Ciprofloxacin

Evidence Level: L4

Predicted Indications: 10

Ciprofloxacin
Ciprofloxacin: From Bacterial Infections (Typhoid Fever, Pneumonia, Anthrax and Others) to Diffuse Scleroderma

## Pharmacist Assessment Report

Ciprofloxacin: From Bacterial Infections (Typhoid Fever, Pneumonia, Anthrax and Others) to Diffuse Scleroderma

One-Sentence Summary

Ciprofloxacin is a fluoroquinolone antibiotic, originally used for bacterial infections such as typhoid fever, bacterial pneumonia, anthrax, and infectious diarrhoea. The TxGNN model predicts it may be effective for diffuse scleroderma, but there are no registered clinical trials and only 2 publications that are limited and indirect, so this remains an early hypothesis.

Quick Overview

Item	Content
Original Indication	Bacterial infections (typhoid fever, salmonellosis, bacterial pneumonia, anthrax, shigellosis and others, from the knowledge graph; Singapore licence records list no indication text)
Predicted New Indication	Diffuse scleroderma
TxGNN Prediction Score	99.87%
Evidence Level	L4
Singapore Market Status	✓ Marketed
Number of Registrations	20
Recommended Decision	Hold

Why is This Prediction Reasonable?

Detailed mechanism of action data is not available in the compiled data. Ciprofloxacin is a fluoroquinolone antibacterial that inhibits bacterial DNA gyrase and topoisomerase IV. Its efficacy in bacterial infections is well established. Mechanistically, it could apply to scleroderma in two ways.

Antifibrotic effect in the skin. One publication (PMID 20507401) investigated oral ciprofloxacin as an antifibrotic in patients with scleroderma. This mechanism is hypothetical and not established.
Treating a complication. Small bowel bacterial overgrowth is a common gastrointestinal complication of systemic sclerosis. A cohort study (PMID 7728404) examined its detection and treatment outcome. An antibacterial agent can plausibly help here, but this treats the complication, not the underlying disease.

The link between the original indication (infection) and scleroderma (an autoimmune fibrotic disease) is therefore weak and indirect. The high model score has limited support from clinical data.

Clinical Trial Evidence

Currently no related clinical trials registered.

Literature Evidence

PMID	Year	Type	Journal	Key Findings
20507401	2010	Exploratory study (abstract describes a controlled, double-blind, randomized design)	The Journal of Dermatology	Assessed whether oral ciprofloxacin reduces scleroderma severity as an antifibrotic in the skin. The results are not available in the compiled abstract.
7728404	1995	Cohort / diagnostic study	British Journal of Rheumatology	24 systemic sclerosis patients with malabsorption symptoms were investigated for small bowel bacterial overgrowth, and treatment outcome was assessed. Evidence is indirect.

Singapore Market Information

Twenty valid single-ingredient licences are registered. The five below are representative. Approved indication text is not recorded in the licence data compiled for this report.

Authorization Number	Product Name	Dosage Form	Approved Indication
SIN03028P	Ciprobay 250 Tablet 250 mg	Film-coated tablet	Not recorded
SIN05085P	Ciprobay 500 Tablet 500 mg	Film-coated tablet	Not recorded
SIN11851P	Cirok Injection 2 mg/ml	Injection	Not recorded
SIN11265P	Ciloxan Sterile Ophthalmic Ointment 3 mg/g	Ointment	Not recorded
SIN14596P	Cetraxal Ear Drops Solution 2 mg/ml	Solution	Not recorded

Safety Considerations

Contraindication-related conditions (from the knowledge graph, not package insert text): long QT syndrome (including familial), torsades de pointes, epilepsy, kidney disease, potassium deficiency, tendinitis and other tendon-related conditions (Achilles bursitis, heel spur, periarthritis), peripheral neuropathy and peripheral nervous system disease, myasthenia gravis and neuromuscular junction disease, and Clostridium difficile colitis.
Drug Interactions: 100 interactions were identified.
- Major: corticosteroids (hydrocortisone, triamcinolone, dexamethasone, betamethasone) and bupropion. The corticosteroid combination is particularly relevant, as scleroderma patients are often treated with steroids and tendon-related risk is a known concern with fluoroquinolones.
- Moderate (examples): metformin, pioglitazone, acarbose, alogliptin, albiglutide, famotidine, loperamide, aprepitant, acetylsalicylic acid, and budesonide.

Please refer to the package insert for authoritative warnings, as label-level warnings and contraindications were not available for this report.

Conclusion and Next Steps

Decision: Hold

Rationale:

No registered trials support ciprofloxacin in diffuse scleroderma.
The only directly relevant publication has no accessible results, and the antifibrotic mechanism is hypothetical.
The TxGNN score is high, but it is a computational prediction.
The listed contraindication-related conditions (tendon disorders, neuropathy) overlap with possible scleroderma comorbidities and need careful consideration.

To proceed, the following is needed:

Full text and results of the 2010 controlled study (PMID 20507401), with an assessment of its design quality and sample size
Mechanism of action data and preclinical evidence for an antifibrotic effect
Package insert warnings and contraindications from the HSA, reviewed for safety screening
A plan for a prospective, adequately powered trial if the first two items are supportive
A review of the tendon, neuropathy, and corticosteroid interaction risks in scleroderma patients

Note: Among the other predictions in the data compiled for this report, septicemic plague (TxGNN score 99.64%) has the strongest support. It has L1 evidence, including a 2025 randomized trial of ciprofloxacin for bubonic plague (PMID 40768716) and guideline support. However, it is an extension of the existing antibacterial use rather than novel repurposing, and direct evidence for the septicemic form specifically has not been verified.

Disclaimer

This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.