Page 164 - 2025 Ranger Medic Handbook

CIPROFOXACIN (CIPRO)
Class: Antimicrobial – antibiotic; quinolone. All fluoroquinolones now have a US Black Box Warning due to seri-
ous adverse reactions including tendonitis and tendon rupture, peripheral neuropathy and CNS effects. How-
ever, in some rare cases, benefits may outweigh the risks of fluoroquinolone use. Fluoroquinolones require
prior approval from unit physician or physician assistant
Action: Synthetic broad-spectrum bactericidal agent; inhibits DNA-gyrase, an enzyme necessary for bacterial DNA
replication, transcription, repair, recombination, and transposition; effective against many gram-positive and gram-
negative organisms including Citrobacter diversus, Enterobacter cloacae, Enterobacter aerogenes, Escherichia coli,
Haemophilus influenzae, Klebsiella pneumoniae, Neisseria gonorrhoeae, Proteus miribilis, Proteus vulgaris, Pseudo-
monas aeruginosa, Serratia marcescens, Staphylococcus aureus, Streptococcus pyogenes, Shigella, and Salmonella;
less active against gram- positive than gram-negative bacteria, although active against many gram-positive aero-
bic bacteria, including penicillinase-producing, non– penicillinase-producing, and methicillin-resistant staphylococci;
however, many strains of streptococci are relatively resistant; inactive against most anaerobic bacteria; resistant to
some strains of methicillin-resistant Staphylococcus aureus (MRSA)
SECTION 4 NOTE: Not first-line treatment
Dose: 250–750mg PO bid or 200–400mg IV q8–12hr
Indications: For infections of the lower respiratory tract, skin and skin structures, bone and joints, GI tract, urinary
tract, prostate; also used for nosocomial pneumonia, acute sinusitis, and postexposure prophylaxis for anthrax
Contraindications: Quinolone hypersensitivity; syphilis, viral infection; tendon inflammation or tendon pain; preg-
nancy category consider alternative during pregnancy and avoid while breastfeeding
Adverse/Side-effects: Nausea, vomiting, diarrhea, cramps, gas, pseudomembranous colitis; tendon rupture; head-
ache, vertigo, malaise, peripheral neuropathy, seizures
Interactions: May increase theophylline levels; antacids, sucralfate, iron decrease absorption; may increase PT for
patients on warfarin; may cause false positive on opiate screening tests
Mission Impact: GROUNDING medication for personnel on flight status
K9 Dosage: DO NOT GIVE

CLINDAMYCIN (CLEOCIN)
Class: Antimicrobial – antibiotic
Action: Suppresses protein synthesis by binding to 50S subunits of bacterial ribosomes; effective against strains of
anaerobic streptococci, Bacteroides (especially B. fragilis), Fusobacterium, Actinomyces israelii, Peptococcus, Clos-
tridium sp., and aerobic gram-positive cocci, including Staphylococcus aureus, Staphylococcus epidermidis, strepto-
cocci (except S. faecalis), and pneumococci
Dose: 600–1,800mg/d in 2–4 divided doses; up to 2,400mg/d in 4 divided doses may be given for severe infections.
Cleocin T: topically AAA bid
Indications: For moderate to severe infections; topical applications used in treatment of acne vulgaris
Contraindications: Clindamycin or lincomycin hypersensitivity; history of regional enteritis, ulcerative colitis, or
antibiotic–associated colitis; pregnancy category may use during pregnancy and while breastfeeding
Adverse/Side-effects: Fever, serum sickness, sensitization, swelling of face, generalized myalgia, superinfections,
proctitis, pain, induration, sterile abscess; thrombophlebitis; hypotension, cardiac arrest (rapid IV); diarrhea, abdominal
pain, flatulence, bloating, nausea, vomiting, pseudomembranous colitis; esophageal irritation, loss of taste, medicinal
taste (high IV doses), jaundice, abnormal liver function tests; leukopenia, eosinophilia, agranulocytosis, thrombocyto-
penia; skin rashes, urticaria, pruritus, dryness, contact dermatitis, gram-negative folliculitis, irritation, oily skin
Interactions: Chloramphenicol and erythromycin are possibly antagonistic; neuromuscular blocking action enhanced
by neuromuscular blocking agents (atracurium, tubo curarine, pancuronium)
Mission Impact: GROUNDING medication for personnel on flight status.
K9 Dosage: DO NOT GIVE
150 SECTION 4 RANGER MEDIC PHARMACOLOGY & FORMULARY