Cifran, 500 mg, film-coated tablets, 10 pcs.

Pharmacological action of Tsifran

Cifran is a broad-spectrum antimicrobial drug, the main active ingredient of which is ciprofloxacin. The therapeutic effect of the drug is based on the mechanism of inhibiting the bacterial enzyme and disrupting the synthesis of their DNA. In addition, Cifran is able to increase the permeability of the cell membrane of harmful microorganisms (in particular bacteria) and have a bactericidal effect on them. The drug affects both bacteria in the reproduction phase and those at rest.

Cifran is active against a number of aerobic gram-negative bacteria, including Enterobacter spp, Escherichia coli, Citrobacter spp, Shigella spp, Morganella morganii, Moraxella spp, Salmonella spp and others. Tsifran's activity against aerobic gram-positive bacteria was also noted: Listeria monocytogenes, Staphylococcus aureus, Streptococcus pneumoniae and a number of others, including strains that produce penicillinase. Finally, the drug is active against intracellular bacteria: Brucella spp, Chlamydia trachomatis, Legionella spp, Mycoplasma hominis.

However, the instructions for Cifran note the resistance of anaerobic bacteria to the drug.

The post-antibiotic effect after taking the drug lasts up to 6 hours, which helps prevent further bacterial growth.

In addition, treatment with Cifran does not disrupt the natural microflora of the vagina and intestines.

Interaction with other drugs

It is extremely important to consider the compatibility of the antibiotic with other medications, since in some cases dosage adjustment is required:

• With Theophylline. The effect of this medicine is enhanced, and the removal of active substances from the body slows down. In this case, a dose adjustment of Theophylline is required, as the risk of toxic effects on the body increases.
• With Didanosine. With this combination, ciprofloxacin complexes are formed with the aluminum and magnesium buffers contained in Didanosine. As a result, the absorption of the antibiotic is reduced.
• With Warfarin. With this combination, the risk of bleeding increases sharply.
• With medications containing iron, zinc, aluminum, magnesium, as well as with antacid medications. In their presence, ciprofloxacin is absorbed more slowly. For this reason, it is necessary to maintain an interval of 4 hours between doses.

Release form

Three forms of the drug are available in pharmacy chains:

• Tablets with a mass fraction of ciprofloxacin 250 or 500 mg. The tablets are coated and packaged in a cardboard box in quantities of 10 or 100 pieces;
• Solution for infusion containing ciprofloxacin in the amount of 2 mg in 1 ml of Cifran. The content of the drug in one bottle is 100 ml. The bottle is placed in a box;
• Eye drops. 1 ml of drops contains 3 mg of ciprofloxacin. The drops are packaged in a dark glass bottle and placed in a cardboard box.

Overdose

The maximum daily dose of Cifran tablets is 1500 mg. If this amount is exceeded, nausea, a feeling of severe weakness, dizziness, and vomiting often occur.

If an overdose is detected, the necessary detoxification procedures must be carried out as soon as possible. To do this, perform the following steps:

1. Gastric lavage. You can do this by drinking a few glasses of water. After that, fingers are applied to the root of the tongue, inducing vomiting. Thanks to this procedure, the remnants of the medicine that have not yet had time to be absorbed will be removed from the stomach.
2. Immediately after this, the patient should take magnesium and calcium-containing drugs.
3. After vomiting, you should drink as much liquid as possible in small portions. This is necessary for faster removal of the active component from the body.

Indications for use of Tsifran

Indications for Cifran are infectious and inflammatory diseases caused by microorganisms sensitive to the action of the drug. According to the instructions for Cifran, the drug is effective for the following diseases:

• for infections of the genitourinary system (including chronic and acute pyelonephritis, cystitis, prostatitis, epididymitis);
• for respiratory tract infections, which include bronchopneumonia, pneumonia, exacerbation of chronic bronchitis, acute bronchitis, pleurisy, empyema, infected bronchiectasis, lung abscesses;
• for gonorrhea, urethritis, proctitis, pharyngitis, including forms caused by resistant gonococci;
• for infections of the ENT organs, including otitis media and external, mastoiditis, sinusitis;
• for infections of soft tissues and skin, including wounds and burns, infected ulcers, cellulitis, abscesses;
• for gastrointestinal infections, including peritonitis, cholangitis, typhoid fever, intra-abdominal abscesses, gallbladder empyema;
• for infectious and inflammatory diseases of the pelvic organs, including endometritis and salpingitis;
• for infections of joints and bones, including chronic and acute osteomyelitis, septic arthritis;
• for septicemia, bacteremia, infections in patients with a weakened immune system.

The instructions for Tsifran describe the effectiveness of intravenous administration of the drug in the prevention of postoperative infections.

Analogs

Among the analogues of “Cifran 500 mg” the following should be mentioned:

• “Polymik.” This medicine is available in tablet form and includes an identical active ingredient. Like “Tsifran”, it is prescribed for infectious diseases of the respiratory tract, ENT organs, and urinary system.
• “Ofor.” These tablets are a complete analogue, which means they include an active component from the same group of second-generation fluoroquinols and have similar indications for use.

• “Abaktal.” A medicine from the fluoroquinolone group containing pefloxacin. Recommended for the treatment of diseases of the ENT organs, as well as the urinary and respiratory systems.
• "Abiflox". The tablets contain levofloxacin and are used to treat mild and moderate forms of infectious diseases.
• “Gati.” This medication contains the active substance gatifloxacin. Doctors often recommend this medicine to patients with acute infectious diseases. Diagnoses may include inflammation of the urinary tract and respiratory system.
• “Ophlogexal.” Ofloxacin, included in this medication, is highly effective in combating infections of the ENT organs and genitourinary system.

Full analogues: “Medociprin”, “Flaprox”, “Tsiprinol”, “Tsiprolet”, “Citeral” (the same active ingredient).

Even if the tablets have a large number of similar characteristics to the drug “Cifran” (active substance, indications), you should not change the medicine yourself. This can be explained by different dosages and the possible presence of contraindications. If for one reason or another “Tsifran” is not suitable, you should contact your doctor for treatment correction.

Contraindications

Treatment with Cifran is not recommended in case of hypersensitivity to quinols, in particular to ciprofloxacin. Also contraindications are pregnancy and lactation, age under 12 years.

The use of Cifran by some groups of patients is permissible only under the condition of careful medical supervision during treatment, these include:

• patients with severe cerebral atherosclerosis;
• patients with cerebrovascular accidents;
• patients with diagnosed mental illness;
• patients with epileptic syndrome and epilepsy;
• patients with severe liver and/or kidney failure;
• elderly patients.

Interactions of the drug Cifran

The simultaneous use of tizanidine and ciprofloxacin is contraindicated. As with other quinolones, the combined use of ciprofloxacin with theophylline may increase the concentration of theophylline in the blood serum and prolong its half-life. This may increase the risk of developing theophylline-related adverse reactions. If concomitant use of these drugs cannot be avoided, monitor serum theophylline levels and adjust the dosage regimen accordingly. Some quinolones, including ciprofloxacin, affect the metabolism of caffeine. This may result in decreased clearance of caffeine and prolongation of its plasma half-life. Concomitant use of any drug of the quinolone class, including ciprofloxacin, with multivalent cation-containing drugs, such as antacids containing magnesium or aluminum hydroxide, sucralfate, didanosine chewable tablets, or products containing calcium, iron or zinc, may significantly reduce its absorption due to of which the concentration in blood serum and urine will be significantly lower than necessary. Antagonists of histamine H2 receptors apparently do not have a significant effect on the bioavailability of ciprofloxacin. Absorption of the drug may be slightly reduced (20%) if used in combination with omeprazole. Changes in serum phenytoin levels (increase or decrease) were noted in patients who simultaneously took ciprofloxacin. The combined use of ciprofloxacin with a sulfonylurea rarely resulted in severe hypoglycemia. Some quinolones, including ciprofloxacin, have been associated with transient increases in serum creatinine in patients concomitantly taking cyclosporine. There have been reports that quinolones, including ciprofloxacin, enhance the effect of the oral anticoagulant warfarin or its derivatives. If simultaneous use of these drugs is necessary, prothrombin time and other blood coagulation parameters should be carefully monitored. Probenecid affects the secretion of ciprofloxacin by the renal tubules, as a result of which the concentration of ciprofloxacin in the blood serum increases. These circumstances must be taken into account if the patient is taking both drugs at the same time. The renal tubular transport of methotrexate may be inhibited by concomitant use of ciprofloxacin, potentially leading to increased plasma levels of methotrexate. This may increase the risk of toxic reactions due to methotrexate. Patients receiving methotrexate therapy require careful monitoring if they are prescribed ciprofloxacin therapy at the same time. Metoclopramide significantly accelerates the absorption of orally taken ciprofloxacin, thereby increasing the time to reach its maximum plasma concentration. However, no effect on the bioavailability of ciprofloxacin was noted.

Instructions for use of Tsifran

The dosage during treatment with Cifran is set strictly individually, based on the severity of the disease, type of pathogen, body weight, patient age and kidney function.

For children over 12 years of age, Cifran is indicated in an amount of 5-10 mg/kg body weight per day. In this case, the dosage is divided into two doses. It is preferable to take the tablets before meals.

Cifran in the form of intravenous infusion is administered to adults in the amount of 200 mg twice a day for infections of the lower extremities and urinary tract. The drug is administered slowly. For other infections, Cifran should be administered at the same rate in the amount of 200 mg every 12 hours.

For septicemia and bacteremia, up to 400 mg of the drug is administered every 12 hours.

In case of severe renal impairment, the daily dose is reduced by 2 times.

The duration of IV use of Cifran 200 mg is 60 minutes.

In some cases, after a course of IV administration of Cifran, you should switch to oral administration of the drug.

The duration of treatment with Cifran and drug analogues is determined by the doctor based on the patient’s individual parameters. It is recommended to carry out treatment for at least 5-7 days for acute infectious diseases; after the clinical symptoms of infection disappear, the course of treatment is extended for another 3 days.

It is recommended to instill eye drops 1-2 drops into the lower conjunctival sac of the affected eye every 4 hours for mild to moderate diseases. gravity. In case of severe disease, the indications for Cifran are as follows: every hour, 2 drops until improvement occurs. After this, the dose of the drug is reduced.

Pharmacokinetics

The drug “Cifran” is quickly absorbed when it enters the gastrointestinal tract. Its bioavailability is about 70%. If the medicine is taken after a meal, absorption slows down somewhat. About 20-40% of the active substance is bound to proteins.

Ciprofloxacin, when taken orally, is distributed throughout soft tissues and enters fluids. The maximum amount of medicine in the body is reached 1-1.5 hours after administration. Biotransformation takes place in the liver. Excretion from the body occurs in urine and feces (in small quantities). This process begins after 3-3.5 hours.

Side effects of Tsifran

The use of Tsifran and analogues of the drug in rare cases can cause a number of undesirable reactions. You should familiarize yourself with their list before starting your appointment:

• abdominal pain, flatulence, vomiting, nausea, hepatitis;
• paresthesia, headache, irritability, dizziness, confusion, migraine, fainting, depression, tremors of extremities;
• disturbances of smell, vision and taste, hearing loss;
• heart rhythm disturbances, tachycardia;
• leukopenia, eosinophilia, anemia, leukocytosis, hemolytic anemia, thrombocytosis;
• hypoprothrombinemia, hyperglycemia, increased activity of liver transaminases;
• hematuria, glomerulonephritis, polyuria, dysuria, urinary retention, urethral bleeding;
• arthralgia, myalgia, tenosynovitis, arthritis, tendon ruptures;
• general weakness, photosensitivity, superinfections (in the form of candidiasis, pseudomembranous colitis).

Cifran®

Severe infections, staphylococcal infections and infections caused by gram-positive and anaerobic bacteria

When treating severe infections, staphylococcal infections and infections caused by anaerobic bacteria, ciprofloxacin should be used in combination with appropriate antibacterial agents.

Infections caused by Streptococcus pneumoniae

Ciprofloxacin is not recommended for the treatment of infections caused by Streptococcus
pneumoniae due
to its limited effectiveness against the pathogen.

Genital tract infections

For genital infections suspected of being caused by strains of Neisseria
gonorrhoeae
resistant to fluoroquinolones, information about local resistance to ciprofloxacin should be taken into account and the sensitivity of the pathogen should be confirmed by laboratory tests. Urinary tract infections

Resistance to fluoroquinolones in Escherichia
coli ,
the most common pathogen causing urinary tract infections, varies depending on the region of the Russian Federation.
When prescribing, it is recommended to take into account the local prevalence of Escherichia coli
to fluoroquinolones.

Heart disorders

Ciprofloxacin has an effect on prolongation of the QT interval (see section "Side effects"). Given that women have a longer average QT interval compared to men, they are more sensitive to drugs that cause QT prolongation. Elderly patients also have increased sensitivity to the effects of drugs that prolong the QT interval. Ciprofloxacin should be used with caution in combination with drugs that prolong the QT interval (for example, class IA and III antiarrhythmic drugs, tricyclic antidepressants, macrolides and antipsychotic drugs) (see section "Interaction with other drugs"), or in patients with increased risk of QT prolongation or development of cardiac arrhythmias (eg, congenital long QT syndrome, uncorrelated electrolyte imbalances such as hypokalemia or hypomagnesemia, and cardiac conditions such as heart failure, myocardial infarction, bradycardia).

Use in children

It was found that ciprofloxacin, like other drugs of this class, causes arthropathy of large joints in animals. When analyzing the current data on the safety of ciprofloxacin in children under 18 years of age, most of whom have cystic fibrosis, no connection has been established between cartilage or joint damage with the drug. It is not recommended to use ciprofloxacin in children for the treatment of diseases other than the treatment of complications of pulmonary cystic fibrosis (in children from 5 to 17 years of age) associated with Pseudomonas
aeruginosa
and for the treatment and prevention of pulmonary anthrax (after suspected or proven infection
with Bacillus anthracis ).
Hypersensitivity

Sometimes, after taking the first dose of ciprofloxacin, hypersensitivity to the drug may develop (see section “Side effects”), including allergic reactions, which should be reported to your doctor immediately. In rare cases, after the first use, anaphylactic reactions up to anaphylactic shock may occur. In these cases, the use of ciprofloxacin should be stopped immediately and appropriate treatment should be instituted.

Gastrointestinal tract

If severe and prolonged diarrhea occurs during or after treatment with ciprofloxacin, the diagnosis of pseudomembranous colitis should be excluded, which requires immediate discontinuation of the drug and the appointment of appropriate treatment (vancomycin orally at a dose of 250 mg 4 times a day). In this situation, the use of drugs that suppress intestinal motility is contraindicated.

Hepatobiliary system

Cases of liver necrosis and life-threatening liver failure have been reported with the use of ciprofloxacin. If you have the following signs of liver disease, such as anorexia, jaundice, dark urine, itching, a painful abdomen, you should stop taking ciprofloxacin (see section “Side effects”).

Patients taking ciprofloxacin who have had liver disease may experience a temporary increase in the activity of liver transaminases and alkaline phosphatase or cholestatic jaundice.

Musculoskeletal system

Patients with myasthenia gravis should use ciprofloxacin with caution, as exacerbation of symptoms may occur.

At the first signs of tendinitis (painful swelling in the joint area, inflammation), the use of ciprofloxacin should be stopped and physical activity should be avoided, because There is a risk of tendon rupture, and consult a doctor.

When taking ciprofloxacin, cases of tendinitis and tendon rupture (mainly the Achilles tendon), sometimes bilaterally, may occur within the first 48 hours after the start of therapy. Inflammation and rupture of the tendon may occur even several months after stopping treatment with ciprofloxacin. In elderly patients and in patients with tendon diseases who are simultaneously treated with corticosteroids. There is an increased risk of tendinopathy.

Ciprofloxacin should be used with caution in patients with a history of tendon diseases associated with quinolones.

Nervous system

Ciprofloxacin, like other fluoroquinolones, can provoke seizures and lower the seizure threshold. Patients with epilepsy and previous diseases of the central nervous system (for example, a decrease in the seizure threshold, a history of seizures, cerebrovascular accidents, organic brain lesions or stroke) due to the risk of developing adverse reactions from the central nervous system. ciprofloxacin should be used only in cases where the expected clinical effect outweighs the possible risk of side effects of the drug.

Cases of status epilepticus have been reported when using ciprofloxacin (see section "Side effects"). If seizures occur, use of the drug should be discontinued. There is a risk of developing mental reactions that may occur even after a single dose of ciprofloxacin. In rare cases, depression or psychotic reactions may progress to suicidal thoughts and suicide attempts, including completed ones (see section "Side effects"). In case of development of any side effects from the central nervous system, including mental disorders, it is necessary to immediately discontinue the drug Cifran® and begin appropriate therapy. In these cases, it is recommended to switch to therapy with another antibiotic other than fluoroquinolones. if possible.

In patients taking fluoroquinolones. including ciprofloxacin, cases of sensory or sensorimotor polyneuropathy and hypoesthesia have been reported. dysesthesia or weakness. If symptoms such as pain, burning, tingling, numbness, or weakness occur, patients should inform their doctor before continuing to use the drug.

Skin

Photosensitivity reactions may occur when taking ciprofloxacin, so patients should avoid contact with direct sunlight and UV light. Treatment should be discontinued if symptoms of photosensitivity are observed (for example, changes in the skin reminiscent of sunburn, see section “Side effects”).

Dysglycemia

As with other fluoroquinolones, changes in blood glucose concentrations, including hypo- and hyperglycemia, are possible when using ciprofloxacin. During therapy with ciprofloxacin, dysglycemia may more often occur in elderly patients and patients with diabetes mellitus receiving concomitant therapy with oral hypoglycemic drugs (for example, sulfonylureas) or insulin. When using ciprofloxacin in such patients, the risk of developing hypoglycemia, including hypoglycemic coma, increases. It is necessary to inform patients about the symptoms of hypoglycemia (confusion, dizziness, ravenous appetite, headache, nervousness, palpitations or increased pulse rate, pale skin, perspiration, trembling, weakness). If the patient develops hypoglycemia, treatment with ciprofloxacin should be stopped immediately and appropriate therapy should be initiated. In these cases, it is recommended to switch to therapy with an antibiotic other than a fluoroquinolone, if possible. When treating with ciprofloxacin in elderly patients and patients with diabetes mellitus, careful monitoring of blood glucose concentrations is recommended.

Cytochrome P450

It is known that ciprofloxacin is a moderate inhibitor of CYP 450 1A2 isoenzymes. Caution should be exercised when simultaneous use of ciprofloxacin and drugs metabolized by these enzymes, such as tizanidine, theophylline, methylxanthine. caffeine, duloxetine. ropinirole, clozapine, olanzapine, agomelatine. since an increase in the concentration of these drugs in the blood plasma, due to the inhibition of their metabolism by ciprofloxacin, can cause specific undesirable reactions. The simultaneous use of ciprofloxacin and tizanidine is contraindicated.

To avoid the development of crystalluria, it is not permissible to exceed the recommended daily dose; sufficient fluid intake and maintaining an acidic urine reaction are also necessary.

In vitro, ciprofloxacin may interfere with the bacteriological study of Mycobacterium tuberculosis, inhibiting its growth, which can lead to false negative results when diagnosing this pathogen in patients taking ciprofloxacin.

Overdose of the drug Cifran, symptoms and treatment

Symptoms : confusion, drowsiness, lethargy, disorientation, dizziness, nausea, vomiting, reversible renal failure. Treatment: there is no specific antidote for ciprofloxacin; If necessary, carry out symptomatic therapy. Rinse the stomach, induce vomiting; the patient should be carefully monitored and receive supportive care, including monitoring of renal function; administration of antacids containing magnesium, aluminum or calcium, which may reduce the absorption of ciprofloxacin; maintaining adequate water regime. Only a small amount of ciprofloxacin (≤10%) is removed from the body by hemodialysis or peritoneal dialysis.