Mar Vista Animal Medical Center

3850 Grand View Blvd.
Los Angeles, CA 90066

(310)391-6741

www.marvistavet.com

CIPROFLOXACIN

(for veterinary information only)

 

BRAND NAME: CIPRO, CIPRO XR

AVAILABLE AS
100 mg, 250 mg, 500 mg, 750 mg & 1000 mg
TABLETS
AND AS
ORAL SUSPENSION

BACKGROUND

Human beings have been at odds with microbes since the beginning of time and the quest for new medications continues even today. When sulfa drugs came on the scene in the 1940's, an "age of antibiotics" was born and a new dimension had opened in the combat against microbes. From there a proliferation of antibiotics developed, each new medication exploiting a different aspect of bacterial metabolism until it seemed that the war on microbes would soon be won.

Despite this progress, one particular bacterial species remained seemingly invincible: Pseudomonas aeruginosa. This species of bacteria was able to change its antibiotic susceptibility with each antibiotic exposure, become resistant to multiple drugs in response to every medication used against it. Eventually, the aminoglycoside class of antibiotics was developed and there was finally a way to kill Pseudomonas fairly reliably but the price was that medication was injectable only, necessitating hospitalization for the patient, and potential kidney damage could result with prolonged use.

A major breakthrough against Pseudomonas came with the development of the fluoroquinolone class of antibiotics (including ciprofloxacin which was produced for human use and enrofloxacin for animal use). These medications are active against many bacterial types including  Pseudomonas. They are available as tablets and are not associated with the serious side effects that plagued the aminoglycoside group.

Fluoroquinolones act by deactivating bacterial enzymes necessary for the transcription of DNA. DNA is very tightly coiled in order to fit inside a cell. Segments of DNA to be used in protein production must be uncoiled by an enzyme called DNA gyrase. The fluoroquinolone antibiotics deactivate DNA gyrase making the reading of DNA impossible. The bacterial cell dies. Mammalian DNA gyrase is of a completely different shape and remains untouched.

Enrofloxacin is the veterinary fluoroquinolone introduced by Bayer to address the need for treatment of Pseudomonas infections in pets. It was the first quinolone for veterinary use and despite decades of use, still dominates the quinolone class for animal use. Ciprofloxacin is approved for human use and is converted to enrofloxacin within the body. Because of inexpensive generics are available for ciprofloxacin, it is tempted to use ciprofloxacin in pets instead of enrofloxacin. There are two reasons why this is not the greatest idea. The first is that antibiotic use creates bacterial resistance and ciprofloxacin is a key treatment in many human diseases. If resistance to ciprofloxacin develops, human life could be lost. This is a basic tenet of responsible antibiotic use which can be extended to the use of any antibiotic.


DNA Double Helix
(Photocredit: NIH Public Image Library)

The second issue with ciprofloxacin use in pets is that bioavailability is highly variable between individuals. This means that a particular dose of ciprofloxacin might be absorbed just fine by one dog and not at all by another, yielding an unpredictable response or lack thereof. Higher doses are recommended to get the most medication into the patient's body where it can achieve its effect.

USES OF THIS MEDICATION

This medication may be used in either dogs or cats to combat different types of infections, especially those involving Pseudomonas and/or other Gram negative bacteria. Ciprofloxacin is also active against Staphylococci, and thus could be used for skin infections.

SIDE EFFECTS

As with most oral medications, the most common side effects of ciprofloxacin are related to the GI tract: vomiting, diarrhea, reduced appetite.
In immature dogs (less than 8 months of age) damage to developing joint cartilage can occur. This phenomenon is only seen in growing dogs and does not seem to be a problem in cats. It is preferable not to use this medication in puppies unless the severity of the infection present warrants it.

Enrofloxacin, the first veterinary fluoroquinolone, was found to lead to retinal damage and blindness when used in higher doses in cats. This is because the feline retina has a tendency to accumulate enrofloxacin. Because ciprofloxacin is converted to enrofloxacin and because higher doses of ciprofloxacin are generally needed to overcome bioavailability issues, this may not be the best choice antibiotic for cats.  That said, ciprofloxacin tends not to accumulate in the feline retina and the vision issues of enrofloxacin have not been reported with ciprofloxacin.

Fluoroquinolone antibiotics may lower the seizure threshold and increase a patient's tendency to have seizures. This is of no concern in a normal animal but is worth a cautionary statement for patients with a pre-existing seizure disorder.

Ciprofloxacin has been known to form crystals in urine and form actual bladder stones in human beings. Hydration should be maintained in pets taking ciprofloxacin to avoid any issues.

INTERACTIONS WITH OTHER DRUGS

Sucralfate (a medication used to treat stomach ulcers) may bind ciproflxacin and prevent it from entering the body. These medications should be given at least 2 hours apart if they are used together. A similar phenomenon occurs with magnesium and calcium-containing antacids.

Theophylline (an airway dilator) blood levels may be higher than usual if this medication is used concurrently with ciprofloxacin. The dose of theophylline may need to be reduced.

If ciprofloxacin is used with oral cyclosporine (an immunosuppressive medication used for inflammatory bowel disease), the kidney damaging properties of cyclosporine may become worse.

Medications or supplements containing iron, zinc, magnesium or aluminum will bind ciprofloxacin and prevent absorption into the body. Such medications should be separated from ciprofloxacin by at least 2 hours.

CONCERNS AND CAUTIONS

Pseudomonas infections are especially common in canine ears and if not controlled decisively, can become resistant. Higher doses of fluoroquinolones are needed to kill this particularly nefarious bacterium and there is significant expense associated. It is tempting to use ciprofloxacin as there is an inexpensive generic but if bioavailability proves inadequate and the infection prevails, it will become even more difficult to clear. In other words, it may not be worth taking a chance on using an inexpensive medication and the use of ciprofloxacin in this situation should be carefully weighed against the monetary savings.

Ciprofloxacin should not be used in pregnant, or nursing pets or in immature dogs unless the severity of the infection warrants it.

Page posted: 3/19/2016
Page last updated: 1/19/2017