Altsipro instructions for use
Please pay your attention that before buying the drug Altsipro you should carefully read the instructions for use, methods of application and dosage, as well as other useful information about the drug Altsipro. On the site "Encyclopaedia of Diseases" you will find all the necessary information: instructions for proper use, dosage, contraindications, as well as reviews of patients who have already used this medication.
Altsipro - Indications for use
Bacterial infections caused by sensitive microorganisms: diseases of the respiratory tract - acute and chronic (at the stage of exacerbation) bronchitis, pneumonia, bronchiectasis, cystic fibrosis .
Infections of the ENT organs - otitis media, sinusitis, frontal sinusitis, mastoiditis, tonsillitis, pharyngitis.
Infections of the organs of the small pelvis and genital organs - prostatitis , adnexitis , salpingitis , oophoritis , endometritis , tubular abscess, pelvioperitonitis, gonorrhea, chancroid, chlamydia.
Infections of the abdominal cavity - bacterial infections of the gastrointestinal tract, biliary tract, peritonitis, intraperitoneal abscesses, salmonellosis , typhoid fever , campylobacteriosis , iersiniosis , shigellosis, cholera .
Infections of the skin and soft tissues - infected ulcers, wounds, burns, abscesses, phlegmon .
Infections against the background of immunodeficiency (arising in the treatment of immunosuppressive drugs or in patients with neutropenia).
Prevention of infections during surgical interventions.
Altsipro - Pharmacodynamics
Altsipro acts bactericidally on gram-negative organisms in the period of rest and division (because it affects not only DNA-gyrase, but also causes lysis of the cell wall), and gram-positive microorganisms only during the fission period.
Low toxicity for macroorganism cells is explained by the absence of DNA-gyrase in them. Against the background of taking ciprofloxacin, there is no parallel development of resistance to antibiotics, which do not belong to the group of inhibitors of gyrase, which makes it highly effective against bacteria that are resistant, for example to aminoglycosides, penicillins, cephalosporins, tetracyclines and many other antibiotics.
Gram-negative aerobic bacteria are sensitive to ciprofloxacin: enterobacteria (Escherichia coli, Salmonella spp., Shigella spp., Citrobacter spp., Klebsiella spp., Enterobacter spp., Proteus mirabilis, Proteus vulgaris, Serratia marcescens, Hafnia alvei, Edwardsiella tarda, Providencia spp. , Morganella morganii, Vibrio spp., Yersinia spp.), Other gram-negative bacteria (Haemophilus spp., Pseudomonas aeruginosa, Moraxella catarrhalis, Aeromonas spp., Pasteurella multocida, Plesiomonas shigelloides, Campylobacter jejuni, Neisseria spp.), Some intracellular pathogens - Legionella pneumophila, Brucella spp., Chlamydia trachomatis, Listeria monocytogenes, Mycobacterium tuberculosis, Mycobacterium kansasii, Corynebacterium diphtheriae; Gram-positive aerobic bacteria: Staphylococcus spp. (Staphylococcus aureus, Staphylococcus haemolyticus, Staphylococcus hominis, Staphylococcus saprophyticus), Streptococcus spp. (Streptococcus pyogenes, Streptococcus agalactiae).
The majority of staphylococci, resistant to methicillin, are resistant to ciprofloxacin. The sensitivity of Streptococcus pneumoniae, Enterococcus faecalis, Mycobacterium avium (located intracellularly) is moderate (their suppression requires high concentrations).
The drug is resistant: Bacteroides fragilis, Pseudomonas cepacia, Pseudomonas maltophilia, Ureaplasma urealyticum, Clostridium difficile, Nocardia asteroides. Not effective against Treponema pallidum. Resistance develops very slowly, since on the one hand, after the action of ciprofloxacin, there are practically no persistent microorganisms, and on the other hand bacterial cells do not have enzymes that inactivate it.
Altsipro in pregnancy
Contraindicated in pregnancy (safety and efficacy in women during pregnancy is not established).
The use of local forms of ciprofloxacin in pregnancy is possible if the intended use exceeds the potential risk to the fetus.
The action category for fetus by FDA is C.
Ciprofloxacin is excreted into breast milk, so during lactation it is necessary to decide whether to stop taking ciprofloxacin or breastfeeding, based on the importance of the use of drugs for the mother.
Be wary of using local forms of ciprofloxacin during lactation (it is not known whether ciprofloxacin is excreted in breast milk for topical application).
Altsipro - Contraindications
Hypersensitivity (including to other fluoroquinolones), deficiency of glucose-6-phosphate dehydrogenase, children and adolescence (up to 18 years, end of the period of intensive growth - for systemic use); in ophthalmology: viral keratitis, children's age (up to 1 year - for eye drops, up to 2 years - for ophthalmic ointment).
Altsipro - Side effects
On the part of the digestive tract: nausea, vomiting, eating disorders, diarrhea, constipation, pseudomembranous colitis, epigastric and abdominal pain, abdominal discomfort, hiccups, ulcers, dryness and soreness of the oral mucosa, flatulence, bleeding in the digestive tract, pancreatitis, cholestatic jaundice , hepatitis, necrosis of liver cells.
From the nervous system and sensory organs: headache, dizziness , agitation, a sense of anxiety, insomnia, nightmares, confusion, depression , phobias, a feeling of fatigue, impaired vision (changing color vision, diplopia, nystagmus , pain in the eyes), violation taste, smell, tinnitus, transient hearing impairment, mood change, gait disturbance, increased intracranial pressure, paresthesia, sweating, ataxia, tremor, convulsions, toxic psychosis , paranoia, hallucinations, migraines.
From the cardiovascular system and blood (hematopoiesis, hemostasis): decreased blood pressure, cardiovascular collapse, arrhythmia, cerebral thrombosis, paroxysmal tachycardia, leukopenia, leukocytosis, anemia, thrombocytopenia, thrombocytosis, prothrombin level change.
On the part of the respiratory system: pulmonary embolism, dyspnea, respiratory distress, bronchospasm, effusion to the pleura.
From the musculoskeletal system: arthralgia, myalgia, tendovaginitis.
On the part of the genitourinary system: frequent urination, crystalluria, hematuria, cylinduria, polyuria, proteinuria, acidosis, urinary retention, hemorrhagic cystitis, nephritis, vaginitis, gynecomastia.
Allergic reactions: rash, petechiae, blisters, papules, skin vasculitis, Stevens-Johnson syndrome, Lyell syndrome, erythema multiforme exudative, exfoliative dermatitis, skin itching, swelling of the lips, face, neck, conjunctiva, limbs, angioedema, urticaria, anaphylactic shock .
Other: hyperpigmentation, eosinophilia, fever, photosensitivity, transient increase in hepatic transaminases, alkaline phosphatase, creatinine, urea, serum triglycerides, glucose, potassium, bilirubin; dysbiosis, candidiasis; on the spot in / in the introduction - pain, burning sensation, phlebitis.
Altsipro - Dosage and administration
Inside, to 0.25 g 2-3 times a day, with severe infections - 0.5-0.75 g 2-3 times a day.
With infections of the urinary tract - 0.25-0.5 g 2 times a day; course of treatment - 7-10 days.
With uncomplicated gonorrhea - 0.25-0.5 g once; when combined gonococcal infection with Chlamydia and Mycoplasma - 0.75 g every 12 hours for 7-10 days.
With chancroid, 0.5 g 2 times a day for several days. When meningococcal carriage in the nasopharynx - once, 0.5 or 0.75 g.
With chronic carrier of salmonella - inside, 0.25 g 4 times; course of treatment - up to 4 weeks. If necessary, the dosage can be increased to 0.5 g 3 times a day.
With pneumonia, osteomyelitis - inside, at 0.75 g 2 times a day. The duration of treatment of osteomyelitis can be up to 2 months.
For gastrointestinal infections caused by Staphylococcus aureus, 0.75 g every 12 hours for 7-28 days. Treatment should continue for at least 3 days after the normalization of body temperature or the disappearance of clinical symptoms. At the glomerular filtration rate (CK 31-60 ml / min / 1.73 m2 or serum creatinine concentration from 1.4 to 1.9 mg / 100 ml), the maximum daily dose is 1 g. At a glomerular filtration rate below 30 ml / min / 1.73 square meters. m or serum creatinine concentration above 2 mg / 100 ml maximum daily dose - 0.5 g. If the patient undergoes hemodialysis or peritoneal dialysis - 0.25-0.5 g / day, but the drug should be taken after a hemodialysis session.
In severe infections (for example, with recurrent cystic fibrosis, infections of the abdominal cavity, bones and joints) caused by Pseudomonas or staphylococci, with acute pneumonia caused by Streptococcus pneumoniae, and with chlamydial infections of the urogenital tract, the dose should be increased to 0.75 g every 12 hours. Tablets should be swallowed whole with a small amount of liquid after ingestion.
When taking Altsipro tablets on an empty stomach, the active substance is absorbed more quickly. IV infusion: the duration of infusion is 30 minutes at a dose of 0.2 g and 60 minutes at a dose of 0.4 g. Infusion solutions ready for use can be combined with 0.9% NaCl solution, Ringer's and Ringer's lactate solution, 5 and 10% solution dextrose, 10% fructose solution, and also a solution containing 5% dextrose solution with 0.225-0.45% NaCl solution.
In uncomplicated urinary tract infections, infections of the lower respiratory tract, a single dose of 0.2 g; with complicated infections of the upper sections of the urinary tract, in severe infections (including pneumonia, osteomyelitis), a single dose of 0.4 g.
If necessary, in / in the treatment of especially severe, life-threatening or recurrent infections caused by Pseudomonas, Staphylococcus or Streptococcus pneumoniae, the dose may be increased to 0.4 g with a multiplicity of administration up to 3 times a day. The duration of treatment for osteomyelitis can reach up to 2 months.
With chronic carrier of salmonella - 0.2 g 2 times a day; course of treatment - up to 4 weeks. If necessary, the dosage can be increased to 0.5 g 3 times a day.
In acute gonorrhea - 0.1 g once. To prevent infections during surgical interventions - 0.2-0.4 g for 0.5-1 h before surgery; When the duration of the operation is more than 4 hours, re-enter in the same dose. Average duration of treatment: 1 day - with acute uncomplicated gonorrhea and cystitis; up to 7 days - with infections of the kidneys, urinary tract and abdominal cavity, during the entire neutropenic phase - in patients with weakened body defenses, but no more than 2 months - with osteomyelitis and 7-14 days - with all other infections.
With streptococcal infections due to the danger of late complications, as well as with chlamydial infections, treatment should last at least 10 days. In patients with immunodeficiency treatment is carried out throughout the neutropenia period. Treatment should be conducted for at least 3 days after the normalization of body temperature or the disappearance of clinical symptoms. At the glomerular filtration rate (CK 31-60 ml / min / 1.73 m2 or serum creatinine concentration from 1.4 to 1.9 mg / 100 ml) the maximum daily dose is 0.8 g. At the glomerular filtration rate (CC below 30 ml / min / 1.73 m2 or a serum creatinine concentration above 2 mg / 100 ml), the maximum daily dose is 0.4 g. Elderly patients are reduced by 30%.
In peritonitis, it is permissible to use intraperitoneal administration of infusion solutions at a dose of 50 mg 4 times per day per liter of dialysate. After IV application, you can continue treatment orally.
Altsipro - Overdose
Treatment: a specific antidote is unknown. It is necessary to carefully monitor the patient's condition, perform gastric lavage and other emergency measures, ensure sufficient fluid intake.
With the help of hemo- or peritoneal dialysis, only a small (less than 10%) amount of the drug can be excreted.
Altsipro - Interaction with other drugs
Due to a decrease in the activity of microsomal oxidation in hepatocytes, it increases the concentration and prolongs T1 / 2 theophylline (and other xanthines, for example caffeine), oral hypoglycemic drugs, indirect anticoagulants, and helps to reduce the prothrombin index.
When combined with other antimicrobial drugs (beta-lactam antibiotics, aminoglycosides, clindamycin, metronidazole), synergy is usually observed; can be successfully used in combination with azlocillin and ceftazidime in infections caused by Pseudomonas spp .; with mezlocillin, azlocillin, etc. beta-lactam antibiotics - with streptococcal infections; with isoxazole penicillins and vancomycin - with staphylococcal infections; with metronidazole and clindamycin - with anaerobic infections.
Altsipro increases the nephrotoxic effect of cyclosporine, there is an increase in serum creatinine, in such patients monitoring of this indicator is necessary 2 times a week. With simultaneous reception increases the effect of indirect anticoagulants.
Alzipro's oral administration together with Fe-containing drugs, sucralfate and antacid medicines containing Mg2 +, Ca2 + and Al3 +, leads to a decrease in the absorption of ciprofloxacin, therefore it should be prescribed 1-2 hours before or 4 hours after the administration of the above drugs. NSAIDs (excluding ASA) increase the risk of seizures. Didanosine reduces the absorption of ciprofloxacin due to the formation with it of complexes with didanosine-containing Al3 + and Mg2 +. Metoclopramide accelerates absorption, which leads to a decrease in the time to reach its Cmax.
Co-administration of uricosuric drugs leads to a delay in excretion (up to 50%) and an increase in the plasma concentration of ciprofloxacin. The infusion solution is pharmaceutically incompatible with all infusion solutions and drugs that are physically and chemically unstable under acidic conditions (the pH of the infusion solution of ciprofloxacin is 3.9-4.5). Do not mix the IV solution with solutions having a pH of more than 7.
Altsipro - Special instructions for admission
With the simultaneous administration of ciprofloxacin and drugs for general anesthesia from the barbituric acid derivative group, continuous monitoring of heart rate, blood pressure, and ECG is necessary. To avoid the development of crystalluria, exceeding the recommended daily dose is inadmissible, adequate fluid intake and maintenance of acid urine reaction are also necessary.
During treatment, one should refrain from engaging in potentially dangerous activities that require increased attention and speed of mental and motor reactions.
Patients with epilepsy, seizures in the anamnesis, vascular diseases and organic brain lesions, in connection with the threat of the development of adverse reactions from the central nervous system, ciprofloxacin should be prescribed only for "vital" indications.
If a severe and prolonged diarrhea occurs during or after treatment, the diagnosis of pseudomembranous colitis should be ruled out, which requires immediate discontinuation of the drug and the appropriate treatment.
When pain occurs in the tendons or the first signs of tendovaginitis treatment should be discontinued (individual cases of inflammation and even rupture of tendons during treatment with fluoroquinolones are described). During the treatment period, avoid direct sunlight.
List B .: Store in a dry, dark place at a temperature below 25 ° C.
Shelf life Altsipro 36 months.