Which of the following is a side effect of ciprofloxacin when treating urinary tract infections?

Ciprofloxacin, also known as Cipro, is a common medication used to treat prostatitis. It is also useful for urinary infections and other bacterial infections.

It is an antibiotic, a member of a class named quinolones. The primary mode of action is stopping or slowing down the growth of the bacteria.

Ciprofloxacin inhibits an enzyme called topoisomerase, or DNA gyrase. This enzyme is present in many bacteria. It is essential to maintain DNA integrity.

By inhibiting this enzyme, Ciprofloxacin promotes the breakage of DNA. The antimicrobial spectrum of Cipro includes gram-positive and gram-negative microorganisms.

For example, Streptococcus pneumoniae, Enterobacteriaceae, Haemophilus influenza, and many others. That is why it is used in respiratory infections and cases of urinary tract infections.

As it happens with all prescription drugs, Ciprofloxacin should be used with care, and under the advice of a doctor. That’s how we can prevent side effects and detect any severe adverse event.

Common and rare Cipro side effects

Most medications have a long list of side effects, including Cipro. The list is not designed to discourage users from taking drugs. Moreover, they are not likely to experience all of them.

Most patients experience very mild side effects or none at all. What the list does is helping patients and doctors determine when a new symptom is caused by Cipro.

There are rare and common side effects, depending on the proportion of patients reporting them.

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What are the possible serious side effects of Cipro?

Serious side effects are not common. If you experience any of these, you should get medical help as soon as possible:

• Severe dizziness and fainting: Feeling severe dizziness and fainting should warn you. Look for medical advice right away. Ciprofloxacin can cause changes in the electrocardiogram in susceptible patients. Some of them are very severe and cause episodes of syncope or fainting. In some cases, patients may even have a cardiac arrest and require defibrillation (1).
• Heartbeat irregularities: Ciprofloxacin and all fluoroquinolones may cause heartbeat problems. Patients may feel very rapid or irregular heartbeats. In patients with arrhythmia, Ciprofloxacin may trigger one or worsen the heart condition. Ciprofloxacin is less likely to produce severe arrhythmia compared to levofloxacin. Still, it is a side effect to look for in cardiac patients (2).

• Symptoms of aortic dissection: Aortic dissection is the rupture or tear of the aorta. Ciprofloxacin can cause this problem in patients with a dilated aorta. Patients with a high risk for aortic dissection or aneurysm may experience this severe side effect. Symptoms include severe and sudden pain in the chest, back or stomach, shortness of breath, and cough (3).
• Severe allergic reactions: As it happens with medicines and foods, some people may develop allergic reactions. They are rare but are still reported by some patients. Symptoms to detect severe allergic reactions include skin rash with severe itching, shortness of breath, swelling of the face, tongue, and throat.
• Kidney and liver problems: Cipro is metabolized by the liver and eliminated through the urine. As such, it may cause kidney or liver problems in susceptible patients. Talk to your doctor if you have changes in the amount of urine, pink, or stained urine. Also, care to report if you get a yellowish tone in the skin and eyes, stomach pain, and persistent vomiting episodes.

When do the side effects of Cipro go away?

The side effects of Ciprofloxacin can last for as long as the treatment is held. In most cases, stopping the medication is the best way to end the severe side effects listed above.

However, some of them may be long-lasting, and others may not go away. It depends on the side effect and the reason it was triggered in the first place.

Ciprofloxacin is never prescribed for over 3 months to prevent long-lasting side effects. However, the majority of them are transient. After stopping the medication, it may take around one day or two, and they go away.

What are the common side effects of Ciprofloxacin?

The most common side effects of Ciprofloxacin are not severe. Some of them are very mild, and some patients don’t care to report them. If you experience these symptoms after using Ciprofloxacin, it may be a side effect of the medication:

• Nausea: Gastrointestinal symptoms are common when using antibiotics, especially nausea. Drug-induced nausea can be very mild, but may sometimes cause vomiting episodes. In some cases, it leads to treatment failure. Patients may also report loss of appetite and other gastrointestinal symptoms.
• Diarrhea: As it happens with many antibiotics, Cipro can cause alterations to the gut microbiota. After destroying the healthy bacteria in the gut, it can be colonized by pathogens. Thus, talk to your doctor if you develop persistent diarrhea after using Cipro. He might recommend using probiotics to re-establish the gut microbiota. This usually happens when we use a combination of antimicrobial agents or use them for extended periods of time (4).
• Dizziness and lightheadedness: It is another common side effect. More specifically, dizziness as a side effect is clinically named vertigo. It is caused by an alteration of the inner ear, which regulates the balance of the body. As such, dizziness/vertigo is common as a temporary side effect in many drugs (5).
• Yeast infections: In patients who use Ciprofloxacin repeatedly, they can experience an overgrowth of candida. They may appear in the oral mucosa (oral thrush) or the vagina. In some cases, the overgrowth may also appear in the gastrointestinal tract (6).
• Neurologic symptoms: In most cases, patients may only experience headaches. In other cases, their neurologic symptoms may also include insomnia and depression. Very rare cases of hallucinations, psychotic reactions, or myasthenia gravis have been described, too (7, 8).

Other symptoms worth noting include:

• Tendon problems
• Muscle weakness
• Bruising or bleeding symptoms
• Skin rash

Foods to avoid when taking Cipro

What foods are better to be avoided when taking Ciprofloxacin? You do need a slight change in your diet, but it won’t affect you much.

Why should you avoid certain foods when taking Cipro?

The liver metabolizes antibiotic medicines through a series of enzymes. Absorption in the gastrointestinal tract may also require specific conditions.

That’s why we should be careful about what to eat and drink when we’re taking regular meds. Otherwise, their action can be either prolonged or weakened by our dietary habits.

What are the best foods to take Cipro with?

It is recommended to take Cipro with food. And you can make a smart move and take foods that help you control your infection.

For example, if you have a urinary tract infection, you may benefit from vitamin C-rich meals. Taking your daily dose of Cipro and vitamin C helps your body combat infections.

Another recommendation is probiotic foods and supplements. Non-dairy fermented foods may contribute to your gut microbiota and prevent diarrhea. Some ideas are sauerkraut, kimchi, tempeh, miso soup, and pickled vegetables.

What foods should you avoid when you are taking Cipro?

If you’re trying to combat infections with Cipro, you should stay away from milk and dairy products.

They bind to the molecule of Ciprofloxacin and block its absorption. This is common with the majority of quinolones. Therefore, you should avoid the following foods (9):

• Milk
• Cream
• Yogurt
• Ice cream
• Cheese

Another recommendation is to stay away from alcoholic beverages. In some patients, drinking alcohol can trigger additional adverse reactions in the skin.

You won’t develop myasthenia gravis, tendon rupture, and other tendon problems after drinking a margarita.

But regardless of this, keep in mind that alcohol will be cleared very slowly from your system if you’re taking Cipro (10).

If you still have doubts about the adverse effects of Ciprofloxacin, you can also talk to your doctor or pharmacist.

Drugs that are known to interact with Cipro. Not many foods interact with Cipro, but there’s a long list of drug interactions.

What drug interactions with Ciprofloxacin should you be aware of?

Certain drug interactions may trigger adverse reactions or increase your risks. In other cases, Ciprofloxacin prolongs the half-life of other medications, which can be dangerous sometimes (11).
Be especially careful with the following medications:

• Sotalol
• Quinidine
• Procainamide
• Dofetilide
• Amiodarone
• Some diuretic medications

These medications affect the heart rhythm, and using them with Cipro increases the risk of arrhythmia.

Be careful with these medications, too:

• Warfarin and any other blood-thinning drugs
• Theophylline
• Xanthines, caffeine
• Tizanidine
• Duloxetine

• Flibanserin
• Tasimelteon

In their case, Ciprofloxacin slows down their clearance from the blood. This may be dangerous in some cases, especially if you’re taking warfarin.

What drugs will impact the effectiveness of Ciprofloxacin?

There’s another list of drugs that impact the effectiveness of Ciprofloxacin. What they do is reducing the bioavailability of quinolones.

In other words, they don’t allow quinolones to be absorbed or circulate freely in the blood. As such, taking these drugs along with Cipro, can cause a therapeutic failure.

They are as follows:

• Sucralfate
• Aluminum and aluminum-containing drugs
• Magnesium zinc
• Iron and calcium supplements
• Antacids

What are the warnings and precautions for those taking Ciprofloxacin?

Consider the following precautions if you’re using Ciprofloxacin to control a urinary tract infection or any other:

• Inform your doctor or pharmacist if you’re allergic or had an adverse effect after taking Cipro.
• Inform your doctor about irregular heartbeat problems or any other relevant medical history.
• Talk to your doctor if you experience a rapid heartbeat. Ciprofloxacin may trigger QT prolongation in the electrocardiogram.
• Talk to your doctor if you experience muscle weakness. In some cases, Cipro can cause tendon rupture or myasthenia gravis.
• Inform your doctor if you have episodes of diarrhea or vomiting. They may reduce your levels of magnesium and potassium in the blood and trigger heartbeat problems.
• If you have diabetes, check your blood sugar regularly.
• Limit your sun exposure and use sunscreen and protective clothing.

Alternative antibiotics to Cipro

In patients with an allergic reaction to Ciprofloxacin, using an alternative antibiotic is a must-do. It is also useful to know alternatives to Cipro if you don’t find the medication you’re looking for.

Cipro is a common antibiotic, and all pharmacies should have it. But maybe the bacteria you’re trying to fight is resistant, and you need another. Cipro is a potent antibiotic, as we will see in this section. But it has many alternatives, which can be prescribed for different reasons.

Why would Cipro be prescribed instead of other antibiotics?

Ciprofloxacin is one of the most popular antimicrobial agents for urinary tract infections. It is also prescribed for patients with symptoms of respiratory infection.

As it happens with other quinolone antibiotics, Cipro has a very wide spectrum of treatment. It fights members of the gram-positive and gram-negative group of bacteria. Thus, it can be useful for urinary tract, gastrointestinal tract, and respiratory infections.

But, why is it prescribed instead of other antibiotics?

• Cipro vs. Metronidazole: It can be used to treat gastrointestinal infections. Sometimes it is used in combination with Cipro. However, Ciprofloxacin is better because it is tolerated with fewer side effects. And some studies show that it is more effective (12).
• Cipro vs. Cefpodoxime: This one is a third-generation cephalosporin. But it has been used too much, and some bacteria have developed resistance. According to a study, Cipro has 4% resistance to urinary tract bacteria, and Cefpodoxime has 8% (13).
• Cipro vs. erythromycin: They are both used to treat patients with chancroid, a sexually-transmitted disease. But studies show Cipro is equally effective with less adverse effects (14). In a nutshell, Cipro is prescribed instead of other antibiotics because it is better tolerated. Side effects are less common in Cipro, compared to others. Additionally, more bacteria are still sensitive to Ciprofloxacin.

Why is Cipro considered a strong antibiotic?

Ciprofloxacin is considered a strong antibiotic because it has a low level of resistance. As mentioned above, bacteria are still sensitive to Cipro. In other words, Cipro is still able to clear the infection.

However, this is an ever-changing situation because a potent antibiotic may become weak in the future. That’s because bacteria create resistance when we use an antibiotic too much.

Thus, patients are encouraged not to take Ciprofloxacin without a prescription. If they have a prescription, it should be followed strictly. Otherwise, the bacteria may create resistance against the antibiotic.

What antibiotics could be used instead of Cipro?

Your doctor may consider an alternative if the bacteria are resistant to Cipro or you have nerve damage, myasthenia gravis, cardiac problems, and other adverse reactions.

One of the best alternatives in the case of bacteria resistance is levofloxacin (Levaquin). It is another quinolone, very similar to Cipro. However, keep in mind that levofloxacin is a potent antibiotic. That’s why it is administered in fewer doses than Cipro.

According to studies, levofloxacin can be as effective as Ciprofloxacin for bacterial prostatitis treatment (15). The same holds true with respiratory infections and urinary tract infections. And the adverse events are almost the same as Cipro.

Other antimicrobial agents for patients allergic to quinolones are as follows (16):

• Trimethoprim/Sulfamethoxazole: It is a useful alternative to Cipro in patients with urinary infections. When the urinary tract infection has complicated to pyelonephritis. In these cases, we can use gentamicin or trimethoprim/sulfamethoxazole.
• Fosfomycin: In cases of uncomplicated urinary tract infection, fosfomycin can be useful. Especially if there are culture results to make sure the bacteria is sensitive.

• Ceftriaxone: When a urinary infection becomes a major problem, we can use ceftriaxone. It is recommended as an option in patients with sepsis of urinary origin. In uncomplicated urinary tract infections, Cefpodoxime is the second choice after Cipro.

Conclusion

Ciprofloxacin, also known as Cipro, is a very useful antimicrobial agent. It is a quinolone, similar to levofloxacin. It works by slowing down the replication of the bacteria and inducing DNA breaks. It is a strong antibiotic with a very wide spectrum and works for different types of infections.

However, Cipro has various side effects that include rare and severe adverse events and more common and mild problems. Common Cipro side effects include nausea, headaches, diarrhea, and other gastrointestinal complaints.

Rare and severe side effects of Cipro include myasthenia gravis and other neuronal problems, arrhythmia, and prolongation of the QT interval in electrocardiograms and others. Some patients may also develop allergies to fluoroquinolones, but it is not very common.

When taking Ciprofloxacin, we should also consider not drinking alcohol, milk, or dairy products. Ciprofloxacin will also interact with drugs that prolong to QT interval or make it less effective. Thus, inform your doctor if you’re taking medications or have any chronic diseases.

Sources

1. Prabhakar, M., & Krahn, A. D. (2004). Ciprofloxacin-induced acquired long QT syndrome. Heart Rhythm, 1(5), 624-626.
2. Liu, X., Ma, J., Huang, L., Zhu, W., Yuan, P., Wan, R., & Hong, K. (2017). Fluoroquinolones increase the risk of serious arrhythmias: A systematic review and meta-analysis. Medicine, 96(44).
3. LeMaire, S. A., Zhang, L., Luo, W., Ren, P., Azares, A. R., Wang, Y., … & Shen, Y. H. (2018). Effect of ciprofloxacin on susceptibility to aortic dissection and rupture in mice. JAMA surgery, 153(9), e181804-e181804.
4. McCusker, M. E., Harris, A. D., Perencevich, E., & Roghmann, M. C. (2003). Fluoroquinolone use and Clostridium difficile–associated diarrhea. Emerging infectious diseases, 9(6), 730.
5. Chimirri, S., Aiello, R., Mazzitello, C., Mumoli, L., Palleria, C., Altomonte, M., … & De Sarro, G. (2013). Vertigo/dizziness as a Drugs’ adverse reaction. Journal of pharmacology & pharmacotherapeutics, 4(Suppl1), S104.
6. Mavromanolakis, E., Maraki, S., Cranidis, A., Tselentis, Y., Kontoyiannis, D. P., & Samonis, G. (2001). The impact of norfloxacin, ciprofloxacin and ofloxacin on human gut colonization by Candida albicans. Scandinavian journal of infectious diseases, 33(6), 477-478.
7. Mulhall, J. P., & Bergmann, L. S. (1995). Ciprofloxacin-induced acute psychosis. Urology, 46(1), 102-103.
8. Mumford, C. J., & Ginsberg, L. (1990). Ciprofloxacin and myasthenia gravis. BMJ: British Medical Journal, 301(6755), 818.
9. Neuvonen, P. J., Kivistö, K. T., & Lehto, P. (1991). Interference of dairy products with the absorption of ciprofloxacin. Clinical Pharmacology & Therapeutics, 50(5-1), 498-502.
10. Tillonen, J., Homann, N., Rautio, M., Jousimies-Somer, H., & Salaspuro, M. (1999). Ciprofloxacin decreases the rate of ethanol elimination in humans. Gut, 44(3), 347-352.
11. Polk, R. E. (1989). Drug-drug interactions with ciprofloxacin and other fluoroquinolones. The American journal of medicine, 87(5), S76-S81.
12. Shen, B., Achkar, J. P., Lashner, B. A., Ormsby, A. H., Remzi, F. H., Brzezinski, A., … & Fazio, V. W. (2001). A randomized clinical trial of ciprofloxacin and metronidazole to treat acute pouchitis. Inflammatory bowel diseases, 7(4), 301-305.
13. Hooton, T. M., Roberts, P. L., & Stapleton, A. E. (2012). Cefpodoxime vs ciprofloxacin for short-course treatment of acute uncomplicated cystitis: a randomized trial. Jama, 307(6), 583-589.
14. D’SOUZA, P. A. S. C. H. A. L., Pandhi, R. K., Khanna, N., Rattan, A., & Misra, R. S. (1998). A comparative study of therapeutic response of patients with clinical chancroid to ciprofloxacin, erythromycin, and cotrimoxazole. Sexually transmitted diseases, 25(6), 293-295.
15. Bundrick, W., Heron, S. P., Ray, P., Schiff, W. M., Tennenberg, A. M., Wiesinger, B. A., … & Kahn, J. B. (2003). Levofloxacin versus ciprofloxacin in the treatment of chronic bacterial prostatitis: a randomized double-blind multicenter study. Urology, 62(3), 537-541.
16. https://www.uwhealth.org/cckm/cpg/infection-and-isolation/related/Antibiotic-Alternatives-to-FQs—General-Care.pdf