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Ciprofloxacin [60] is a synthetic antibiotic of the fluoroquinolone drug class. It kills bacteria by interfering with the enzymes that cause DNA to rewind after being copied, which stops synthesis of DNA and of protein.

Ciprofloxacin is marketed worldwide with over three hundred different brand names. In the United States, Canada, and the UK, it is marketed as Baycip, Ciloxan, Ciflox, Cipro , Cipro XR, Cipro XL, Ciproxin, Prociflor, and most recently, Proquin. It is also marketed as Ciprex in India and Russia and "Cetraxal" in Spain. In addition, ciprofloxacin is available as a generic drug under a variety of different brand names and is also available for limited use in veterinary medicine. 

Ciprofloxacin is used to treat a number of infections mostly, but not exclusively, bacterial, including: 

• malignant otitis externa
• cellulitis
• anthrax
• chancroid
• Urinary tract infections (not recommended as a first-line antibiotic)
• Acute uncomplicated cystitis in females
• Chronic bacterial prostatitis (not recommended as a first-line antibiotic choice)
• Lower respiratory tract infections (not recommended as a first-line antibiotic choice)

• Acute sinusitis (not recommended as a first-line antibiotic choice) – “Antibiotics may not improve the long-term clinical outcome for sinusitis”

• Skin and skin structure infections
• Bone and joint infections
• Infectious diarrhea
• Typhoid fever (enteric fever) caused by Salmonella typhi
• Uncomplicated cervical and urethra gonorrhea (due to N. gonorrhoeae) – however, this indication is no longer effective in some areas (for example, Asian countries, United States (including Hawaii), Canada, and Scotland) due to bacterial resistance.

As we can see, its use is restricted and limited…………

"Data exist suggesting that resistance to macrolides and older fluoroquinolones (ciprofloxacin and levofloxacin) results in clinical failure. Other studies have shown that repeated use of fluoroquinolones predicts an increased risk of infection with fluoroquinolone-resistant pneumococci...."

Also “When prescribed for chronic bronchitis The use of antibiotics such as ciprofloxacin to treat bronchitis is to be considered unnecessary and as such exposes the patient to an unacceptable risk of suffering a severe adverse reaction.   Additionally, antibiotics have no effect upon viral infections, such as the common head cold or viral respiratory infections”

The paediatric use of ciprofloxacin is restricted to proven complicated urinary tract infections and pyelonephritis due to E. coli and inhalation anthrax “Ciprofloxacin is not to be considered a first line agent for inhalation anthrax in the pediatric population”

The most recent long term study, BAY 0 9867 Cipro Pediatric Use Study (QUIP), which followed pediatric patients from 1999–2008, supports the current expert opinion that the risk of permanent injury continues to outweigh the potential benefits of ciprofloxacin therapy in the pediatric population. 

Serious adverse events occur more commonly with fluoroquinolones than with any other antibiotic drug classes. There have been a number of regulatory actions taken as a result of such adverse reactions, which included published warnings,  additional warnings and safety information added to the package inserts together with the recent addition of Black Box Warnings.

Ciprofloxacin is a broad-spectrum antibiotic active against both Gram-positive and Gram-negative bacteria. It functions by inhibiting DNA gyrase,  thereby inhibiting cell division.  This mechanism can also affect mammalian cell replication. In particular, some congeners of this drug family (for example those that contain the C-8 fluorine) are toxic to cultured mammalian cells.  .

“There continues to be debate as to whether or not this DNA damage is to be considered one of the mechanisms of action concerning the severe adverse reactions experienced by some patients following fluoroquinolone therapy”

So what are these ‘severe adverse reactions’?  Side effects include  - peripheral neuropathy (irreversible nerve damage), tendon damage, heart problems, pseudomembranous colitis, and rhabdomyolysis (muscle breakdown), severe central nervous system disorders (CNS), psychotic reactions and confusional states, acute pancreatitis,  bone marrow depression,  and Clostridium difficile associated disease  as well as photosensitivity/phototoxicity reactions.

Additional serious adverse reactions include temporary, as well as permanent, loss of vision irreversible double vision, drug induced psychosis and chorea (involuntary muscle movements), impaired color vision,  abdominal pain, malaise, and intracranial hypertension (IIH).

Ciprofloxacin is eliminated primarily by renal excretion. However, the drug is also metabolized and partially cleared through the liver and the intestines.  However, since the drug is known to be substantially excreted by the kidneys, “there are risks of toxic reactions”.  Interstitial nephritis  -and acute liver failure or serious liver injury and hemolytic anemia also occur.

Some groups refer to these adverse events as "fluoroquinolone toxicity".

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