When is nasal congestion more than just a stuffy nose? A sinus infection, also referred to as sinusitis, is more than just having trouble breathing through your nose. It’s infection and inflammation of your sinus cavities. You have several sinus cavities located on either side of your nose and above and below your eyes, so there may be pain in various places throughout your face or an overall sinus headache. What do you need to know about this miserable malady? Sinus infections are typically a side effect of allergies or a viral infection like a cold or the flu. They may also be caused by irritants like nasal sprays, cigarette smoke, or cocaine. Sinus infections share some symptoms with the problems that trigger them, but they also have some unique symptoms. Sinus infection symptoms include: If a sinus infection is caused by a virus like the flu or a cold, then that illness may be contagious. Fluoroquinolones are a class of antibiotics approved to treat or prevent certain bacterial infections. Food and Drug Administration (FDA) advises against using fluoroquinolone antibiotics for the treatment of three common infections: acute sinusitis, acute bronchitis, and urinary tract infections (UTI) without complications. The fluoroquinolone antibiotics include ciprofloxacin (Cipro), gemifloxacin (Factive), levofloxacin (Levaquin), moxifloxacin (Avelox), and ofloxacin (Floxin). The agency made this decision because the chances of serious side effects outweigh the benefits for most people. However, some people who take these medicines may develop disabling and potentially permanent side effects of the tendons, muscles, joints, nerves, and central nervous system. The FDA says it’s OK use fluoroquinolones for other serious infections or for patients who have no other choice of treatment. This might include patients with allergies to other antibiotics or infections caused by hard-to treat, resistant bacteria. The FDA approved changes to the labels and medication guides of fluoroquinolones taken by mouth or by injection based on patient reports of side effects. The FDA revised the boxed warning, the agency’s strongest, to address these serious safety issues, and updated the patient medication guide. The medication guide is a paper handout that comes with many prescription medicines.
Antibiotics are medications derived from naturally occurring chemicals produced by bacteria and molds to inhibit the growth of competing microorganisms. Penicillin was discovered in 1929 by Alexander Fleming and its popular derivative amoxicillin remains effective for 80% of acute bacterial sinus infections and 99% of strep throat infections. Although 60% of episodes of acute bacterial sinusitis will resolve without treatment, antibiotics have been consistently demonstrated to shorten the course of illness and reduce the frequency of complications from sinusitis. Antibiotics are recommended for acute bacterial sinusitis lasting longer than 10 days, or getting worse after the first week. The most common symptoms include facial pain or pressure, nasal stuffiness or congestion, and thick, discolored nasal drainage. Antibiotics are also commonly prescribed for chronic sinusitis, although many cases of chronic sinusitis are not caused by bacteria. Studies have shown that 80% of patients with acute sinusitis will improve in a week on antibiotics, while 73% of patients treated with placebo will improve. Mild/moderate: 500 mg PO q12hr or 400 mg IV q12hr for 7-14 days Severe/complicated: 750 mg PO q12hr or 400 mg IV q8hr for 7-14 days Limitations-of-use: Reserve fluoroquinolones for patients who do not have other available treatment options for acute bacterial exacerbation of chronic bronchitis Acute uncomplicated: Immediate-release, 250 mg PO q12hr for 3 days; extended-release, 500 mg PO q24hr for 3 days Mild/moderate: 250 mg PO q12hr or 200 mg IV q12hr for 7-14 days Severe/complicated: 500 mg PO q12hr or 400 mg IV q12hr for 7-14 days Limitations-of-use: Reserve fluoroquinolones for patients who do not have other available treatment options for uncomplicated urinary tract infections Dry powder for inhalation: Orphan designation for patients with NCFB who suffer from frequent severe acute pulmonary bacterial exacerbations which lead to further inflammation, airway, and lung parenchyma damage Indication for treatment and prophylaxis of plague due to Yersinia pestis in pediatric patients from birth to 17 years of age 15 mg/kg PO q8-12hr x10-21 days; not to exceed 500 mg/dose, OR 10 mg/kg IV q8-12hr x 10-21 days; not to exceed 400 mg/dose Postexposure therapy IV: 10 mg/kg q12hr for 60 days; individual dose not to exceed 400 mg PO: 15 mg/kg q12hr for 60 days; individual dose not to exceed 500 mg Change antibiotic to amoxicillin as soon as penicillin susceptibility confirmed Nausea (3%) Abdominal pain (2%) Diarrhea (2% adults; 5% children) Increased aminotransferase levels (2%) Vomiting (1% adults; 5% children) Headache (1%) Increased serum creatinine (1%) Rash (2%) Restlessness (1%) Acidosis Allergic reaction Angina pectoris Anorexia Arthralgia Ataxia Back pain Bad taste Blurred vision Breast pain Bronchospasm Diplopia Dizziness Drowsiness Dysphagia Dyspnea Flushing Foot pain Hallucinations Hiccups Hypertension Hypotension Insomnia Irritability Joint stiffness Lethargy Migraine Nephritis Nightmares Oral candidiasis Palpitation Photosensitivity Polyuria Syncope Tachycardia Tinnitus Tremor Urinary retention Vaginitis Acute generalized exanthematous pustulosis (AGEP), erythema multiforme, exfoliative dermatitis, fixed eruption, photosensitivity/phototoxicity reaction Agitation, confusion, delirium Agranulocytosis, albuminuria, serum cholesterol and TG elevations, blood glucose disturbances, hemolytic anemia, marrow depression (life threatening), pancytopenia (life threatening or fatal outcome), potassium elevation (serum) Anaphylactic reactions (including life-threatening anaphylactic shock), serum sickness like reaction, Stevens-Johnson syndrome Anosmia, hypesthesia Constipation, dyspepsia, dysphagia, flatulence, hepatic failure (including fatal cases), hepatic necrosis, jaundice, pancreatitis Hypertonia, hypotension (postural), increased INR (in patients treated with Vitamin K antagonists), QT prolongation, torsade de pointes, ventricular arrhythmia Methemoglobinemia Myasthenia, exacerbation of myasthenia gravis, myoclonus, nystagmus, peripheral neuropathy that may be irreversible, phenytoin alteration (serum), polyneuropathy, psychosis Myalgia, tendinitis, tendon rupture, toxic epidermal necrolysis (Lyell’s Syndrome), twitching Infections: Candiduria, vaginal candidiasis, moniliasis (oral, gastrointestinal, vaginal), pseudomembranous colitis Renal calculi Vasculitis Because the risk of these serious side effects generally outweighs the benefits for patients with acute bacterial sinusitis, acute exacerbation of chronic bronchitis, and uncomplicated UTIs, that fluoroquinolones should be reserved for use in patients with these conditions who have no alternative treatment options Use in pregnancy, though generally contraindicated for all quinolones, is allowed for life-threatening situations; limited data from use of ciprofloxacin in pregnancy show no higher rate of birth defects than background Do not use oral suspension in nasogastric tube; to prepare, add microcapsules to diluent Commonly seen adverse reactions include tendinitis, tendon rupture, arthralgia, myalgia, peripheral neuropathy, and central nervous system effects (hallucinations, anxiety, depression, insomnia, severe headaches, and confusion); these reactions can occur within hours to weeks after starting therapy, including in patients of any age or without pre-existing risk factors; discontinue therapy immediately at first signs or symptoms of any serious adverse reaction; in addition, avoid use of fluoroquinolones, in patients who have experienced any serious adverse reactions associated with fluoroquinolones (see Black Box Warnings) Peripheral neuropathy: sensory or sensorimotor axonal polyneuropathy affecting small and/or large axons resulting in paresthesias, hypoesthesias, dysesthesias, and weakness reported; peripheral neuropathy may occur rapidly after initiating and may potentially become permanent In prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); adjust dose in renal impairment; superinfections may occur with prolonged or repeated antibiotic therapy; discontinue use immediately if signs and symptoms of hepatitis occur Not first drug of choice in pediatrics (except in anthrax), because of increased incidence of adverse events in comparison with control subjects, including arthropathy; no data exist on dosing for pediatric patients with renal impairment (ie, Cr Cl Distributed widely throughout body; tissue concentrations often exceed serum concentrations, especially in kidneys, gallbladder, liver, lungs, gynecologic tissue, and prostatic tissue; cerebrospinal fluid (CSF) concentration is 10% in noninflamed meninges and 14-37% in inflamed meninges; crosses placenta; enters breast milk Protein bound: 20-40% Vd: 2.1-2.7 L/kg Additive: Aminophylline, amoxicillin, amoxicillin-clavulanate, amphotericin, ampicillin-sulbactam, ceftazidime, cefuroxime, clindamycin, floxacillin, heparin, piperacillin, sodium bicarbonate, ticarcillin Y-site: Aminophylline, ampicillin-sulbactam, azithromycin, cefepime, dexamethasone sodium phosphate, furosemide, heparin, hydrocortisone sodium succinate, magnesium sulfate(? ), methylprednisolone sodium succinate, phenytoin, potassium phosphates, propofol, sodium bicarbonate(? ), sodium phosphates, total parenteral nutrition formulations, warfarin Solution: Compatible with most IV fluids Additive: Amikacin, aztreonam, dobutamine, dopamine, fluconazole, gentamicin, lidocaine, linezolid, metronidazole (ready-to-use form is compatible; hydrochloride form in vial is incompatible), midazolam, potassium chloride, tobramycin Y-site: Amiodarone, calcium gluconate, clarithromycin, digoxin, diphenhydramine, dobutamine, dopamine, linezolid, lorazepam, midazolam, promethazine, quinupristin/dalfopristin, tacrolimus The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.
[Posted 12/20/2018]AUDIENCE: Health Professional, Infectious Disease, Cardiology, Patient ISSUE: FDA review found that fluoroquinolone antibiotics can increase the occurrence of rare but serious events of ruptures or tears in the main artery of the body, called the aorta. These tears, called aortic dissections, or ruptures of an aortic aneurysm can lead to dangerous bleeding or even death. They can occur with fluoroquinolones for systemic use given by mouth or through an injection. BACKGROUND: Fluoroquinolone antibiotics are approved to treat certain bacterial infections and have been used for more than 30 years. They work by killing or stopping the growth of bacteria that can cause illness. Without treatment, some infections can spread and lead to serious health problems (see List of Currently Available FDA-Approved Systemic Fluoroquinolones, available at RECOMMENDATION: Healthcare professionals should: Taking ciprofloxacin increases the risk that you will develop tendinitis (swelling of a fibrous tissue that connects a bone to a muscle) or have a tendon rupture (tearing of a fibrous tissue that connects a bone to a muscle) during your treatment or for up to several months afterward. Cipro (ciprofloxacin) is a brand-name prescription antibiotic medication. Cipro belongs to a class of antibiotics called fluoroquinolones. Cipro is effective for treating infections caused by many different types of bacteria. These include bacteria that cause infections in the urinary tract, abdomen, skin, prostate, and bone, as well as other types of infections. Cipro comes in several forms: Cipro can cause mild or serious side effects. The following list contains some of the key side effects that may occur while taking Cipro. This list does not include all possible side effects. For more information on the possible side effects of Cipro, or tips on how to deal with a troubling side effect, talk with your doctor or pharmacist.
However, I must state that I do know of ENT specialists who prescribe ciprofloxacin for bacterial sinusitis. I expect it works in many cases as well. This is because bacterial sinusitis is usually. Learn about Cipro I. V. Ciprofloxacin IV may treat, uses, dosage, side effects, drug interactions, warnings, patient labeling, reviews, and relatedCIPRO IV ciprofloxacin for Intravenous Infusion.