October 21, 2022

Dear Colleagues,

Welcome back to Pharmacy Phriday.  This week’s topic will focus on a medication that the prehospital provider will more likely encounter on a patient’s list of prescribed medications than as a routine treatment in prehospital emergency care.  This week we focus on a strong antibiotic, Ciprofloxacin, more commonly referred to as Cipro. 

Antibiotics are not a common medication being administered by paramedics in the field.  However, some recent studies have investigated the field use of this class of medications in sepsis (see UH’s monthly CE training in July 2022, “Sepsis Review” by Dr. Garlisi). But currently, Cipro is only listed in the UH protocols under “special medications” for cases of anthrax exposure or for other exposures to a microorganism exposure deemed a public health threat. 

Ciprofloxacin is more typically an antibiotic agent prescribed for the treatment of various bacterial infections such as urinary tract infections, pneumonia, and others.  It is also used in the treatment of anthrax, plague, and salmonella. The paramedic provider may find themselves administering this medication for post-exposure prophylaxis (PEP) during an emergency, as mentioned above. 

Ciprofloxacin is available orally, intravenously, in topical formulations, and at various doses.  Doses may vary depending on the specific infection, circumstance, or condition.  Doses specified in the UH protocols of 500 mg PO or 400 mg IV are standard initial doses for adults (In the event of an actual emergency, pediatric guidelines would likely be released at that time).  Antibiotic treatments typically will continue for multiple days.  In the case of anthrax exposure, treatments could last up to 60 days. 

Cipro is effective as it inhibits the DNA replication of Anthrax spores, but some spores can remain inside the body and take up to 60 days or more before they are activated. That is why people who have been exposed to anthrax must take antibiotics for 60 days. It will protect them from any anthrax spores in their body when the spores are activated.

As mentioned previously, Cipro is a strong antibiotic and has many potential side effects that quite possibly might be the reason EMS was called.  The most common side effect one may see in the patient taking this antibiotic is GI complaints such as nausea, vomiting, and diarrhea.  Other serious side effects can include Clostridioides difficile (C-diff), prolonged QT interval, hyper or hypoglycemia, and photosensitivity. 

Look for next week’s Pharmacy Phriday, when we will continue our look at anthrax exposures and yet another antibiotic that could be used in the treatment of exposure.  As homework, you are encouraged to search out answers to these questions relating to anthrax:

• What is a common source of anthrax spores naturally?

• When was anthrax first used as a weapon?

• What are the common routes of anthrax exposure?

Until then, stay safe!

Sincerely,

The UH EMS-I Team

University Hospitals