Cinoxacin

Cinoxacin is a synthetic antibacterial agent that belongs to the class of quinolone antibiotics. It is primarily used in the treatment of urinary tract infections (UTIs) caused by susceptible bacteria. Cinoxacin works by inhibiting the bacterial enzyme DNA gyrase, which is essential for DNA replication, transcription, repair, and recombination. This action leads to the death of the bacteria and the resolution of the infection.

Mechanism of Action

Cinoxacin exerts its antibacterial effect by targeting the DNA gyrase enzyme in bacteria. DNA gyrase is a type II topoisomerase that introduces negative supercoils into DNA, which is a critical step in DNA replication and transcription. By inhibiting this enzyme, cinoxacin prevents the replication of bacterial DNA, leading to the elimination of the bacteria causing the infection.

Indications

Cinoxacin is indicated for the treatment of acute, uncomplicated urinary tract infections caused by susceptible strains of the following microorganisms:

• Escherichia coli
• Proteus mirabilis
• Klebsiella pneumoniae
• Staphylococcus saprophyticus

It is important to note that cinoxacin is not recommended for the treatment of pyelonephritis or perinephric abscesses due to insufficient data supporting its efficacy in these conditions.

Pharmacokinetics

After oral administration, cinoxacin is absorbed from the gastrointestinal tract. Its bioavailability is approximately 90%, and peak plasma concentrations are reached within 1 to 2 hours. The presence of food can delay the absorption but does not significantly affect the overall bioavailability. Cinoxacin is minimally metabolized in the liver and is primarily excreted unchanged in the urine, where it achieves high concentrations that are effective against urinary pathogens.

Adverse Effects

The most common adverse effects associated with cinoxacin include:

• Nausea
• Vomiting
• Diarrhea
• Rash
• Headache
• Dizziness

As with other quinolones, cinoxacin may cause tendinitis or tendon rupture, particularly in older adults, those on corticosteroid therapy, and in patients with kidney, heart, or lung transplants. Patients should be advised to stop taking cinoxacin at the first sign of tendon pain, swelling, or inflammation.

Contraindications

Cinoxacin is contraindicated in patients with a history of hypersensitivity to cinoxacin, other quinolones, or any component of the formulation. Caution is advised in patients with a history of seizure disorders, as quinolones may lower the seizure threshold.

Drug Interactions

Cinoxacin may interact with several other medications, including:

• Antacids containing magnesium or aluminum, as well as sucralfate, can decrease the absorption of cinoxacin, leading to reduced efficacy.
• Caffeine: Cinoxacin may increase the half-life of caffeine, leading to increased effects or toxicity.
• Warfarin: Cinoxacin may enhance the effects of warfarin, increasing the risk of bleeding.

Patients should be advised to inform their healthcare provider of all medications they are taking, including over-the-counter drugs and dietary supplements.

Conclusion

Cinoxacin is a quinolone antibiotic used in the treatment of uncomplicated urinary tract infections caused by susceptible bacteria. Its mechanism of action involves the inhibition of bacterial DNA gyrase, leading to bacterial cell death. While effective, it is associated with certain adverse effects and drug interactions that should be considered before use. As with all antibiotics, it is important to use cinoxacin as directed by a healthcare provider to ensure the best possible outcome and to help prevent the development of antibiotic resistance.