Overview
Ciprofloxacin is a prominent, second-generation fluoroquinolone antibiotic. It is characterised by its broad-spectrum bactericidal activity, particularly against Gram-negative bacteria. It is frequently utilised for treating a variety of challenging infections, including complicated urinary tract infections, severe gastroenteritis, bone and joint infections, and certain types of respiratory tract infections.

Mechanism of Action
Ciprofloxacin works by directly interfering with the bacteria’s ability to replicate and repair its DNA. It achieves this by binding to and inhibiting two critical bacterial enzymes: DNA gyrase and topoisomerase IV. Without these functional enzymes, the bacterial DNA cannot be properly uncoiled or separated during cell division, which rapidly and effectively leads to the death of the bacterial cell.

Dosage and Administration
The dosage and duration of therapy depend heavily on the severity and location of the infection. For adults, typical oral doses range from 250 mg to 750 mg taken twice daily (every 12 hours). It is vital to take ciprofloxacin at least 2 hours before or 6 hours after consuming antacids, calcium, iron, or zinc supplements, as these multivalent cations can bind to the drug in the gut and significantly reduce its absorption.

Side Effects
While generally effective, ciprofloxacin carries a risk of significant side effects. The most common are gastrointestinal, such as nausea and diarrhea. However, it is also associated with more severe risks, including tendinitis and tendon rupture (most notably the Achilles tendon), peripheral neuropathy, and central nervous system effects like dizziness, confusion, or seizures. It can also increase sensitivity to sunlight (photosensitivity).

Contraindications and Warnings
It is contraindicated in patients with a history of hypersensitivity to ciprofloxacin or other fluoroquinolones. Due to the risk of severe musculoskeletal and neurological side effects, it carries black box warnings and should generally be avoided for uncomplicated infections if other treatment options exist. It is also contraindicated with concurrent administration of tizanidine.

Pregnancy and Lactation
Ciprofloxacin is generally avoided during pregnancy unless the potential benefits clearly outweigh the risks, as animal studies have shown potential for cartilage damage in developing fetuses. It is excreted in breast milk, and nursing mothers are advised to either discontinue breastfeeding or discontinue the drug, depending on the importance of the medication to the mother.