With everyone from our Congress to Gov. of NY takin this drug, I thought it would behoove us to know the "possible" side effects.

CIPRO - Most common side effect :

Nausea

Less common side effects may include:

Abdominal pain/discomfort, diarrhea, headache, rash, restlessness, vomiting

Rare side effects may include:

Abnormal dread or fear, achiness, bleeding in the stomach and/or intestines, blood clots in the lungs, blurred vision, change in color perception, chills, confusion, constipation, convulsions, coughing up blood, decreased vision, depression, difficulty in swallowing, dizziness, double vision, drowsiness, eye pain, fainting, fever, flushing, gas, gout flare up, hallucinations, hearing loss, heart attack, hic­cups, high blood pressure, hives, inability to fall or stay asleep, inability to urinate, indigestion, intestinal inflammation, involuntary eye movement, irregular heartbeat, irritability, itching, joint or back pain, joint stiffness, kidney failure, labored breathing, lack of muscle coordination, lack or loss of appetite, large volumes of urine, light-headedness, loss of sense of identity, loss of sense of smell, mouth sores, neck pain, nightmares, nosebleed, pounding heartbeat, ringing in the ears, seizures, sensitivity to light, severe allergic reaction, skin peeling, redness, sluggishness, speech difficulties, swelling of the face, neck, lips, eyes, or hands, swelling of the throat, tender, red bumps on skin, tingling sensation, tremors, unpleasant taste, unusual darkening of the skin, vaginal inflammation, vague feeling of illness, weakness, yellowed eyes and skin

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Cipro may cause you to become dizzy or light-headed; therefore, you should not drive a car, operate dangerous machinery, or participate in any hazardous activity that requires full mental alertness until you know how the drug affects you.

Continued or prolonged use of this drug may result in a growth of bacteria that do not respond to this medication and can cause a secondary infection. Therefore, it is important that your doctor monitor your condition on a regular basis.

Convulsions have been reported in people receiving Cipro. If you experience a seizure or convulsion, notify your doctor immediately.

This medication may stimulate the central nervous system, which may lead to tremors, restlessness, light-headedness, confusion, and hallucinations. If these reactions occur, consult your doctor at once.

If you have a known or suspected central nervous system disorder such as epilepsy or hardening of the arteries in the brain, make sure your doctor knows about it when prescribing Cipro.

You may become more sensitive to light while taking this drug. Try to stay out of the sun as much as possible.

If you must take Cipro for an extended period of time, your doctor will probably order blood tests and tests for urine, kidney, and liver function.

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Serious and fatal reactions have occurred when Cipro was taken in combination with theophylline (Theo-Dur). These reactions have included cardiac arrest, seizures, status epilepticus (continuous attacks of epilepsy with no periods of consciousness), and respiratory failure.

Products containing iron, multi-vitamins containing zinc, or antacids containing magnesium, aluminum, or calcium, when taken in combination with Cipro, may interfere with absorption of this medication.

Cipro may increase the effects of caffeine.

If Cipro is taken with certain other drugs, the effects of either could be increased, decreased, or altered. These drugs include:

Cyclophosphamide (Cytoxan) Cyclosporine (Sandimmune, Neoral) Glyburide (DiaBeta, Glynase, Micronase) Metoprolol (Lopressor) Phenytoin (Dilantin) Probenecid (Benemid) Sucralfate (Carafate) Theophylline (Theo-Dur) Warfarin (Coumadin)"

-- meg davis (meg9999@aol.com), October 17, 2001

Answers

ANTIBIOTIC: Overuse of Cipro can breed lethal bacteria

Sabin Russell, Chronicle Medical Writer Wednesday, October 17, 2001

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Doctors are warning that inappropriate use of a potent antibiotic to guard against anthrax could wind up exposing Americans to dangerous infections of drug-resistant bacteria.

Faced with growing concern of terrorist attacks, health experts began issuing new alarms yesterday about the dangers of overprescribing the drug Cipro, one of the last and best weapons in the arsenal against routine bacterial infections.

Hundreds of employees of NBC News in New York and American Media Inc. in Florida -- where anthrax has been found -- have been placed on a 60-day course of the antibiotic because it can prevent the spores from blossoming into a deadly blood infection.

But thousands more Americans are seeking supplies of the drug in the wake of terrifying stories of anthrax popping out of envelopes mailed to news organizations and

-- most recently -- the offices of Senate Majority Leader Tom Daschle.

The danger is that people taking Cipro, the trade name for ciprofloxacin, can breed microbes in their bodies resistant to the antibiotic -- placing themselves and those around them in jeopardy.

"If we lose Cipro, we lose a very important antibiotic," said Dr. Carol Baker, president of the Infectious Diseases Society of America, an Alexandria, Va., organization of 6,000 specialists in viral and bacterial infections.

Some doctors are also questioning the use of ciprofloxacin in the Florida anthrax incident, because disease investigators learned early on that the strain there was treatable with other antibiotics, such as penicillin and doxycycline.

Because anthrax spores in the body can bloom as long as 60 days after exposure, patients taking antibiotics to prevent the disease must keep doing so for the same two-month period. That's much longer than common usages of ciprofloxacin, where the course of treatment is five days to two weeks.

"The chances that somebody will get into serious trouble because of antibiotic resistance are much higher than the risk they would get anthrax," Baker said.

Ciprofloxacin also carries with it a range of unpleasant and occasionally dangerous side effects. It is not recommended for pregnant women or nursing mothers. It is not recommended for children because it can cause abnormal bone growth and joint disorders.

The biggest danger of antibiotic resistance occurs when a patient's own supply of harmless bacteria in the digestive tract are killed by the drug. There will likely be a small number of bacteria that survive the antibiotic because they have a natural resistance to it. And if these bacteria later cause a bladder infection -- a common condition treated with Cipro -- the drug won't cure it.

"Instead of simple bladder infection, it may be a resistant kidney infection, with fever," Baker explained.

Dr. Rachel Chin, an emergency room physician at San Francisco General Hospital, notes that antibiotic resistance is much more of a problem for the community at large than a given individual.

Resistance develops in bacteria populations over time -- often a period of years -- but can create serious public health problems. Increasing microbial resistance to a variety of antibiotics is one of the most serious issues in modern medicine -- not just a post-Sept. 11 concern.

TREATMENTS FOR FLORIDA STRAIN The anthrax that struck down Florida tabloid editor Robert Stevens is treatable with "a wide range of antibiotics, including penicillin," according to the Centers for Disease Control and Prevention.

Dr. Michael Ascher, director of California's infectious disease lab in Richmond, said doctors in Florida knew that the strain is sensitive to penicillin long before they began treating other employees with ciprofloxacin as a precaution.

"Cipro is a very valuable antibiotic that should be reserved for situations where it is truly necessary," said Ascher, who co-wrote public health guidelines for handling an anthrax attack.

Ciprofloxacin is still the drug of choice during the onset of an suspected anthrax attack because there are a few lethal strains of anthrax known to be resistant to penicillin. They were developed by Russian biowarfare scientists in the 1970s.

Those guidelines, published in the Journal of the American Medical Association in May 1999, also make clear that, once it is determined that the infectious strain of anthrax can be treated with something other than ciprofloxacin, it should be.

"The most widely available, efficacious, and least toxic antibiotic should be administered to patients and persons seeking post-exposure prophylaxis," the guidelines state.

Those guidelines also recommend that those exposed to anthrax take at least three shots of the anthrax vaccine, which is currently available only to the military and is in short supply.

E-mail Sabin Russell at srussell@sfchronicle.com.

http://www.sfgate.com/cgi-bin/article.cgi? file=/c/a/2001/10/17/MN159235.DTL

-- Martin Thompson (mthom1927@aol.com), October 17, 2001.

meg and martin, I will not be taking cipro. I am not one of the ones calling my doctor up and hassleing him about it. That long list of adverse or possible adverse effects is just awful! Gosh, I'd rather take my chances.!

-- Tess (no@ciproforme.com), October 17, 2001.

To date, the anthrax attacks have been localized and small, so the infrastructure surrounding those potentially infected is still intact. As long as this is true, no one should take any antibiotic without a specific doctor's prescription. "Anti" = against, "Bio" = Life. Thus, "antibiotic" means "against life". The word itself should command respect, to alert all to use only when absolutely necessary.

However, the time might come when a bio-terror attack is large scale enough that the medical system is overloaded. Worse is the situation where the entire infrastructure, except Emergency Broadcast Radio and battery-operated radios, collapses. The Emergency Broadcast Radio could still inform those prepared what the bioterror agent used is, and THIS scenario is the ONLY time a person should take "prophylactic" antibiotics, without a specific physician consultation prior to usage.

This is also the scenario where prophylactic antibiotics will not be available, unless stockpiled in advance. Anyone seeking such an "ahead of need" prescription from their doctor should clearly communicate the above attitude and usage guidelines to the doctor. This will increase the chance of getting the prescription desired for preparatory stockpiling.

There is nothing wrong with this, as with any preparation for emergencies: The ability of the Nation to withstand and recover from major terrorism increases with the emergency preparedness level of the general public. Thus, such emergency preparedness is an individual responsibility and is a very patriotic action. However, in the case of prescription drugs, especially antibiotics, the "Emergency Use Only" restrictions should be adhered to strictly.

-- Robert Riggs (rxr.999@worldnet.att.net), October 19, 2001.