Experiences with

Ciprofloxacin

Ciprofloxacin is an antibiotic. It belongs to a group of antibiotics called fluoroquinolones. It works by killing the bacteria that causes an infection.

Ciprofloxacin is a broad-spectrum antibiotic which means that it's used to treat a number of bacterial infections, such as:

• uncomplicated urinary tract infections (UTIs) where other antibiotics are not suitable and complicated UTIs
• chest infections (including pneumonia)
• skin and bone infections
• sexually transmitted infections (STIs)
• conjunctivitis
• eye infections
• ear infections
• infections that other antibiotics have been unable to treat

It is also used to help prevent people getting meningitis if they have been in close contact with someone with the infection.

Ciprofloxacin is only available on prescription.

It comes as tablets, a liquid that you drink, ear drops and eye drops. It's also given by injection, but this is usually done in hospital.

Ciprofloxacin ear drops also come mixed with other medicines, such as fluocinolone, known as Cetraxal Plus, or dexamethasone.

Ciprofloxacin tablets and liquid are only used when no other antibiotics are suitable, because there's a risk of serious and long-term side effects.

Who can take or use ciprofloxacin

Most adults and children aged 1 year and over can take or use ciprofloxacin.

Who may not be able to take or use ciprofloxacin

Ciprofloxacin is not suitable for some people. To make sure it's safe for you, speak to your doctor or pharmacist before taking or using it if you:

• have ever had an allergic reaction to ciprofloxacin or any other medicine
• have ever had a serious side effect with ciprofloxacin or another antibiotic (particularly a fluroquinolone)
• have had diarrhoea while taking antibiotics before
• have ever had depression, anxiety, suicidal feelings or any another mental health condition
• have an abdominal aortic aneurysm or any other problem with the aorta (the large blood vessel running from the heart to the abdomen), or if someone in your family has had this
• have a fast, pounding heartbeat, or irregular heartbeats
• have a heart infection, congenital heart disease or heart valve disease
• have uncontrolled high blood pressure
• have rheumatoid arthritis, Behcet's disease or a connective tissue disorder such as Marfan syndrome
• have problems with your tendons
• have epilepsy or another health problem that puts you at risk of seizures or fits
• have problems with your kidneys
• have diabetes, as ciprofloxacin might affect your blood sugars
• are pregnant, trying to get pregnant or breastfeeding

Dosage and strength of ciprofloxacin tablets and liquid

Ciprofloxacin is available in different strengths. It comes as:

• 100mg, 250mg, 500mg and 750mg tablets
• a liquid that contains 250mg in 5ml

The usual dose of ciprofloxacin tablets or liquid is 250mg to 750mg twice a day. For some infections, you might only need to take a single dose.

Doses are usually lower for children and people with kidney problems.

Dosage for ciprofloxacin eye drops

The usual dose is 1 or 2 drops into the affected eye 4 times a day.

Dosage for ciprofloxacin ear drops

You'll usually use up to 5 drops, twice a day.

How to take or use it

You can take ciprofloxacin tablets and liquid with or without food. However, avoid dairy products like milk, cheese and yoghurt, as they can affect how your medicine works.

Taking ciprofloxacin tablets

Swallow the tablets whole with lots of water. Do not chew them.

Taking ciprofloxacin liquid

Ciprofloxacin liquid comes as 2 bottles, one containing granules and one containing liquid.

1. Empty the granules into the larger bottle. Do not add any water to the liquid.
2. Close the larger bottle containing the liquid and granules and shake for about 15 seconds.
3. Open the bottle and measure your dose.

Always use the plastic syringe or spoon provided, to help you take the right amount. If you do not have one, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount.

Using ciprofloxacin eye drops

You'll usually put 1 or 2 drops into the affected eye 4 times a day.

For severe infections, your doctor may tell you to use the drops as often as every 15 minutes for the first 6 hours. You can then reduce how often you use it.

1. Wash your hands.
2. Gently pull down your lower eyelid and tilt your head back.
3. Hold the bottle over your eye and allow a single drop to fall into the space between your lower lid and your eye.
4. Put in a second drop if you have been told to.

Using ciprofloxacin ear drops

Ciprofloxacin ear drops come in single-dose containers or as a 5ml bottle. If you are using single-dose ciprofloxacin, use 1 container for 1 dose.

1. Warm the drops by holding the container or bottle in your hands for a few minutes.
2. Wash your hands before using.
3. Tilt your head and bring the container or bottle up to the affected ear, with the open end close to your ear hole.
4. Squeeze the drops into your ear.
5. If you can, lie down for at least 5 minutes afterwards.
6. If you are only treating 1 ear, turn your head to one side, so your affected ear is towards the ceiling.

Do not touch your ear with the dropper as it may cause infection to spread.

Put up to 5 drops into the affected ear twice a day, or as your doctor advises. If you are using ear drops from a 5ml bottle, use 4 drops for each dose.

How long to take or use it for

It's usual to take or use ciprofloxacin for a week or two. For some infections you might only need to take or use it for a day, but for others it might be up to 3 months.

Your doctor will tell you how long to take or use ciprofloxacin.

It's very important that you keep taking or using ciprofloxacin until your course is finished. Do this even if you feel better.

If you stop your treatment early, the infection could come back. It also gives any remaining bacteria a chance to change or adapt so they are no longer affected by the antibiotic. This is known as antibiotic resistance.

If you forget to take or use it

If you forget a dose, take it as soon as you remember, unless it's nearly time for your next dose. In this case, just skip the missed dose and take your next one at the usual time.

Make sure you finish your full course of antibiotics. Do not have 2 doses to make up for a missed dose.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to remember your medicines.

If you take or use too much

If you're using the eye or ear drops, do not worry if you use a bit too much. This does not usually cause any problems.

If you take more than your prescribed dose of the tablets or liquid, you may get side effects. These can include feeling or being sick (nausea or vomiting), diarrhoea and a pounding or irregular heartbeat. If you have epilepsy, you might have seizures or fits.

• your child takes more than their prescribed dose of ciprofloxacin
• you take 2 extra doses of ciprofloxacin or more
• you've taken more than your prescribed dose of ciprofloxacin and are getting side effects

Go to 111.nhs.uk or call 111 . Call 111 if you're asking about a child under the age of 5 years.

If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the ciprofloxacin packet or leaflet inside it, any remaining medicine, and any other medicines you take.

Common side effects

These common side effects of ciprofloxacin happen in more than 1 in 100 people. There are things you can do to help cope with them:

Speak to a doctor or pharmacist if this advice on how to cope does not help and a side effect is still bothering you or lasts more than a few days.

Serious side effects

Very few people taking or using ciprofloxacin have serious side effects.

They are less likely to happen with the eye drops or ear drops.

These serious side effects can happen in less than 1 in 100 people. Stop taking ciprofloxacin and call your doctor or call 111 now if:

• you, or your friends or family, notice changes in your mood or behaviour
• you have severe tiredness, feel anxious, low in mood or depressed, or have panic attacks
• you have confusion, or have difficulty sleeping or remembering things
• you have confusion, anxiety or depression
• you have muscle weakness, pain or swelling in your joints or tendons. This often begins in the ankle or calf, but could also be in your shoulder, arms or legs. It can happen in the first 2 days of taking ciprofloxacin or even several months after stopping. It is more common in children
• you have pain or abnormal sensations (such as pins and needles that do not go away, tingling, tickling, numbness or burning) or weakness in your body, especially in your legs or arms
• you have ringing in your ears (tinnitus), loss of taste, are seeing double, or have any other changes in your sight, smell, taste or hearing
• you have diarrhoea (perhaps with muscle cramps) that contains blood or mucus – if you have severe diarrhoea without blood or mucus for more than 4 days, also speak to a doctor
• you have a faster or irregular heartbeat, or heartbeats that suddenly become more noticeable (palpitations)
• you have sudden breathlessness, especially when you're lying down
• you have swollen ankles, feet or stomach

• you have thoughts about harming yourself or ending your life

Find your nearest A&E

• you have sudden, severe pain in your stomach, chest or back
• you have seizures or fits

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to ciprofloxacin.

These are not all the side effects of ciprofloxacin. For a full list, see the leaflet inside your medicine packet.

Ciprofloxacin and pregnancy

Ciprofloxacin tablets and liquid are not generally recommended during pregnancy. However, it's OK to use the ear or eye drops.

If you're trying to get pregnant or you're already pregnant, talk to your doctor about taking ciprofloxacin. It is likely that they will recommend an alternative antibiotic that is safer to take in pregnancy.

Ciprofloxacin and breastfeeding

If your doctor or health visitor says your baby is healthy, you can take ciprofloxacin while you are breastfeeding.

Ciprofloxacin passes into breast milk in small amounts and is unlikely to cause any side effects in your baby. However, there has been one report of severe diarrhoea in a breastfed baby.

Although other medicines might be preferred while you are breastfeeding, it is important that you take a medicine that works for you. Talk to your doctor or pharmacist to help you decide.

If your baby is not feeding as well as usual, is being sick or has diarrhoea, has oral thrush (mouth thrush) or a skin rash, or if you have any other concerns about your baby, talk to your doctor, pharmacist, health visitor or midwife.

Ciprofloxacin and fertility

There's no good evidence to suggest that taking ciprofloxacin will reduce fertility in either men or women.

However, speak to a pharmacist or your doctor before taking it if you're trying to get pregnant.

Cautions with other medicines

Some medicines can affect the way ciprofloxacin works. They can also make you more likely to get side effects.

It's important to tell your doctor if you take any of the following medicines before taking ciprofloxacin:

• antacids for heartburn or indigestion – take ciprofloxacin at least 2 hours before antacids or at least 4 hours after
• methotrexate, a medicine used to treat conditions such as rheumatoid arthritis
• phenytoin, a medicine for epilepsy
• steroids, such as prednisolone
• theophylline or aminophylline for asthma
• tizanidine, a medicine used for muscle stiffness
• warfarin, a medicine to help prevent blood clots

Mixing ciprofloxacin with herbal remedies and supplements

Iron tablets (such as ferrous sulfate or ferrous fumarate), calcium and zinc supplements can affect ciprofloxacin. Leave 2 hours in between taking supplements and your dose of ciprofloxacin tablets or liquid.

There's not enough information to say whether other complementary medicines, herbal remedies and supplements are safe to take with ciprofloxacin. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

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