ciprofloxacin (Ciloxan, Cipro)

Drug description
Ciprofloxacin is one of the drugs used in combination to treat MAC. If you are HIV+ and travelling to a country where intestinal infection is common, discuss what drug you should take with your doctor. The risk of intestinal infections may be reduced by taking preventive drugs such as norfloxacin, ciprofloxacin, and Bactrim, though in some instances these drugs might actually worsen infection by disrupting normal intestinal bacteria. Recent Public Health Service recommendations suggest either clarithromycin or azithromycin as the first line treatment for MAC, along with at least one other drug, usually ethambutol and one of the following: ciprofloxacin or rifabutin.

Side effects
Nausea, diarrhea, vomiting, and abdominal pain are the most frequent side effects of ciprofloxacin. Bad taste in the mouth, restlessness, rash, sensitivity to sunlight and seizures are other possible side effects.

Dosage
Cipro comes in intravenous and pill form. Pills are taken on an empty stomach 2 hours after meals, 250-750 mg every 12 hours. If there is stomach irritation, the pill can be taken with meals. Food slows and may slightly decrease absorption. If you are taking antacids, you should take them at least 2 hours before or after the cipro. Intravenous infusion is 200-400 mg every 12 hours. Infusion takes one hour. Cipro is also given in drops into the eye to treat some eye infections. You will be given 1-2 drops 4-6 times daily until the infection is controlled. Children under 18 should not take ciprofloxacin. Safety is not established if you are breast feeding. Dosage reduction is required if your kidneys are damaged. If you have any CNS infections, cipro must be used with caution.

How long it may take to work
Variations in response depend on the state of your general health and immune system, the strain of MAC you are infected with, and the ability to tolerate a combination of drugs. The decision about what drug to take must partly be based on how sick you are and whether treatment has a chance of improving your quality of life. If you have clinical symptoms but a relatively well-functioning liver and kidneys, you will respond best to treatment. Treatment usually helps within 2 to 4 weeks. If it does work, ongoing maintenance therapy to suppress the infection is necessary. Maintenance treatment means you keep taking the drug to control an infection so that you don't become ill.

Managing side effects
Cipro may cause dizziness or lightheadedness. If you have loose or foul-smelling stools, tell your doctor as that could be a sign of another strain of MAC or a different infection. Drink a lot of high calorie fluids such as juices and nectars to prevent dehydration.

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