시프로플록사신

플루오로퀴놀론계 항생제Critically Important

**시프로플록사신(Ciprofloxacin)**은 2세대 **플루오로퀴놀론계 항생제**로 인의에서 널리 사용되며 수의학에서도 허가 외(off-label)로 자주 사용됩니다. * **항균 스펙트럼**: 광범위 항생제로 많은 그람 음성 간균 및 구균(녹농균, 대장균, 클레브시엘라 종 포함)과 일부 그람 양성균(메티실린 내성균을 포함한 포도상구균 종 등)에 매우 효과적입니다. 혐기성 세균과 대부분의 연쇄상구균에 대한 활성은 약합니다. * **약동학적 특징**: 개에서 경구 생체이용률은 엔로플록사신보다 현저히 낮고 불규칙합니다(엔로플록사신이 >80%인 반면 약 40-50%에 불과). 따라서 개에서 엔로플록사신을 1:1로 대체하는 경구약으로는 일반적으로 간주되지 않습니다. * **임상적 유용성**: 진정한 정맥주사(IV) 플루오로퀴놀론 제제가 필요하거나, 특정 배양 검사 결과에 따른 치료, 또는 더 큰 경구 투여 용량이 필요할 때 주로 선택됩니다.

작용 기전: Ciprofloxacin is a **bactericidal**, **concentration-dependent** antibiotic. * It enters the bacterial cell and inhibits two key type-II topoisomerase enzymes: **DNA gyrase** (primary target in gram-negative bacteria) and **Topoisomerase IV** (primary target in gram-positive bacteria). * Inhibition of these enzymes → prevents DNA supercoiling and relaxation → halts DNA replication and transcription → rapid bacterial cell death (within 20-30 minutes of exposure). * Exhibits a significant **post-antibiotic effect (PAE)**, meaning bacterial growth continues to be suppressed even after drug concentrations fall below the minimum inhibitory concentration (MIC).

동물 종별 용량

Cats

Susceptible infections · 5-15 mg/kg PO q12h · PO · q12h · Avoid or reduce dosage in severe renal failure; avoid in young animals or pregnant/breeding animals.
Ocular infections · 1 drop to affected eye · topical · q6h · Not specified · Standard therapy
Severe ocular infections (intensive therapy) · 1 drop to affected eye · topical · q30-120mins · 1-2 days · For short-term intensive use

Ferrets

Susceptible infections · 5-15 mg/kg PO twice daily · PO · twice daily

Birds

Susceptible gram-negative infections · 20-40 mg/kg PO twice daily · PO · twice daily · Using ciprofloxacin 500 mg tablets. Crushed tablet goes into suspension well, but must be shaken well before administering.
Susceptible gram-negative infections · 20 mg/kg PO q12h · PO · q12h · Using crushed tablets
Susceptible gram-negative infections · 10-15 mg/kg PO q12h · PO · q12h · Using crushed tablets or suspend
Susceptible infections (Ratites) · 3-6 mg/kg PO twice daily · PO · twice daily

SmallMammals

Susceptible infections (Rabbits) · 5-20 mg/kg PO q12h · PO · q12h

투여 경로

POIVTopical (Ophthalmic)

금기

Hypersensitivity to fluoroquinolones
Small and medium breed dogs 2-8 months of age (due to cartilage damage)
Large and giant breed dogs during their rapid growth phase (past 8 months of age)
Known hypersensitivity to ciprofloxacin or other fluoroquinolones

이상반응

GI distress (vomiting, anorexia)
Cartilage abnormalities in young, growing animals
CNS stimulation (dizziness, seizures)
Crystalluria
Hypersensitivity reactions
Local irritation after application
Local burning and itching (reported in humans)
Lid margin crusting (reported in humans)
Hyperaemia (reported in humans)
Taste disturbances (reported in humans)
Corneal staining (reported in humans)
Keratitis (reported in humans)
Lid oedema (reported in humans)
Lacrimation (reported in humans)
Photophobia (reported in humans)
Corneal infiltrates (reported in humans)

약물 상호작용

Antacids/Dairy Products (Mg++, Al+++, Ca++) · May bind to ciprofloxacin and prevent its absorption; separate doses by at least 2 hours
Antibiotics (aminoglycosides, 3rd-generation cephalosporins, extended-spectrum penicillins) · Synergism may occur against some bacteria (particularly Pseudomonas aeruginosa)
Cyclosporine · May exacerbate nephrotoxicity and reduce the metabolism of cyclosporine
Glyburide · Severe hypoglycemia possible
Iron, Zinc (oral) · Decreased ciprofloxacin absorption; separate doses by at least two hours
Methotrexate · Increased MTX levels possible with resultant toxicity
Nitrofurantoin · May antagonize the antimicrobial activity of fluoroquinolones; concomitant use not recommended
Phenytoin · May alter phenytoin levels
Probenecid · Blocks tubular secretion of ciprofloxacin and may increase its blood level and half-life
Quinidine · Increased risk for cardiotoxicity
Sucralfate · May inhibit absorption of ciprofloxacin; separate doses by at least 2 hours
Theophylline · May increase theophylline blood levels

모니터링

Clinical efficacy
Adverse effects (GI signs, CNS stimulation)
Hydration status
Clinical resolution of ocular infection
Corneal healing (via fluorescein staining)
Signs of local irritation or hypersensitivity

과용량

Little specific information is available for ciprofloxacin overdosage in veterinary species. Overdoses may result in GI distress, CNS signs (tremors, seizures), or renal toxicity (crystalluria). Treatment should consist of supportive care, maintaining adequate hydration to prevent crystalluria, and gastric decontamination if ingestion was recent. See the enrofloxacin monograph for more extrapolated information.

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