Introduction
Ciprofloxacin antibiotic belongs to a group of antibiotics known as the Fluoroquinolones, this family of drug are known for its broad spectrum of activity against a wide range of organisms, ciprofloxacin have activity on gram positive organisms such as Staphylococcus aureus (MSSA), Staphylococcus epidermis, Staphylococcus saprophyticus, Streptococcus pneumoniae ( these examples are not comprehensive, but to list a few) and gram negative organisms inclusive, making ciprofloxacin to be found in most prescription.
Artemether Lumefantrine Combination therapy is widely prescribed for the treatment of plasmodium falciparum. It is an Artemisinin based combination therapy for the eradication and treatment of uncomplicated malaria caused by P. Falciparum, Artemether Lumefantrine is the first line prescription medication in practice.
Mechanisim of Action and Pharmacology
The Fluoroquinolone antibiotic Ciprofloxacin works by inhibiting the relaxation of DNA; inhibits DNA gyrase in susceptible organisms; promote breakage of double stranded DNA. In he Body, Ciprofloxacin is highly distributed to body proteins, and also ciprofloxacin increases plasma concentration of other drugs metabolize by CYP1A2 when co administered.
Lumefantrine binds to hemin produced during hemoglobin breakdown, which prevent detoxification to crystalline malaria pigment (hemozoin), during the same process, the peroxide group in Artemether binds to heme and releases its toxic free radical.
Artemether has high affinity for protein molecules, Artemether Lumefantrine should not be used with drugs that inhibit CYP3A4 as it is metabolize by this enzyme, and it is also an inducer of enzyme CYP2D6.
Interaction of Ciprofloxacin and Artemether Lumefantrine
In a study by Oshikoya et Al on “The pattern of interaction, drug pairs and their profile” Ciprofloxacin and Artemether/Lumefantrine had a 16.2% frequency of prescription among other drugs and a “Moderate and Clinicial Significant” Severity.
The co administration of Ciprofloxacin and Artemether Lumefantrine causes prolongation of the QT-interval, although the activity of Ciprofloxacin on the QT interval is minimal.
Also, Ciprofloxacin and Artemether Lumefantrine co-administration expose the patient to torsade de pointes which is undesirable.
Other potential adverse event that can occur as a result of the co administration of this drug include:
- Fainting
- Sudden dizziness
- Shortness of breath
- Light headedness
In a scenario where co administration must be employed, close monitoring of patient should be done in Accordance with practice guideline.
References
- World Health Organization: Guidelines for treatment of malaria (2020). 3rd edition; p: 31-36
- . Warhurst, D. C.; Adagu, I. S.; Beck, H. P.; Duraisingh, M. T; Kirby, G. C; Von, S. L.; Wright C. W; (2001). Mode of action of Artemether Lumefantrine (Coartem): the sole, fixed, oral ADCC and it’s role in combating multi drug resistance. The southeast Asia journal of tropical medicine and public health,32(suppl.) Pp.4-8. ISSN 0125-1563
- Coartem-artemether and Lumefantrine tablet Dailymed. 5th August 2019 retrieved 26th April 2020.
- Kazeem A. O.; ibrahim A. O; Brian G; Fisayo S. O; Joseph F; Samuel O; Amos M; Idowu O. S.(2016). Potential drug-drug interactions in paediatric outpatient prescriptions in Nigeria and implications for the future. Pp. 18-24.