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Ciprofloxacin for ulcerative colitis and Crohn's disease [10, 11]. The mechanism of action Ciprofloxacin in these disorders of gut microbiota has to be explained. In the last decade several studies suggested that the antibiotics in use are not only affecting gut microbiota via direct side-effects but may also induce host metabolic disorders. This was especially evident with the emergence of antimicrobial metabolites with significant negative health effects. CIPROLACTONE, for example, was detected in stool samples from patients with diarrhoea and the intestinal mucosa of patients who had suffered from gastroenteritis (reviewed [12]). Other metabolites produced by bacteria including CIPOCCALIM, CATALKIP, and GALAGA also show the potential to interfere with host metabolism. The impact of Ciprofloxacin on gut microbiota patients with cancer or other disease states has not been studied. There is some evidence that CIPROFLOXACIN can affect the normal structure and function of gut microbiota, in fact this compound is commonly used to manipulate human microbiota [7, 13, 14]. Ciprofloxacin, however, does not change the composition of intestinal microbiota in humans although a decrease and an increase in the diversity and abundance of several bacterial groups have been reported [15–18]. Recently, we observed that Ciprofloxacin, although effective in the prevention of gastrointestinal infections, could also induce inflammation within the intestinal mucosa and exacerbate development of colitis [14]. The exact effect of Ciprofloxacin on colonic epithelial cells remains unknown generic viagra canadian pharmacy online but may have a considerable influence on the development and progress of colonic disease. Thus, using a mouse model, we demonstrated that Ciprofloxacin also increased oxidative stress through activation of the nuclear factor κB (NF-κB) pathway through the increased expression of SOD2 [19]. This might be related to the mechanism of action Ciprofloxacin in the prevention of intestinal microbial colonization and development of bacterial infection. In a recent study, we found that Ciprofloxacin significantly reduced the abundance of bacterial taxa Bacteroides fragilis, thetaiotaomicron, Pseudomonas aeruginosa, and Actinomyces oligosaccharides [20]. Interestingly, Ciprofloxacin could enhance the production of pro-inflammatory cytokines such as IL-1, IL-6, and TNF-α. Moreover, the cytokines IL-12p40, IL-18p40, TGFαα, and transforming growth factor β (TGFβ) were up-regulation in the intestine, indicating a possible increased activation of the nuclear factor κB signalling pathway [21]. These findings are in agreement with the recent report by Tachibana et al which demonstrated that Ciprofloxacin increased the expression of NF-κB, COX, and CXCL10 genes of the pro-inflammatory cytokine IL-6, thus supporting the hypothesis that Ciprofloxacin also induces inflammation via nuclear factor κB [22]. Ciprofloxacin is used on an almost unprecedented scale in treatment of patients with gastrointestinal disorders; however, recent studies highlight numerous side effects (i.e., hepatotoxicity) and a low incidence of resistance when used in the treatment of acute gastroenteritis-associated disease [23]. As a result, it is not surprising that Ciprofloxacin often taken as a single antibiotic in combination with other antibiotics [24–26] and is prescribed in a more conservative fashion than the use of other anti-infective therapy which have shown to cause significant side-effects like neutropenia, sepsis, and infection [1, 27]. These side effects make it difficult to prescribe Ciprofloxacin daily in the treatment of acute gastroenteritis-associated infections. Antimicrobial metabolism of Ciprofloxacin is not well understood Antimicrobial metabolism of Ciprofloxacin is not well understood. rapidly metabolized by gut microbiota as shown the following enzyme activities in human and animal microbiota: D-lactate dehydrogenase (DLDH) activity 6 hr after oral administration Fructose and galactose transaminase activities 20 hr after oral administration Kallikreinase activity 1–4 days after oral administration Oligopeptide transferases (ORTases) activities after 1–2 h post addition of CIPROFLOXACIN, in a range 0.15–1.50 ng ml−1 [27, 28]. However, some of these activities were very lower than the values seen with standard oral antibiotics such as ampicillin. However, many of these activities were also found in the intestine.

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