Ciprofloxacin

• Contraindications and precautions
• Ciprofloxacin should not be used in people with a history of tendon disease/disorder related to quinolone treatment, or who are taking tizanidine or methotrexate.
• Ciprofloxacin should be used with caution in people with central nervous system disorders who may be predisposed to seizure [CSM, 1991].
• Because of the possible risk of arthropathy, ciprofloxacin should not routinely be prescribed to children and adolescents. Other quinolones are not licensed for use in these age groups.
• Pregnancy and breastfeeding
• Because of the risk of arthropathy in the fetus and infant, all manufacturers of quinolones recommend that these antibiotics should be avoided in women who are pregnant or breastfeeding. Seek specialist advice before prescribing quinolones in these women.
• Advise the person to stop taking ciprofloxacin if they develop any of the following:
• Tendinitis or tendon rupture (especially of the Achilles tendon): this can be bilateral and occur as soon as within the first 48 hours of treatment [CSM, 2002]. The risk of tendonopathy may be increased in elderly people and in people who are also taking corticosteroids.
• Convulsions: quinolones such as ciprofloxacin are known to trigger seizures or lower the seizure threshold. Ciprofloxacin should be used with caution in people with central nervous system disorders which may predispose them to seizure.
• Polyneuropathy; neurological symptoms such as pain, burning, sensory disturbances, or muscle weakness, alone or in combination.
• Inform the person that:
• Ciprofloxacin has been shown to cause photosensitivity reactions. People taking ciprofloxacin should avoid direct exposure to extensive sunlight or ultraviolet irradiation during treatment.

Azithromycin

• Contraindications
• The manufacturer of azithromycin recommends that people prescribed ergot derivatives (such as ergotamine — not commonly prescribed) should avoid azithromycin because of the theoretical possibility of ergotism.
• Pregnancy
• Azithromycin is recommended as the first-line antibiotic by WHO for treating traveller's diarrhoea in pregnant women [WHO, 2009].
• Breastfeeding
• Information is limited on the excretion of azithromycin in breast milk.
• Although not contraindicated, the manufacturer advises that the decision to prescribe azithromycin should be based on an assessment of benefits and harms to the mother and fetus.
• Azithromycin is regarded as a second-line macrolide for use in women who are breastfeeding [Schaefer et al, 2007].

[ABPI Medicines Compendium, 2008b; ABPI Medicines Compendium, 2008c]