemoglobinemia Myasthenia, exacerbation of myasthenia gravis, myoclonus, nystagmus, peripheral neuropathy that may be irreversible, phenytoin alteration (serum), polyneuropathy, psychosis Myalgia, tendinitis, tendon rupture, toxic epidermal necrolysis (Lyell’s Syndrome), twitching Infections: Candiduria, vaginal candidiasis, moniliasis (oral, gastrointestinal, vaginal), pseudomembranous colitis Renal calculi Vasculitis Because the risk of these serious side effects generally outweighs the benefits for patients with acute bacterial sinusitis, acute exacerbation of chronic bronchitis, and uncomplicated UTIs, that fluoroquinolones should be reserved for use in patients with these conditions who have no alternative treatment options Use in pregnancy, though generally contraindicated for all quinolones, is allowed for life-threatening situations; limited data from use of ciprofloxacin in pregnancy show no higher rate of birth defects than background Do not use oral suspension in nasogastric tube; to prepare, add microcapsules to diluent Commonly seen adverse reactions include tendinitis, tendon rupture, arthralgia, myalgia, peripheral neuropathy, and central nervous system effects (hallucinations, anxiety, depression, insomnia, severe headaches, and confusion); these reactions can occur within hours to weeks after starting therapy, including in patients of any age or without pre-existing risk factors; discontinue therapy immediately at first signs or symptoms of any serious adverse reaction; in addition, avoid use of fluoroquinolones, in patients who have experienced any serious adverse reactions associated with fluoroquinolones (see Black Box Warnings) Peripheral neuropathy: sensory or sensorimotor axonal polyneuropathy affecting small and/or large axons resulting in paresthesias, hypoesthesias, dysesthesias, and weakness reported; peripheral neuropathy may occur rapidly after initiating and may potentially become permanent In prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); adjust dose in renal impairment; superinfections may occur with prolonged or repeated antibiotic therapy; discontinue use immediately if signs and symptoms of hepatitis occur Not first drug of choice in pediatrics (except in anthrax), because of increased incidence of adverse events in comparison with control subjects, including arthropathy; no data exist on dosing for pediatric patients with renal impairment (ie, Cr Cl Distributed widely throughout body; tissue concentrations often exceed serum concentrations, especially in kidneys, gallbladder, liver, lungs, gynecologic tissue, and prostatic tissue; cerebrospinal fluid (CSF) concentration is 10% in noninflamed meninges and 14-37% in inflamed meninges; crosses placenta; enters breast milk Protein bound: 20-40% Vd: 2.1-2.7 L/kg Additive: Aminophylline, amoxicillin, amoxicillin-clavulanate, amphotericin, ampicillin-sulbactam, ceftazidime, cefuroxime, clindamycin, floxacillin, heparin, piperacillin, sodium bicarbonate, ticarcillin Y-site: Aminophylline, ampicillin-sulbactam, azithromycin, cefepime, dexamethasone sodium phosphate, furosemide, heparin, hydrocortisone sodium succinate, magnesium sulfate(? ), methylprednisolone sodium succinate, phenytoin, potassium phosphates, propofol, sodium bicarbonate(? ), sodium phosphates, total parenteral nutrition formulations, warfarin Solution: Compatible with most IV fluids Additive: Amikacin, aztreonam, dobutamine, dopamine, fluconazole, gentamicin, lidocaine, linezolid, metronidazole (ready-to-use form is compatible; hydrochloride form in vial is incompatible), midazolam, potassium chloride, tobramycin Y-site: Amiodarone, calcium gluconate, clarithromycin, digoxin, diphenhydramine, dobutamine, dopamine, linezolid, lorazepam, midazolam, promethazine, quinupristin/dalfopristin, tacrolimus The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information. Its empirical formula is C17H18FN3O3 and MW is 331.3. The chemical structure is: Ciprofloxacin inhibits the enzyme bacterial DNA gyrase and prevents replication of bacterial DNA during bacterial growth and reproduction. Ciprofloxacin is well absorbed after oral administration. Blood concentrations of intravenously administered drug are similar to those of orally administered drug. Ciprofloxacin is active against many gram-positive bacteria and gram-negative bacteria. Ciprofloxacin has rapidly bactericidal activity and high potency. Protective intestinal streptococci and anaerobes are spared. Dose modification is needed in patients of renal impairment. Caution in paediatric, geriatric, pregnant and nursing patients.
OTOVEL ciprofloxacin and fluocinolone acetonide otic solution, 0.3% / 0.025% is a sterile, preservative-free, clear otic solution containing the fluoroquinolone antibacterial, ciprofloxacin Ciprofloxacin is contraindicated in persons with a history of hypersensitivity to ciprofloxacin, any member of the quinolone class of antibacterials, or any of the.