CIPROXINE

CIPROFLOXACINE ARROW is indicated in the treatment of the following infections (see sections 4.4 and 5.1). Particular attention should be paid to the available information on bacterial resistance to ciprofloxacin before initiating treatment.

Official recommendations regarding the appropriate use of antibacterials should be taken into account.

In adults

· Lower respiratory tract infections due to Gram-negative bacteria:

o exacerbation of chronic obstructive pulmonary disease. In the exacerbation of chronic obstructive pulmonary disease, CIPROFLOXACINE ARROW should be used only when the antibiotics usually recommended for the treatment of these infections are deemed inappropriate;

o broncho-pulmonary infections in cases of cystic fibrosis or bronchiectasis;

o pneumonias.

· Chronic purulent otitis media.

· Acute exacerbations of chronic sinusitis, particularly due to Gram-negative bacteria.

· Urinary tract infections:

o uncomplicated acute cystitis. In uncomplicated acute cystitis, CIPROFLOXACINE ARROW should be used only when the antibiotics usually recommended for the treatment of these infections are deemed inappropriate;

o acute pyelonephritis;

o complicated urinary tract infections;

o bacterial prostatitis.

· Genital tract infections:

o gonococcal urethritis and cervicitis due to sensitive strains of Neisseria gonorrhoeae;

o orchiepididymitis, including infections due to sensitive strains of Neisseria gonorrhoeae;

o upper gynecological infections including infections due to sensitive strains of Neisseria gonorrhoeae.

· Gastrointestinal infections (for example traveler's diarrhea).

· Intra-abdominal infections.

· Skin and soft tissue infections due to Gram-negative bacteria.

· Malignant external otitis.

· Osteoarticular infections.

· Prophylaxis of invasive Neisseria meningitidis infections.

· Anthrax disease (prophylaxis after exposure and curative treatment).

Ciprofloxacin may be used for the treatment of febrile neutropenic patients where a bacterial origin is suspected.

In children and adolescents

· Broncho-pulmonary infections due to Pseudomonas aeruginosa in patients with cystic fibrosis.

· Complicated urinary tract infections and acute pyelonephritis.

· Anthrax disease (prophylaxis after exposure and curative treatment).

Ciprofloxacin may also be used to treat severe infections in children and adolescents, if necessary.

Treatment should be initiated exclusively by physicians experienced in the treatment of cystic fibrosis and/or severe infections in children and adolescents (see sections 4.4 and 5.1).

Pregnancy

Available data on the administration of ciprofloxacine in pregnant women show no malformation or fetal/neonatal toxicity of ciprofloxacine. Animal studies reveal no direct or indirect toxic effect on reproduction. In the prenatal phase and in young animals, effects on immature cartilage have been observed during exposure to quinolones. The occurrence of joint damage caused by the drug on the cartilage of the immature human body/fetus therefore cannot be excluded (see section 5.3).

As a precautionary measure, it is preferable to avoid the use of ciprofloxacine during pregnancy.

Breastfeeding

Ciprofloxacine is excreted in breast milk. Given the potential risk of joint damage, ciprofloxacine must not be used during breastfeeding.

Due to its neurological effects, ciprofloxacine may affect reaction time. The ability to drive vehicles or use machines may therefore be impaired.

The most frequently reported treatment-related adverse effects are nausea and diarrhoea.

The adverse effects reported during clinical trials and after the marketing of ciprofloxacin (oral, intravenous and sequential treatment) are listed below by frequency. The analysis of frequencies takes into account both oral and intravenous administration data of ciprofloxacin.

*Very rare cases of serious, persistent (lasting several months or years), disabling and potentially irreversible adverse effects, affecting various sensory organ systems, sometimes multiple (notably effects of the type tendinitis, tendon rupture, arthralgia, pain of the extremities, walking disorders, neuropathies associated with paresthesias and neuralgias, fatigue, psychiatric disorders (including sleep disorders, anxiety, panic attacks, depression, suicidal ideas), memory and concentration disorders, and disorders of hearing, sight, taste and smell) have been reported in association with the use of quinolones and fluoroquinolones, sometimes independently of pre-existing risk factors (see section 4.4).

**Cases of aortic aneurysm and dissection, sometimes complicated by rupture (including fatal), and regurgitation/incompetence of one of the cardiac valves have been reported in patients receiving fluoroquinolones (see section 4.4).

Pediatric population

The incidence of arthropathies (arthralgia, arthritis) mentioned above refers to data collected during studies in adults. In children, arthropathies are reported frequently (see section 4.4).

Reporting of suspected adverse effects

Reporting suspected adverse effects after medicinal product authorization is important. It allows for continuous monitoring of the benefit/risk ratio of the medicinal product. Healthcare professionals report any suspected adverse effect via the national reporting system: French National Agency for Medicines and Health Products Safety (ANSM) and the network of Regional Pharmacovigilance Centres - Website: https://signalement.social-sante.gouv.fr/ .