Abstract

CLINICAL PHARMACOLOGY OF CIPROFLOXACIN IN INFANTS AND CHILDREN

Prof. Gian Maria Pacifici*

ABSTRACT

Ciprofloxacin is a fluoroquinolone and targets bacterial DNA gyrase and topoisomerase IV. For many gram-positive bacteria topoisomerase IV is the primary target. In contrast, DNA gyrase is the primary quinolone target for many gram-negative bacteria. Ciprofloxacin inhibits gyrase-mediated DNA supercoiling at concentrations that correlate with those required to inhibit bacterial growth (0.1 to 10 μg/ml). Ciprofloxacin is active against Proteus, Escherichia coli, Klebsiella, Salmonella, Shigella, Enterobacter, Campylobacter, Chlamydia, Mycoplasma, Legionella, Brucella, Mycobacterium tuberculosis, Mycobacterium fortuitum, and Mycobacterium kansasii. Ciprofloxacin is rapidly absorbed following oral administration and the mean elimination half-life of ciprofloxacin is 16.6, 6.2, 4.2, and 3.3
hours in newborns, infants, children, and adolescents, respectively. Ciprofloxacin is eliminated mainly by renal route and the renal function increases with infant maturation and child development. Ciprofloxacin has been found efficacy and safe in infants and children but can cause adverse-effects and the major adverse-effect is arthropathy which resolves with therapy. Ciprofloxacin interacts with drugs. Prophylaxis with ciprofloxacin prevents bacterial infections and ciprofloxacin treats bacterial infections in infants and children. Ciprofloxacin penetrates into the cerebrospinal fluid in significant amounts and successfully treats bacterial meningitis in infants and children and ciprofloxacin poorly crosses the human placenta and poorly penetrates into the beast-milk. The aim of this study is to review the published data on ciprofloxacin dosing, efficacy and safely, adverse-effects, pharmacokinetics, interaction with drugs, prophylaxis, treatment, penetration into the cerebrospinal fluid, treatment of meningitis in infants and children and ciprofloxacin transfer across the human placental, and migration into the breast-milk.

Keywords: milk, cerebrospinal-fluid, ciprofloxacin, dosing, efficacy-safely, drug-interaction, meningitis, pharmacokinetics, placenta, prophylaxis, and treatment.