Ciprofloxacin Chemistry, Medical Evaluation and Adverse Effect with Special Attention to Ciprofloxacin Chondrotoxicity

Abstract

Ciprofloxacin is the most potent fluoroquinolone and was seen active against a broad range of bacteria. The present study was aimed to review all published animals and human studies in the medical and dental literature about ciprofloxacin use in the period between 1995 and 2021. English language publications, original studies and reviews were included. Several researchers revealed that ciprofloxacin can causes arthropathy. Chondrotoxicity seen in juvenile animals could be due to the deficiency of functionally available magnesium, production of oxidative stresses and lipid peroxidation, chondrocytes loss, decrease in the formation of the cartilage extracellular matrix, decrease in sox9 expression, increase caspase-3 and matrix metalloproteinases expression. In human, ciprofloxacin can induce tendinopathy and tendon rapture. Follow up of children which were treated with ciprofloxacin, showed that only a few percentages of them had developed a ciprofloxacin-related acute arthropathy, but it cannot cause any permanent joint damage. The majority of events were mild to moderate severity. These researches indicated that ciprofloxacin may be a safe drug to be used in children under the age of 18 years old, but only used when there is no a good alternative to its use until a long-term follow-up studies are completed.