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Peritoneal dialysis Adults For the regular tablets and suspension, the FDA-labeled adjustment is to mg PO every 24 hours; doses of mg may also be used, but with careful monitoring. Other recommendations suggest mg PO every 8 hours. Other recommendations suggest mg IV every 8 hours. Ciprofloxacin may be administered with or without meals. Do not administer with dairy products or calcium-fortified juices alone; however, ciprofloxacin may be taken with a meal that contains these products.
Immediate-release tablets If a dose is missed, it should be taken anytime but not later than 6 hours before the next scheduled dose. If less than 6 hours remain before the next dose, do not administer the missed dose and continue with the next scheduled dose. Do not take double doses to compensate for a missed dose. If a dose is missed, it should be taken anytime but not later than 8 hours before the next scheduled dose. If less than 8 hours remain before the next dose, do not administer the missed dose and continue with the next scheduled dose.
Reconstitution Pour the microcapsules from the small bottle into the large bottle of supplied diluent. Do not add water to the suspension. Close the large bottle and shake vigorously for about 15 seconds. Each bottle will contain mL total volume.
Storage: The reconstituted suspension is stable for 14 days when stored below 30 degrees C 86 degrees F. Do not freeze. Administration Shake vigorously for about 15 seconds before each use. Use a calibrated oral syringe or other calibrated oral device to measure accurate dosage. Instruct patient not to chew microcapsules when taking the dose. Do not administer ciprofloxacin oral suspension through a feeding tube due to its physical characteristics. If a dose is missed, it should be taken anytime but not later than 6 hours before the next scheduled dose.
Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit. Compatible solutions include 0. Storage: Diluted infusions 0. Infusion may occur via direct infusion or via Y-site. If Y-site administration is chosen, discontinue the administration of other parenteral drug products during the infusion. If this is not possible, then administer ciprofloxacin and the other medication separately i.
Commercially available ophthalmic solutions are not for injection subconjunctivally or into the anterior chamber of the eye. Apply topically to the eye taking care to avoid contamination.
For ophthalmic use only. Instruct patient on proper instillation of eye solution or ointment. Do not to touch the tip of the dropper to the eye, fingertips, or other surface. Otic Solution Cetraxal Commercially available otic solutions are not for injection, inhalation, or topical ophthalmic use. Instruct patient on proper instillation of otic solution.
Warm the container in the hands for at least 1 minute prior to administration to minimize dizziness that may result from the instillation of a cold solution into the ear canal. The patient should lie with the affected ear upward for instillation and continue to maintain this position for at least 1 minute after instillation.
Instill the contents of 1 single use container 0. Discard used container. Otic Suspension Otiprio Gather all materials needed: Acute otitis externa: one vial of ciprofloxacin otic suspension; one 1 mL luer lock syringe for each affected ear; one 18 to 21 gauge preparation needle for each affected ear; one 20 to 24 gauge, 1. Ice pack and drape to keep the otic suspension vial cold is optional.
Otitis media with effusion: one vial of ciprofloxacin otic suspension; two 1 mL luer lock syringes; two 18 to 21 gauge preparation needles; two 20 to 24 gauge, 2 to 3 inch blunt, flexible administration needles; and alcohol pads. Ciprofloxacin suspension MUST be kept cold during preparation; if the suspension thickens during preparation, place vial back in refrigeration. Hold vial by the aluminum seal while shaking to prevent gelation. Shake the vial for 5 to 8 seconds to mix well until a visually homogenous suspension is obtained.
Withdraw 0. Replace the needle with a 20 to 24 gauge, 1. Prime the needle leaving a dose of 0. Using a different syringe, but the same vial, prepare a second syringe for the other ear if needed and dispose of the vial.
Storage: Syringes can be kept at room temperature or in the refrigerator for up to 3 hours prior to administration. Keep syringes on their side. Cetraxal : - Discard unused portion. Do not store for later use. Ciprofloxacin should not be used in patients with quinolone hypersensitivity. Serious and occasionally fatal hypersensitivity reactions have been reported in patients receiving quinolone therapy. Some reactions were accompanied by cardiovascular collapse, loss of consciousness, tingling, pharyngeal or facial edema, dyspnea, urticaria, and pruritus.
Severe hypersensitivity reactions characterized by rash, pyrexia or elevated body temperature, eosinophilia, angioedema, or other symptoms of an allergic reaction have been reported in patients receiving quinolone antibiotics.
Ciprofloxacin should be discontinued at the first appearance of a skin rash or any other sign of hypersensitivity. Serious anaphylactic reactions require immediate emergency treatment with epinephrine.
Oxygen, intravenous steroids, and airway management, including intubation, should be administered as indicated. Use ciprofloxacin cautiously in patients who have cardiac arrhythmias or other cardiac disease that predisposes to cardiac arrhythmias. Females, people 65 years and older, patients with sleep deprivation, pheochromocytoma, sickle cell disease, hypothyroidism, hyperparathyroidism, hypothermia, systemic inflammation e.
Blood glucose disturbances, including symptomatic hyperglycemia and hypoglycemia, have been reported in patients receiving systemic ciprofloxacin. Hypoglycemia, sometimes resulting in coma, occurs more frequently in elderly patients or patients with diabetes mellitus who are receiving an oral hypoglycemic agent or insulin concomitantly with ciprofloxacin; carefully monitor blood glucose concentrations in these patients.
Educate patients on the symptoms of hypoglycemia and how to treat if they experience hypoglycemia. Discontinue ciprofloxacin if a hypoglycemic reaction occurs and initiate appropriate therapy immediately. Patients with diabetes may also be at an increased risk of developing detachment of the retina. Use systemic ciprofloxacin with caution in patients with renal disease. Ciprofloxacin is eliminated primarily by renal excretion; however, the drug is also metabolized and partially cleared through the biliary system of the liver and through the intestine.
These alternative pathways of drug elimination appear to compensate for the reduced renal excretion in patients with renal impairment.
Some modification of dosage is recommended in patients with renal impairment, including those with severe renal dysfunction or renal failure, and in patients receiving dialysis. Systemic ciprofloxacin should be used with caution in patients who have dehydration. Crystalluria related to systemic use has been reported only rarely in humans because human urine is usually acidic.
Alkalinization of the urine should be avoided in patients receiving ciprofloxacin. Hydrate patients well; hydration may help prevent the formation of highly concentrated urine and prevent crystalluria. Use caution when administering ciprofloxacin to patients at risk for or with a preexisting history of hepatic disease. Ciprofloxacin has been associated with severe hepatotoxicity, including hepatic necrosis and hepatic failure both fatal and non-fatal.
Ciprofloxacin-induced hepatotoxicity is often associated with hypersensitivity, has a rapid onset 1 to 39 days , and may be hepatocellular, cholestatic or mixed. Of note, most patients experiencing fatal outcomes have been over the age of 55 years; therefore, caution is advised in older adults. Immediately discontinue use if signs and symptoms of hepatitis e. Patients receiving systemic ciprofloxacin and other fluoroquinolones have experienced phototoxic reactions.
When choosing an antibiotic, physicians should consider the effectiveness, risk of adverse effects, and resistance rates in the local community. Regardless of which antibiotic is chosen for initial empiric therapy, the regimen should be revised as necessary after urine culture susceptibility results are available. Fluoroquinolones are the preferred empiric antimicrobial class in communities where the local prevalence of resistance of community-acquired E.
Although not all clinical microbiology laboratories serving outpatient medical practices provide reports on the source of specimens tested for antibiotic resistance i. If the prevalence of fluoroquinolone resistance among relevant organisms does not exceed 10 percent, patients not requiring hospitalization can be treated with oral ciprofloxacin Cipro; mg twice per day for seven days , or a once-daily oral fluoroquinolone, such as ciprofloxacin 1, mg, extended-release, for seven days or levofloxacin Levaquin; mg for five days.
An initial intravenous dose is appropriate in patients experiencing nausea or vomiting. Table 6 summarizes outpatient treatment options for nonpregnant women with acute pyelonephritis.
If resistance prevalence exceeds 10 percent, see inpatient recommendations in Table 7. If susceptibility profile is unknown, see inpatient recommendations in Table 7.
In such cases, a long-acting, broad-spectrum parenteral drug such as ceftriaxone Rocephin; 1 g or gentamicin 5 mg per kg should be given concurrently as a one-time dose or longer to cover for possible resistance until sensitivities of the organism are known.
Likewise, if the local fluoroquinolone resistance prevalence in E. For women with acute pyelonephritis who require hospitalization, initial intravenous antimicrobial therapy is recommended Table 7. Levofloxacin Levaquin. Ceftriaxone Rocephin. There is moderate evidence for use from opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
If symptoms do not improve, another diagnosis or a complication of acute pyelonephritis should be considered. Therapy with appropriate empiric antibiotics should produce improvement within 48 to 72 hours. If the patient does not improve as expected i. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Reprints are not available from the authors. Author disclosure: Dr. Johnson receives research support from Merck, Inc. The research is not directly related to the topic of this article, and thus is not disqualifying.
The other authors have no relevant financial affiliations to disclose. Nicolle LE. Epidemiology of urinary tract infection. Infect Med. Acute pyelonephritis in US hospitals in hospitalization and in-hospital mortality. Ann Epidemiol. Hospitalization for acute pyelonephritis in Manitoba, Canada, during the period from to ; impact of diabetes, pregnancy, and aboriginal origin.
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Extended-spectrum [beta]-lactamase producing Escherichia coli : changing epidemiology and clinical impact. Curr Opin Infect Dis. Nursing homes as a reservoir of extended-spectrum beta-lactamase ESBL -producing ciprofloxacin-resistant Escherichia coli.
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