CIPROFLOXACIN

J Periodontol. 2004 Dec;75(12):1663-7.
Distribution of systemic ciprofloxacin and doxycycline to gingiva and gingival crevicular fluid.
Lavda M, Clausnitzer CE, Walters JD.
Section of Periodontology, College of Dentistry, The Ohio State University Health Sciences Center, Columbus, OH 43218-2357, USA.

BACKGROUND: Systemic fluoroquinolones and tetracyclines reach steady-state levels in gingival crevicular fluid (GCF) that are several-fold higher than their levels in serum. The mechanism by which this occurs is unclear, but gingival fibroblasts are known to accumulate these agents. Uptake by fibroblasts could enhance their distribution to gingiva. To test this hypothesis, steady-state levels of these agents were assayed in serum, gingival connective tissue (GCT), and GCF. METHODS: Healthy subjects who needed resective periodontal surgery participated in the study. Approximately 78 hours prior to the surgical appointment, each subject began a 3-day regimen of ciprofloxacin or doxycycline. At the surgical appointment (scheduled approximately 6 hours after the last dose), samples of blood and GCT were collected. GCF samples were collected on paper strips and measured with an electronic device. Samples were extracted and analyzed by high performance liquid chromatography. RESULTS: Mean ciprofloxacin levels in serum, GCT, and GCF were 0.40 microg/ml, 1.38 microg/g, and 1.66 microg/ml, respectively (P<0.001, N=9). For doxycycline, these levels were 1.11 microg/ml, 2.03 microg/g, and 2.41 microg/ml, respectively (P=0.002, N=8). For both agents, the GCT and GCF levels were significantly higher than serum levels (P<0.05), but not significantly different from each other. CONCLUSIONS: Our findings suggest that fibroblasts could play an important role in the distribution of fluoroquinolones and tetracyclines to the gingiva. By accumulating these agents in GCT, fibroblasts could contribute to the relatively high levels they attain in GCF.

Harefuah 2002 May;141 Spec No:63-72, 121, 120
Anthrax - an overview at 2002
Mozes YN, Winder A, Tadmor B, Rotman E, Sagi R, Hourvitz A
Children's Ward A, Schneider Children's Medical Centre, Israel

BACKGROUND: Bacillus anthracis, the causative agent of anthrax, is well known in human history as a major cause of disease in domestic and wild animals and as a rare condition in humans. For the last seventy years, anthrax was developed and occasionally stored as an agent of biological weapon arsenal in numerous countries. The incubation period in humans is 1-6 days and the disease may be present as three distinct clinical syndromes: cutaneous, inhalational, and gastrointestinal disease. The major concern in regard of biological warfare is the inhalational form of anthrax, which starts as a febrile flu-like disease. The development of malaise, fatigue, cough and mild chest discomfort is followed by severe respiratory distress with dyspnea, diaphoresis, stridor, and cyanosis. Shock and death occur within 24-36 hours after onset of severe symptoms. Physical findings are non-specific, but a widened mediastinum is usually seen on chest x-ray. A positive blood culture, immunohistochemical methods and the use of the polymerase chain reaction method confirm the diagnosis. Although effectiveness may be limited after severe symptoms are present, a high dose of antibiotic treatment should be administered and aggressive supportive therapy may be necessary. In the situation of an anthrax attack, as was recently seen in the United States, penicillin is no longer recommended as an acceptable first line therapy. In this case, ciprofloxacin or doxycycline is the recommended drug of choice since penicillin-resistant strains may be used, as well as the possibility of the emergence of an inducible beta-lactamase positive bacterium. Since a high infecting dose may exacerbate the clinical course of the disease, a combination antibiotic regimen should be considered. The disease is not contagious and standard precautions are sufficient. Pre-exposure prophylaxis is based on a vaccine administration, while post-exposure prophylaxis is feasible by the initial use of oral ciprofloxacin or doxycycline. In this article we reviewed the literature with emphasis on the recent medical reports from the United States analyzing the eleven cases of inhalational anthrax as well as the new guidelines for diagnosis and treatment that resulted from the bioterrorism attack in October 2001. Although physical findings were non-specific, abnormal findings on chest x-rays were present in all the eleven cases. A positive blood culture, immunohistochemical methods and the use of the polymerase chain reaction method were highly valuable in revealing and confirming the diagnosis of anthrax. In the case of an attack with anthrax spores, the likelihood of exposure to a large infective dose of high quality spores, may require a prolonged period of treatment as well as prolonged post-exposure therapy.

GENERIC NAME: ciprofloxacin
BRAND NAME: Cipro, Cipro XR

DRUG CLASS AND MECHANISM: Many common infections in humans are caused by single cell organisms, called bacteria. Bacteria can grow and multiply, infecting different parts of the body. Medicines that control and eradicate these bacteria are called antibiotics. Ciprofloxacin is an antibiotic that stops multiplication of bacteria by inhibiting the reproduction and repair of their genetic material (DNA).

PREPARATIONS: Tablets: 250mg, 500mg, 750mg. Tablets Cipro XR: 500 and 1000 mg.

STORAGE: Ciprofloxacin should be stored at below 86 degrees F.

PRESCRIBED FOR: Ciprofloxacin is used to treat infections of the skin, lungs, airways, bones, and joints caused by susceptible bacteria. Ciprofloxacin is also frequently used to treat urinary infections caused by bacteria such as E. coli. Ciprofloxacin is effective in treating infectious diarrheas caused by E. coli, campylobacter jejuni, and shigella bacteria.

DOSING: Ciprofloxacin may be taken with or without food. Ciprofloxacin is partially metabolized by the liver and excreted by the kidney. Dosages require adjustment in patients with severely abnormal liver or kidney function. Antacids block the absorption of ciprofloxacin and they should not be taken together.

DRUG INTERACTIONS: Ciprofloxacin administered together with theophylline can lead to elevated blood levels of theophylline. Theophylline is used to open airways in the treatment of asthma. Toxic levels of theophylline can lead to seizures, and disturbances in heart rhythm. If concurrent use of ciprofloxacin and theophylline cannot be avoided, frequent blood tests to monitor theophylline blood levels are performed. Ciprofloxacin should be used with caution in patients with central nervous system diseases such as seizures, because rare seizures have been reported in patients receiving this medication. Ciprofloxacin should be avoided in children and adolescents under 18 years old, as safe use in these patients have not been established.

Many antibiotics, including ciprofloxacin, can alter the normal bacteria in the colon and encourage overgrowth of a bacteria responsible for the development of inflammation of the colon (pseudomembranous colitis). Pseudomembranous colitis can cause fever, abdominal pain, diarrhea, and sometimes even shock. Patients taking ciprofloxacin can develop sensitivity of the skin to direct sunlight. Ciprofloxacin can enhance the action of the anticoagulant warfarin (Coumadin), and increase the risk of bleeding.

PREGNANCY: Ciprofloxacin should be avoided in pregnancy, as safe use in these patients have not been established.

NURSING MOTHERS: Ciprofloxacin should be avoided in nursing mothers, as safe use in these patients have not been established.

SIDE EFFECTS: The most frequent side effects include nausea, vomiting, diarrhea, abdominal pain, rash, headache, and restlessness. Rare allergic reactions have been described, such as hives and anaphylaxis (shock).

Caution! Before starting to take this medicine, it is vital that you should consult your doctor! Do not use it on your own initiative, without medical advice.
Also, you should read carefully important health information about this drug given here:

my.webmd.com