Top 5 Symptoms of Pilonidal Cysts: Surgical Associates of North Texas: Advanced Laparoscopic Surgeons

A pilonidal cyst is a frequently painful condition that originates in the skin at the base of your spine/upper gluteal crease.  While often present for years before becoming symptomatic, once they do their treatment can be very problematic for several reasons including their often recurrent nature and difficult “pain in the butt” location.  Fortunately, if you know what to look for and get early treatment, they can be a very manageable condition.

How pilonidal cysts start

Why precisely pilonidal cysts occur isn’t fully understood, but the primary reason seems to be hair, whether your own or other hairs you’re exposed to from the environment. Since younger people are most affected, it’s believed hormone changes after puberty also play a part.  

Pressure and friction from your clothes press a hair back into your skin, and your body reacts in much the same way as if you developed a splinter. Your immune system jumps into action and forms a cyst to contain what it perceives as a foreign body. It’s even possible to have several pilonidal cysts that connect under the skin.

Potential complications of pilonidal cysts

While a cyst is often not a major problem, it can become infected. During World War II, over 80,000 soldiers required hospital visits due to pilonidal cysts, thought to result from the pressure and friction experienced in rough-riding army jeeps.  This was such a common occurrence that this is still often referred to as “jeep drivers disease”. While most will eventually be self limiting, the chronic nature can rarely cause more serious issues, including an increased risk of developing skin cancer at the site of chronic irritation.

The top 5 symptoms of pilonidal cysts

There are a few common signs that a pilonidal cyst is forming. Given the typical location, you may not notice the cyst until its development is well underway. As the cyst advances, you may notice:

• Tenderness beginning near the base of your spine, just above your buttocks, possibly noted when you’re sitting with pressure on the area
• Pressure and pain developing at the site of the tenderness over time
• A red, swollen bump forming at the site of the cyst that may have a coarse hair protruding
• Pus and/or blood discharge, with bad-smelling pus, coming from at least one hole in your skin
• Accompanying low-grade fever, indicating the cyst has become infected, though this is a less common symptom

Treating a pilonidal cyst

Like other abscesses and boils, antibiotics alone often won’t clear up an active pilonidal cyst. Treatment for these cysts requires draining and cleaning. Depending on the size and shape of the cyst, Dr. deVilleneuve may leave the cyst site open to let it heal from the inside, or he may close the site with stitches. Closing the wound promotes faster healing but may risk recurrence at the site.

If you’ve developed a pilonidal cyst, you can contact Surgical Associates of North Texas by phone or online to schedule an appointment.  Frequently, early diagnosis and initiation of treatment can lessen the severity and shorten the duration of flare ups of the disease. Therefore, if you are concerned that you may have a pilonidal cyst or abscess, don’t delay in seeking treatment.  Even if surgery is needed, it is always an outpatient procedure that is usually accomplished with minimal complications. If you have any questions or concerns, call us today to set up an appointment.

Pilonidal Care Program | Frequently Asked Questions

We understand that the Pilonidal disease can be intimidating, painful and sometimes confusing.  That why we are here to help you in every way possible with any questions or concerns.

“Do I really have this? How can I tell?”

Only a doctor can tell you for sure since Pilonidals take different courses in different people. Some people may just experience a bit of a pain when sitting, others may only have some drainage and no pain, still others will be making a trip to the ER or surgeon because they are in excruciating pain. The usual signs of an acute infection are swelling and pain in the tailbone region. Most people end up at this site by Googling “tailbone pain”. The most singular common symptom is discomfort in the area around the tailbone.

“Why did I get this?”

Even the doctors don’t agree on this issue but we can give you the primary prevailing opinion:

Without getting too technical, the primary theory on Pilonidal Disease involves “follicular occlusion” which is the blocking and inflammation of pores in the midline of the buttocks. This tends to occur in the tailbone area because of the friction and pressure on the area that stretches the pores when the person is sitting. We caution people to make sure your doctor has the latest info on Pilonidal Disease. There are an appalling number of “old school” doctors out there who still think that Pilonidal is completely congenital and there is no way to get rid of it. You can usually spot these doctors by their use of the phrase “the cure is worse than the disease.”

“Is this hereditary?”

Somewhat. There are plenty of instances where multiple family members have Pilonidal Disease. Doctors speculate that this is due to the inherited shape of the buttocks and natal cleft, type of hair and predisposition to blocked follicles/pores.

“Does weight have anything to do with it?”

It is generally suggested that being overweight does encourage Pilonidal Disease but is not a sole cause. Pilonidal Disease occurs most frequently in those with deep natal cleft (aka: your crack), as most of us gain weight, out butts get bigger and the cleft gets deeper. The deeper the cleft, the more moisture and debris that gets trapped in it and the more pressure created when sitting/standing. Plumper buttocks also create a greater seal that keeps out oxygen and provides a happy living accommodation for anaerobic bacteria to thrive.

“Can it be cancerous?”

Very rarely. As of 1999, fewer than 50 cases have been reported and those were mostly in people who had refused treatment for many, many years. When you undergo surgery, your doctor will probably send the tissue to the lab for testing just to be sure.

“Can you get Pilonidal Cysts in other places?”

You may run across references to Pilonidals in other body regions, but technically a Pilonidal occurs in the natal cleft area only. There are similar type cysts that have been reported in the Umbilicus (Navel), on the breast, in the pubic region and in the armpit…these locations suggest Hidradenitis Supperativa, rather than Pilonidal Disease. There is a similar disease called Barbers Pilonidal Sinus that is caused by hair digging into the soft tissues between the fingers. It tends to occur on animal groomers and barbers.

“What does the abscess/cyst feel like?”

In most cases (but not all), you can feel a lump in your tailbone area. The lump can be as small as a pea or as large as a golf ball. The lump moves when you press on it – bone feels like bone and doesn’t move. Usually, the lump will hurt when you press on it. Not every case of Pilonidal Disease involves an obvious lump (abscess), some people just have draining sinuses and abscess is buried too deep to be felt from the top skin.

“What is this little hole in my backside?”

That is a sinus opening. A sinus is a tract that links your abscess to the top of the skin. Not everyone who has a Pilonidal Abscess has a sinus. If you have a sinus, you can be assured there is an abscess to go with it somewhere or one will likely form in the future. It is possible to have multiple sinuses. Some doctors speculate that sinus openings only form in response to flare-ups, but I can tell you that I noticed my sinus hole a good 12 years before my first real flare-up, so the jury is out on this one. There is good reason to suspect that sinus openings that are right in the center of the buttock midline are, in fact, pits (exploded follicles) which are the cause of a Pilonidal.

“How do I know it’s infected?”

It hurts. It really, really hurts. If there is a sinus, there may also be a foul smelling drainage that can be a variety of colors from clear, brownish, white pus or mixed with blood. For a lot of people, the first time they hear the word Pilonidal is in the emergency room where they had to be carried, screaming in pain the whole way. When a Pilonidal Abscess is infected (inflamed, acute, “flaring up”) it will swell and make it almost impossible to sit, stand or lie down, since any movement seems to make the pain worse. Several women have posted that the pain of an acutely infected Pilonidal Abscess is worse than childbirth. So, men, now you know!

“Why am I itching like crazy back there?”

Itching is your skin’s response to the infected fluid draining from the abscess. If you are itching, you have an infection.

“My lower back has been hurting like crazy, it is related?”

Possibly. A significant number of people report this symptom and the pain usually goes away after healing from surgery. There are no notes in the medical literature on the relationship of lower back pain and Pilonidals but some theories are:

• It might be that the abscess is pressing on some of the Sciatic nerves;
• It might be because we tend to sit in funky positions due to pain/discomfort, which throws the back out of alignment;
• It might be from the stress that medical problems bring on.

“Are there any tests to diagnose it?”

Not really. Usually, one isn’t needed since the person is in pain and has an obvious lump/draining sinus. In some cases, Pilonidals are visible on a very high resolution MRI with contrast. Pilonidals are also reportedly visible through Ultrasound, although we have actually seen one ourselves, so this may be just a rumor.

Can Pilonidal Cysts Cause Sciatica or back pain or bowel problems

Sciatica is a condition that causes sciatic nerve pain, numbness, and tingling in the leg or feet. It can be caused by many different things, such as cysts. This article will explore whether sciatica symptoms are related to pilonidal cysts. We’ll discuss what sciatica is, what causes it, and whether or not pilonidal cysts contribute to sciatic pain.

Does Pilonidal Cyst Cause Sciatic Nerve Pain?

Pilonidal cysts are sacs of tissue that contain air or fluid. Cysts like this one commonly develop along the crease of the buttocks. An infection of the skin generally causes pilonidal cysts. As for sciatica, this condition refers to nerve pain originating from your buttock/gluteal area, usually due to an injury or irritation to this nerve.

Although both conditions are located on the buttocks, pilonidal cysts do not cause sciatic pain.

Sciatica is mainly related to the human anatomy’s musculoskeletal system, while pilonidal cysts have more to do with the integumentary system.

Diseases and disorders that usually cause sciatica are correlated to musculoskeletal disorders and neurological disorders.

Both sciatica and pilonidal cysts affect the lower limb anatomy, and the symptom of pain is present in both cases but diagnosis greatly differs.

A pilonidal cyst causes chronic pain due to dead skin and hair trapped in the area of the buttocks. Sitting down can be extremely painful when a pilonidal cyst is present.

Sciatica, on the other hand, is caused by irritation of the sciatic nerve. The leg and lower back are usually the most painful if a person has sciatica. Sciatic pain can often be felt after prolonged sitting or standing.

What Cyst Can Cause Sciatica?

Perineural cysts

A perineural cyst, also known as a Tarlov cyst, is a fluid-filled sac that forms on the nerve root sheath, usually in the sacral area of the spine. Other parts of the spine can also be affected.

A person with a perineural cyst may not have any signs or symptoms. They are usually not noticed by the person who has them. The cysts only become symptomatic when they fill with spinal fluid and increase in size. As a result, the cysts may compress nerves and cause other problems.

Pain is one of the most common symptoms associated with perineural cysts. Enlargement of the cysts can compress the sciatic nerve, which can result in sciatica.

Synovial cysts

A synovial cyst is a small, fluid-filled lump that develops on the lower part of the spine. Cysts of this type are not cancerous and often do not cause symptoms. Unfortunately, they can sometimes result in problems like sciatica.

The synovium lines the inside surface of joints. In addition to lubricating and protecting joints, synovial membranes also produce synovial fluids. Sometimes, synovial cysts develop from the buildup of fluid within the membrane.

Older adults and people with joint conditions such as arthritis are more likely to develop synovial cysts.

One or more of the following symptoms may accompany synovial cysts: back pain, experience pain in the legs, difficulty walking or standing, numbness, or tingling.

What Conditions Can Cause Irritation of the Sciatic?

Piriformis syndrome

Piriformis syndrome refers to a painful condition that occurs when the piriformis muscle spasms. The piriformis muscle can also irritate the sciatic nerve. When the sciatic nerve is upset because of the piriformis muscle, it can cause pain, numbness, and tingling down the back of the leg and even into the foot.

In the buttocks, near the top of the hip joint, is a flat, band-like muscle called the piriformis. The hip joint and thigh are stabilized by this muscle, which lifts and rotates the thigh from the body.

The symptoms of Piriformis syndrome usually begin with pain, tingling, or numbness in the buttocks. It is possible to experience acute pain along the length of the sciatic nerve.

When the piriformis muscle compresses your sciatic nerve, the result is excruciating pain. It is also possible to experience pain while climbing stairs, applying firm pressure directly over the piriformis muscle, or when sitting for long periods.

However, most cases of sciatica are not caused by piriformis syndrome.

Spondylolisthesis

Spondylolisthesis is a condition wherein there is instability in the spine. This instability is due to the vertebrae moving more than they should. A vertebra slips out of place and can cause pressure on a nerve, resulting in lower back pain or leg pain.

Many factors can cause the vertebrae to slip out of place. When the vertebra is out of place, it puts pressure on the bone below it.

Symptoms do not usually accompany spondylolisthesis. If leg pain is felt, it can be due to the compression or a “pinching” of the nerve roots that exit the spinal canal.

By slipping out of place, the vertebrae compress or pinch the nerves, narrowing the space needed for them.

Osteoarthritis

Gradual deterioration of your joints’ cartilage leads to osteoarthritis. Cartilage is a firm, slippery tissue that facilitates joint motion without friction.

Osteoarthritis can affect any joint. However, the condition is most common in your hands, knees, hips, and spine. It is also a prevalent cause of pinched nerve or sciatica pain.

Aside from sciatica, osteoarthritis can also cause stiffness and swelling. In some cases, it can also cause reduced function and disability; some people may not be able to do the things they usually do.

How Can You Manage Sciatica Pain?

Sciatica can often be treated at home in a few weeks. Typically, your doctor will recommend trying some combination of solutions for pains that are relatively mild and aren’t preventing you from doing your everyday activities.

In addition to teaching you stretching and exercise routines, physical therapists can help improve your posture, which will relieve the strain on the sciatic nerve.

Stretches for the lower back can help alleviate sciatica pain. Moving around can help reduce inflammation, so taking a short walk can be beneficial.

You can also try aspirin, ibuprofen, and naproxen. However,  do not use them for an extended period without consulting your doctor. A stronger muscle relaxant or anti-inflammatories might be prescribed by your doctor if over-the-counter remedies do not work.

In about 5-10% of sciatica cases, surgery is the only option left. Your doctor may recommend surgery if you have mild sciatica but are still in pain after 3 months of resting, stretching, and taking medicine.

A rare but serious complication of sciatica is cauda equine syndrome, in which your bladder and bowels become impaired. In that case, surgery is the only option.

How serious is a pilonidal cyst?

It is not dangerous, but pilonidal cyst can turn into an infection, so it should be treated. A pilonidal cyst that becomes infected forms an abscess that drains pus through a sinus. Pain, a foul smell, and bleeding are common symptoms associated with the abscess of pilonidal cyst.

The most common complication of pilonidal cysts is the recurrence of the abscess. A systemic infection is also possible.

Will a pilonidal cyst go away on its own?

Minor surgery is one way of getting rid of a pilonidal cyst.

It is possible for pilonidal cysts to drain and disappear by themselves. A pilonidal cyst may cause you to have recurring symptoms over time.

To get rid of a pilonidal cyst at home, the affected area should be treated daily by applying a warm, wet compress. It will help drain the cyst by pulling out the pus. Pain and itching can be relieved in this way.

A warm, shallow bath may also be helpful. Ibuprofen or other pain relievers can be taken if your cyst hurts.

Why does my pilonidal cyst keep coming back?

Patients sometimes have more than one sinus tract when first operated on for pilonidal cyst, but the second one is not detected. A period of time may pass before that tract begins to cause problems, requiring another surgery.

Other times, the patient acquires another instance of pilonidal disease after the first one. The same factors that led to the first case could contribute to an additional chance of pilonidal cysts, which will result in hair penetrating the skin in the buttocks area.

Excision procedures don’t always completely heal; thus, you may still experience the problems associated with your pilonidal sinus long after your initial surgery.

If an incision scar grows near the cyst, the cyst may return because the area becomes infected again.

How Can I Prevent Pilonidal Cyst From Coming Back?

Select the Best Treatment

Various treatments for chronic pilonidal sinuses have different success rates over time. By choosing the best treatment prescribed by your doctor for your specific case, you might help protect yourself.

Exercise More

Maintaining an active lifestyle not only boosts your health but it can help reduce pressure on your buttock cleft. By doing this, fewer hairs may make their way under the skin.

Furthermore, an active lifestyle can help you lose weight. Weight loss can reduce your risk of developing pilonidal sinuses when you are overweight or obese.

Remove Hair

You may be advised to reduce hair in your buttocks area if you have body hair in that area. Pilonidal sinuses can often develop in people with a lot of body hair.

It is sometimes recommended to use shaving cream and depilatory lotions to remove hair. The use of lasers for hair removal is another good choice.

Follow Doctor’s Advice

Follow your doctor’s post-care management regardless of the type of treatment options you had for pilonidal disease. A surgical infection may occur if you do not follow their medical advice.

Cleanse and keep wounds dry at all times. During the healing process, it is necessary to pack the open surgical site regularly.

Pilonidal cysts are a round sac of tissue that’s filled with air or fluid. This common type of cyst is located in the crease of the buttocks and is usually caused by a skin infection. More than 70,000 cases reported in the U.S. every year. Men are three to four times more likely to be diagnosed with a pilonidal cyst than women. A pilonidal cyst is a non-contagious skin condition – you can’t spread it (just like a pimple) It’s caused by ingrown hairs found in the crease of the buttocks causing a skin infection.

If you have a pilonidial cyst, your provider may spot what looks like a pimple or oozing cyst. They may also ask you several questions, including: Has the cyst changed in appearance? Is it draining any fluid? Do you have any other symptoms? Very rarely, your doctor will be able to tell you if you have an abscess or a sinus cavity.

If you have a pilonidal cyst, you may or may not need surgery to remove it. There are several other treatment options besides surgery for the cyst. Antibiotics can treat skin inflammation, but antibiotics can’t heal pilonidial cysts on their own. Laser therapy can remove hair which otherwise might become ingrown and cause more cysts to come back. A pilonidal cyst is not life-threatening, but it can pose several long-term health risks.

Losing weight (if you are currently overweight) and avoiding sitting for too long can lower your risk. Shaving the hair around your buttocks once a week or more can help prevent ingrown hairs. If you have a pilonidial cyst, you may need to take some time off of work if you develop symptoms. Perineural cysts are often misdiagnosed because they rarely cause symptoms. When they do cause symptoms, one of the most common is pain in the lower back, buttocks, or legs.

This occurs when the cysts become enlarged with spinal fluid and press on nerves. In rare cases, cysts that cause symptoms and are not treated will cause permanent damage to the nervous system. The cysts can be drained to provide temporary relief of symptoms. Only surgery can keep them from refilling with fluid and producing symptoms again. Most people with perineural cysts will never have any symptoms or need any treatment.

If you have symptoms, they may need treatment to relieve pressure and discomfort. Surgery to remove the cysts is a dangerous procedure that carries significant risks. Only 1 percent of people with these cysts experience symptoms. The only permanent treatment for them is to have them surgically removed.

• Pilonidal Cyst A pilonidal cyst is a round sac of tissue that’s filled with air or fluid.
• This common type of tarlov cyst is located in the crease of the buttocks and is usually caused by a skin infection.
• Pilonidal cysts are a common condition, with more than 70,000 cases reported in the U.S. every year.
• This common type of cyst is located in the crease of the buttocks and is usually caused by a skin infection.
• Pilonidal cysts can cause pain and need to be treated.
• Is a pilonidal cyst contagious?
• A pilonidal cyst is a non-contagious skin condition – you can’t spread it (just like a pimple).
• There are several steps you can take to help prevent getting pilonidal cysts or to keep them from coming back.
• These steps include: Regularly washing and drying your buttocks (to keep the area clean).
• OUTLOOK / PROGNOSIS Is a pilonidal cyst fatal?
• A pilonidal cyst is not fatal in itself.
• This occurs in rare cases when the cysts become enlarged with spinal fluid and press on nerves.
• Symptoms of perineural cysts People with perineural cysts are not likely to have any symptoms.
• Diagnosis of perineural cysts Because most perineural cysts cause no symptoms, they are typically never diagnosed.
• Your doctor can order imaging tests to identify them if you have symptoms.
• A CT scan with a dye injected into the spine can show if fluid is moving from the spine into cysts in the sacrum.
• Treatments for perineural cysts For most cases of perineural cysts, no treatment is needed.
• The only permanent treatment for perineural cysts is to have them surgically removed.
• Surgery is usually recommended for serious, chronic pain, as well as bladder problems from the cysts.

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An Extremely Rare Complication of the Perianal Abscess

Pol J Radiol. 2016; 81: 370–373.

Rahul Gujrathi,^B,D,E,FKanchan Gupta,^C,D,E,FChetan Ravi,^B,C,D,E,F and Bhujang Pai^B,C,D,E,F

Department of Radiology, Sevenhills Hospital, Mumbai, India

Author’s address: Rahul Gujrathi, SevenHills Hospital, Marol Maroshi Raod, Marol, Andheri East, Mumbai India 400059, e-mail: moc.liamg@ihtarjugluhar

^AStudy Design

^BData Collection

^CStatistical Analysis

^DData Interpretation

^EManuscript Preparation

^FLiterature Search

^GFunds Collection

Received 2015 Dec 25; Accepted 2016 Jan 6.

This is an open access article. Unrestricted non-commercial use is permitted provided the original work is properly cited.

Summary

Background

Sciatica has been classically described as pain in the back and hip with radiation in the leg along the distribution of the sciatic nerve, secondary to compression or irritation of the sciatic nerve. Spinal abnormality being the most common etiology, is one of the most common indications for MRI of the lumbosacral spine. Here we describe imaging findings secondary to a supralevator perianal abscess causing irritation of the sciatic nerve, which was diagnosed on MRI of the lumbosacral spine.

Case Report

A 47-year-old male patient presented to the emergency department with severe acute pain in the right hip and right leg which was aggravated by limb movement. Clinically, a possibility of sciatica was suggested and MRI of the lumbosacral spine was ordered. The MRI did not reveal any abnormality in the lumbosacral spine; however, on STIR coronal images, a right perianal abscess with air pockets was seen. The perianal abscess was extending above the levator ani muscle with and was seen tracking along the sciatic nerve, explaining pain along the distribution of the sciatic nerve. The abscess was surgically drained, followed by an antibiotic course. The patient was symptomatically better post-surgery. Post-operative scan done 3 days later revealed significant resolution of the infra- and supralevator perianal abscess. The patient was discharged from hospital on post-operative day 3 on oral antibiotics for 7 days. On 15^th post-operative day, the patient was clinically completely asymptomatic with good healing of the perianal surgical wound.

Conclusions

Extra-spinal causes are rare and most often overlooked in patients with sciatica. While assessing patients with sciatica, extra-spinal causes for the radiation of pain along the distribution of the sciatic nerve should always be looked for if abnormalities in the MRI of the lumbar spine are not found. Inclusion of STIR sequences in the imaging of the lumbosacral spine, more often than not, helps to identify the extra-spinal cause of sciatica when MRI of the lumbosacral spine does not reveal any abnormality.

MeSH Keywords: Magnetic Resonance Imaging, Perianal Glands, Sciatica

Background

Various pathologies can cause compression or irritation of the sciatic nerve as it courses through the neural foramina and the soft tissues of the pelvis and thigh. Sciatica due to spinal pathologies is most commonly seen in patients undergoing MRI for back pain with radiation to the lower limb. These patients show compression of the sciatic nerve roots at the neural foramina or lateral recess either by herniated disc, osteophytes, hypertrophied ligamentum flavum or arthropathy of the facet joints. At times, combined above mentioned causes lead to compression. Extra-spinal causes, although rare, generally include pelvic bone fractures, dislocations, entrapment syndrome, compartment syndrome of the posterior thigh, inadvertent intramuscular injection in the nerve in the gluteal region, complication of hip joint replacement etc [1,2]. Two cases with perianal abscess causing sciatica have been described in literature [3,4] but none of them describes imaging appearance in detail. Hereby we present imaging appearance of a rare case of ruptured perianal abscess causing sciatica.

Case Report

A forty-seven-year-old man presented with low back and right buttock pain radiating to the right lower limb, from hip to knee joint. The pain was sudden in onset, burning in nature and aggravating by limb movements. No previous history of backache was mentioned. Significant tenderness was present on the posterior aspect of the right thigh. SLRT was positive at 60 degrees. No significant sensory loss was identified on examination.

MRI of the lumbosacral spine was advised for evaluation of the back pain radiating to the right limb. MRI of the lumbosacral spine did not reveal any significant spinal abnormality. However, an abnormal hyperintense signal was noticed in the right gluteal muscles and perianal region on large field of view STIR coronal images (). Subsequently, dedicated T2W and T1W images were taken for assessment of the pelvis. A perianal collection with marked T2WI and T1WI hypointensities suggestive of air was noticed (). Abnormal STIR hyperintense signals with air pockets were also noted extending into the right greater sciatic notch and along the right sciatic nerve. Additionally, the diffusion weighted sequence was planned and it revealed areas of restriction within the right perianal collection (). A CT scan of the pelvis confirmed presence of perianal abscess in the right ischiorectal fossa with multiple air pockets (, ), tracking along the right sciatic nerve up to the mid-thigh. Preoperative evaluation of the patient also revealed high fasting (165 mg/dL) and postprandial (220 mg/dL) blood glucose levels. The right ischiorectal fossa abscess was surgically drained with a drainage tube kept in the ischiorectal fossa. Microbiological examination of the abscess revealed gram-negative rods suggesting Escherichia coli. A postoperative CT scan 3 days later revealed significant resolution of the abscess and the air pockets. The patient was discharged after 3 days of hospitalization on oral antibiotic treatment for gram-negative and anaerobic bacteria for 7 days. On 15^th post-operative day, the patient was completely asymptomatic and showed signs of healthy healing of the perianal surgical wound.

STIR coronal image showing hyperintense signal on the right side of the pelvis (arrow) which is seen extending towards the greater sciatic foramen (arrow heads).

T1WI (A) shows a hypointense lesion in the right ischiorectal fossa region (arrow). T2W Fat sat image (B) shows hyperintense signal in the right ischiorectal fossa region with hyperintense signal extending towards the greater sciatic foramen and along the sciatic nerve (arrow head). Multiple tiny hypointense foci seen in both the T1 and T2W fat sat images representing air as confirmed by corresponding axial CT images (C, D). Tiny pockets of air are also seen along the sciatic nerve (C, D).

Diffusion weighted image (A) and a corresponding ADC image (B) showing restriction of diffusion in the abscess cavity (arrows).

T2 fat sat coronal (A) and corresponding coronal CT image (B) showing hyperintense signal with air pockets along the sciatic nerve (arrows) extending from the pelvis to the thigh. In CT image (B), the arrowhead marks the thickened edematous right levator ani muscle and the asterix (*) marks the ischiorectal fossa abscess.

Discussion

Sciatica is commonly defined as pain in the lower back and hip radiating along the distribution of the sciatic nerve. A variety of common and uncommon causes of sciatica has been described in literature. The causes can be broadly categorized as spinal and extraspinal.

Pathologies affecting the spine are the most common causes of sciatica. Osteophytes, disc herniation, facetal hypertrophy, ligamentum flavum hypertrophy, synovial cysts are the most common spinal pathologies that cause compression or irritation of the sciatic nerve roots. Traumatic fracture, dislocation of facet joints and tumors of the nerve roots have also been mentioned.

Extra-spinal causes of sciatic pain are extremely rare and thereby at times overlooked while assessing a patient with sciatica. Extra-spinal causes can be broadly categorized into traumatic, infective, inflammatory, tumoral, vascular and other etiology.

Traumatic causes like inadvertent intramuscular injection in the gluteal region in the sciatic nerve, traumatic posterior dislocation of the hip, thigh hematoma or total hip replacement surgeries have been described in literature [5,6]. Primary nerve sheath tumors can also cause sciatica. Pelvic and abdominal tumors can cause pressure effect or invasion of the sciatic nerve giving rise to sciatica [7,8]. Other rare causes like pelvic endometriosis, uterine leiomyomas, pyriformis syndrome, pregnancy, aneurysm of the external iliac artery, radiotherapy and osteoarthritis of the sacroiliac or hip joints have also been described [9–13].

Rarely gluteal, perianal and pelvic abscesses can cause pain along the sciatic nerve either by compression or irritation of the nerve [2,3]. Abdominal infections can also spread into the pelvis along the iliopsoas muscles or along the iliac vessels [6,14]. Inflammation in the vicinity of the sciatic nerve due to sacroilitis can elicit referred pain causing sciatica [15].

Active perianal fistulas and abscesses are usually hypointense on TIWI and hyperintense on T2WI and show restriction on DWI [16]. Presence of marked T2- and T1-hypointense foci within the collection was highly suggestive of air which was confirmed by plain CT images [16]. Presence of air in the abscess cavity and along the sciatic nerve was very well demonstrated in our case which suggested perineural spread of abscess.

Conclusions

Although compression of the nerve roots at the level of the lumbar spine constitutes the most common cause of sciatica, rare extraspinal causes should also be looked for while imaging for pain in the sciatic nerve. Awareness of these rare entities is always helpful in making an early diagnosis and in favorable outcome. Including large field-of-view STIR coronal sequences in routine imaging of the lumbar spine is usually helpful in defining the diagnosis in patients with extra-spinal sciatica.

Abbreviations

References

1. Moore KL, Dalley AF. Clinically oriented anatomy. Philadelphia, PA: Lippincott, Williams & Wilkins; 1999. [Google Scholar]2. Maravilla KR, Bowen BC. Imaging of the peripheral nervous system: Evaluation of peripheral neuropathy and plexopathy. Am J Neuroradiol. 1998;19:1011–23. [PMC free article] [PubMed] [Google Scholar]3. Pego-Reigosa R, Brañas-Fernández F, Garcia-Porrua C, Gonzalez-Gay MA. Sciatic nerve palsy as presenting sign of a perianal abscess. Joint Bone Spine. 2003;70(1):85–86. [PubMed] [Google Scholar]4. Herr CH, Williams JC. Supralevator anorectal abscess presenting as acute low back pain and sciatica. Ann Emerg Med. 1994;23(1):132–35. [PubMed] [Google Scholar]5. Villarejo FJ, Pascual AM. Injection injury of the sciatic nerve (370 cases) Childs Nerv Syst. 1993;9:229–32. [PubMed] [Google Scholar]6. Ergun T, Lakadamyali H, Derincek A, et al. Magnetic resonance imaging in the visualization of benign tumors and tumor-like lesions of hand and wrist. Curr Probl Diagn Radiol. 2010;39:1–16. [PubMed] [Google Scholar]7. Beşe NS, Ozgüroğlu M, Dervişoğlu S, et al. Skeletal muscle: An unusual site of distant metastasis in gastric carcinoma. Radiat Med. 2006;24:150–53. [PubMed] [Google Scholar]8. Roncaroli F, Poppi M, Riccioni L, Frank F. Primary non-Hodgkin’s lymphoma of the sciatic nerve followed by localization in the central nervous system: Case report and review of the literature. Neurosurgery. 1997;40:618–21. [PubMed] [Google Scholar]9. Wider C, Kuntzer T, Von Segesser LK, et al. Bilateral compressive lumbosacral plexopathy due to internal iliac artery aneurysms. J Neurol. 2006;253:809–10. [PubMed] [Google Scholar]10. Vilos GA, Vilos AW, Haebe JJ. Laparoscopic findings, management, histopathology, and outcome of 25 women with cyclic leg pain. J Am Assoc Gynecol Laparosc. 2002;9:145–51. [PubMed] [Google Scholar]11. Rossi P, Cardinali P, Serrao M, et al. Magnetic resonance imaging findings in piriformis syndrome: A case report. Arch Phys Med Rehabil. 2001;82:519–21. [PubMed] [Google Scholar]12. Ashkan K, Casey AT, Powell M, Crockard HA. Back pain during pregnancy and after childbirth: An unusual cause not to miss. J R Soc Med. 1998;91:88–90. [PMC free article] [PubMed] [Google Scholar]13. Wouter van Es H, Engelen AM, Witkamp TD, et al. Radiation-induced brachial plexopathy: MR imaging. Skeletal Radiol. 1997;26:284–88. [PubMed] [Google Scholar]14. Letters to the Editor. Joint Bone Spine. 2003;70(1):85–88. [Google Scholar]15. Wong M, Vijayanathan S, Kirkham B. Sacroiliitis presenting as sciatica. Rheumatology. 2005;44:1323–24. [PubMed] [Google Scholar]16. O’Malley RB, Al-Hawary MM, Kaza RK. Rectal imaging: part 2, Perianal fistula evaluation on pelvic MRI–what the radiologist needs to know. Am J Roentgenol. 2012;199:W43–53. [PubMed] [Google Scholar]

Proctologist, Colon, and Rectal Surgeon

Located in the crease of the buttocks, a pilonidal cyst is a chronic skin infection that affects about 70,000 people every year, according to the Cleveland Clinic. Despite the discomfort caused by these cysts, many people feel too embarrassed to mention the condition to their doctor.

Ignoring your pilonidal cyst won’t make them go away. In fact, failing to get treatment may worsen the situation.

Here at Paonessa Colon and Rectal Surgery, P.C., our board-certified general surgeon and proctologist, Dr. Nina Paonessa, specializes in diagnosing and treating pilonidal cysts. She wants you to know more about this common skin condition so you can get the treatment you need. 

Formation of a pilonidal cyst

Experts are still trying to understand all the factors that cause a pilonidal cyst. 

But, it’s believed that the cysts occur from an infection that may start in the hair follicles found in the crease of the buttocks. The hair that grows from this follicle may then grow into the skin and worsen the condition. 

Loose hairs from other parts of the body may also form a pilonidal cyst, says the Mayo Clinic. Pressure and friction from clothing or activities may cause the hair to penetrate the skin. Your skin treats the hair as a foreign invader, creating a cyst around it. 

Signs and symptoms of a pilonidal cyst

If you have what appears to be a large pimple on your tailbone, then you may have a pilonidal cyst. Your cyst may also be painful and drain clear, cloudy, or bloody fluid. 

With an infected pilonidal cyst, you may notice more swelling and redness around your cyst, and drainage may be foul-smelling. You may also develop a fever, nausea, and vomiting with an infected pilonidal cyst.

A pilonidal cyst may be a one-time event. However, when left untreated, your acute pilonidal cyst may turn into a chronic condition in which you develop recurrent pilonidal cysts or the formation of new pilonidal cysts.

Your pilonidal cyst may also increase your risk of developing a life-threatening systemic infection. 

Treating your pilonidal cyst

We create individualized pilonidal cyst treatment plans that best fit your needs. Treatment may depend on the severity of your symptoms, and the frequency of cyst recurrence.

The primary treatment for a pilonidal cyst is drainage of the abscess. We perform this procedure at the office under local anesthesia. Unfortunately, draining the cyst may not prevent a recurrence.

To treat recurrent pilonidal cysts, we perform a surgical procedure to remove the cyst sac. Dr. Paonessa uses advanced surgical techniques during this procedure to limit your recovery and downtime. 

Pilonidal cysts are common and early diagnosis and treatment may prevent chronic problems. To schedule an appointment at our Brielle or Manahawkin, New Jersey, office, call or book online using the website scheduling tool.

Pilonidal Cyst | UVA Health

A pilonidal cyst is a fluid-filled developmental defect at the base of the spine.

The terms cyst, sinus, and abscess refer to different stages of the disease process.

• Cyst — not infected
• Abscess — pocket of pus
• Sinus — opening between a cyst or other internal structure and the outside

While the cyst is not serious, it can become an infection and should therefore be treated. When a pilonidal cyst gets infected, it forms an abscess, eventually draining pus through a sinus. The abscess causes pain, a foul smell, and drainage.

This condition is not serious. But, since it is an infection, it can enlarge and become uncomfortable. Therefore, it should be treated.

Pilonidal Cyst Copyright © Nucleus Medical Media, Inc.

Pilonidal Cyst Causes 

A pilonidal cyst may be congenital or acquired. If congenital, it probably began as a defect that existed when you were born. Sometime later, the defect allowed an infection to develop. If acquired, it may be the enlargement of a simple hair follicle infection or the result of a hair penetrating the skin and causing an infection.

Risk

The following factors increase your chance of developing a pilonidal cyst:

• Personal or family history of similar problems such as acne, boils, carbuncles, folliculitis, and sebaceous cysts
• Large amounts of hair in the region
• Tailbone injury
• Horseback riding, cycling
• Prolonged sitting
• Obesity

Symptoms

Symptoms may include:

• Painful swelling over your sacrum, which is the area just above your tailbone
• A foul smell or pus draining from that area

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. You will be referred to a surgeon for treatment. There are no diagnostic tests required.

Treatment

Talk with your doctor about the best treatment plan for you. The choice of treatment will depend on the extent of the condition and your general overall health. Treatment options include:

Home Treatment

As with all localized infections under the skin, hot water soaks will draw out the infection. This will not completely cure the condition, but it will help.

Incision and Drainage

The abscess is lanced, the pus drained, and the wound is packed with sterile gauze. This helps it heal from the inside out. But, this usually does not cure the problem because abnormal tissue remains.

Excision

To completely cure the condition, all affected tissue needs to be removed. This is a more extensive surgical procedure than simple incision and drainage. The surgical wound may be closed with sutures or left open to heal from the inside.

Laser Hair Removal

There are recent reports that laser hair removal in the area may be an effective treatment for pilonidal cysts.

Prevention

Here are ways to reduce your chance of getting a pilonidal abscess:

• Keep the area clean and dry.
• Avoid sitting for a long time on hard surfaces.
• Remove hair from the area.

Tailbone Pain is Coccydynia

Coccydynia is the answer to the question, “why does my butt bone hurt?” It’s the medical term for pain in your coccyx, or tailbone. Tailbone pain can make sitting and leaning back very uncomfortable. But on the bright side, most people with tailbone pain respond very well to conservative treatment.

Is the Coccyx Part of the Spine or Lower Back?

The coccyx, or tailbone, is the lowest region of your spine, and it sits directly below the sacrum. Your tailbone is made up of 3 to 5 small bones that naturally fuse together by about age 30. It’s positioned at the bottom of your spine, and the coccyx helps support your weight while you sit.

The coccyx, or tailbone, is the lowest region of your spine, and it sits directly below the sacrum. Photo Source: 123RF.com.

Coccydynia Risk Factors

While the medical community doesn’t know the prevalence of coccydynia, they have found that the condition is more likely to affect:

• Adolescents and adults
• Women
• People who are obese

Being female and obese are the 2 biggest risk factors. Women are affected by coccydynia 5 times more than men, which is likely due to injuries during childbirth. Also, the female coccyx is positioned farther back than its male counterpart, making it more vulnerable to trauma.

Researchers believe obesity causes coccydynia because extra weight can alter how a person sits. Plus, more weight puts additional pressure on the coccyx.

A common cause of coccydynia is repetitive movement, such as extensive bike riding. Photo Source: iStock.com.

Coccydynia Causes

Coccydynia has several possible causes, the 3 most common being:

1. Trauma from falling or being bumped
2. Repetitive action, such as extensive bike riding or rowing
3. Childbirth

These activities can fracture, dislocate or bruise the tailbone. If this occurs, you may experience painful inflammation and muscle spasms in the tailbone area.

Other possible causes of coccydynia include:

• Bone spurs on the coccyx: A small bone spur on the lowest part of the coccyx can pinch the surrounding area, and cause pain and discomfort while sitting.

• Joint instability: Coccydynia can occur if the sacrococcygeal joint (which connects the coccyx and sacrum) allows too much or too little movement.

• Osteoarthritis (eg, spinal arthritis)

• Infection, metastatic cancer, chordomas, and arachnoiditis are rare causes.

Tailbone pain and lower back pain can mimic coccydynia in sciatica, infection, pilonidal cysts (a type of skin infection), and fractured bone. Your doctor will rule out these causes to make a coccydynia diagnosis.

How Doctors Diagnose Coccydynia

The doctor primarily relies on your medical history and a physical exam to diagnose coccydynia. While imaging scans are typically not needed, your doctor may order a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan if he or she suspects a separate bone, nerve or tissue problem to be the cause of your tailbone pain.

Your medical history is important, as your doctor wants to know whether you’ve been through a fall, accident, or other recent trauma that may have caused your tailbone pain.

After reviewing your medical history, your doctor conducts a physical exam and asks you about your symptoms. Coccydynia pain is usually localized to your tailbone area, which makes it relatively straightforward to diagnose. Your doctor wants to know whether you have tailbone pain when sitting or leaning back. He or she may also ask you to point to where you feel pain. Pointing to the tailbone may be enough to distinguish your pain as coccydynia (as opposed to another low back pain condition). Your doctor may also touch your tailbone area to feel for areas of inflammation.

Nonsurgical Treatment for Coccydynia

Fortunately, conservative therapy is extremely effective for coccydynia. In fact, 90% of people experience a reduction in pain using nonsurgical means or without any medical intervention.

Coccydynia is usually first treated with these noninvasive methods:

• An ice pack or heating pad can help provide immediate, short-term relief.

• A “donut” or “wedge” cushion provides extra padding to take pressure off your coccyx while sitting. These special cushions are readily available at retail pharmacies.

• Avoid extended sitting (such as a long-haul flight) will help prevent additional pain and injury.

• Rest also plays an important part to help avoid further injury to the tailbone during recovery.

If you still have tailbone pain after trying these conservative therapies, your doctor may recommend over-the-counter or prescription-strength non-steroidal anti-inflammatory drugs (NSAIDs) or other pain medications for relief. If your pain isn’t responding to oral medication, your doctor may give you a cortisone injection or local spine nerve block to send powerful pain relief directly to your tailbone area.

A Rare Option: Surgery for Coccydynia

If you’ve exhausted all other treatment options with no success, surgery may be the next step. The surgical procedure for coccydynia is called a coccygectomy, or removal of the tailbone.

Like all surgeries, coccygectomy bears potential risk that you and your surgeon will discuss before the procedure is performed. These risks include infection, hematoma (an abnormal collection of blood outside an artery or vein), and possible perineal hernia (weakened pelvic muscles supporting the rectum) later in life.

What to Do When Coccydynia Becomes Chronic

A small portion of people with coccydynia develop chronic coccydynia, which means tailbone pain that lasts for more than 2 months. Chronic coccydynia can take a major toll on your quality of life, so talk to your doctor if your symptoms aren’t going away. He or she may refer you to a doctor who specializes in coccydynia pain management.

Protect Your Tailbone

There is no definitive way to prevent coccydynia, but you can reduce your risk for tailbone pain by using caution while participating in certain sports (eg, skating [ice, inline, and roller], biking, and horseback riding) and by taking extra care when walking in icy or hazardous conditions to prevent falls.

90,000 prices for surgery in the Medvedev clinic

A coccyx cyst (fistula) is one of the most difficult and delicate health problems. This term includes varieties of congenital epithelial abnormalities that develop in the form of a subcutaneous cavity filled with purulent secretions. A cyst is a consequence of the inflammation taking place inside.

The disease has other names – epithelial coccygeal passage, pilonidal cyst, dermoid sinus, coccyx fistula.The place of origin and stages of development can be different. The dermoid cyst is usually located close to the skin surface, the epithelial coccygeal passage is in the deep subcutaneous layers, the pilonidal sinus appears as a result of hair ingrowth under the skin, and the tailbone fistula occurs when any of the previous types of ailment suppuration.

The described problems with the coccyx occur in men and women, but according to statistics, the stronger sex suffers from them 3 times more often.The delicacy of the problem lies in the localization of the pathological focus. The formation is located in an intimate place – the area of ​​the coccyx, sacrum and intergluteal fold. When such a problem arises, not everyone can voice it. Not everyone is ready to discuss discomfort even with doctors.

Causes of coccyx cyst

Even in the process of embryo formation, the reduction of muscles and ligaments in the coccyx area may be impaired. Development continues, but prevents the sealing of the sinus course.The result is the formation of a hollow fistulous tract in the tissues, in which the cyst grows.

The reason for this phenomenon is a genetic factor – a deviation in the development of the coccyx can be inherited. Sometimes this is facilitated by disruptions occurring in the body of a pregnant woman, and further disturbances in the formation of the embryo.

But there is an opinion that pathology is not always exclusively congenital in nature. The growth of a cyst can be provoked by factors:

• bruises in the region of the sacrum, coccyx;
• physical inactivity;
• disregard for hygiene rules;
• weakened immunity;

90,020 diaper rash, bedsores;

• hypothermia of the body, especially the lower part of the body;

90,020 infections.

Excessive sweating, excessive hair growth in the lumbar region and buttocks, and disturbances in the functioning of the sebaceous glands can lead to an exacerbation of inflammation. The acute stage occurs due to blockage of the cavity lined with epithelium. It accumulates skin particles, sebum, dirt, hair. They enter through a small opening in the skin that communicates with the cavity. The outer plug makes it difficult to remove organic products to the outside, and therefore they rot inside the cyst capsule.

Coccyx cyst symptoms

Clinical manifestations of the disease in the phase of inflammation are pronounced. The patient suffers from acute throbbing pain in the coccyx region. They intensify if you start to move actively or just change the position of the body.

Can also be observed:

• redness on the skin at the site of inflammation;
• discharge of purulent masses from the opening of the cavity;
• secondary holes – for removing infiltrate or healed;
• lump in the upper part of the intergluteal fold, which interferes with movement and is felt as a foreign object;
• fever, swelling in the region of the lower part of the spinal column – if there is an infectious lesion.

The epithelial coccygeal passage can be uncomplicated and complicated. In the first case, the patient feels normal, sometimes mild dull pains, small discharge make themselves felt. In the second case, abscesses and fistulas develop. This is accompanied by hyperemia and edema, cutting, sharp pain.

Diagnostics and methods of treatment of coccyx cyst

The disease can flow into a chronic one and cause various complications.Therefore, it is important to go to the clinic as early as possible. A diagnosis by a proctologist is possible already during the initial examination. Sometimes, to clarify the presence of pathology, ultrasound and X-ray of the pelvic region are done.

For treatment, doctors use conservative methods. The therapy is of a preventive nature, the actions of specialists are aimed at relieving acute inflammatory processes. For this, the patient is prescribed non-steroidal anti-inflammatory drugs (aspirin, ibuprofen, ketoprofen).Complete removal of the formation can be achieved through surgery. The sooner this is done, the less the likelihood of unwanted complications.

How is coccyx cyst removal performed

Usually, the removal of the coccyx cyst is a planned event. The best option is for the operation to take place during the period of remission of the disease. Before surgery, you need to follow a number of rules:

• the hair on the operated area is removed;
• the intestines should be cleansed with an enema;
• 12 hours before the procedure, stop eating.

Complete elimination of the pathology is possible only by removing the coccyx cyst with the external opening and its branches. Therefore, the surgeons of the multidisciplinary clinic “International Center for Health Protection” conduct a detailed examination and sanitation of the inflammation focus.

Operation stages:

• Introduction of anesthesia. Its type is selected personally, depending on the characteristics of the organism.
• Elimination of the pathological site. With the help of surgical instruments, the patient is removed the epithelial canal and primary openings.
• Wound suturing. Donati sutures are applied to stop bleeding and accurately match the edges of the wound.

Using the SURGITRON radio wave scalpel

The modern method of treating this pathology is the removal of the coccyx cyst with a radio wave scalpel. This is the most painless and safe procedure for the body, involving excision of the neoplasm. Depending on the depth of the lesion of the skin of the sacrum and coccyx, the longest duration of it is an hour.The impact is concentrated only on the affected cells. Healthy tissues are subject to minor damage. This removal of the cyst does not leave noticeable scars on the skin. The coagulating property of the equipment eliminates the possibility of bleeding from the affected vessels or wound infection.

Recovery period after elimination of coccyx cyst

After removal of the neoplasm, the wound is treated daily, the dressings are changed. The stitches are removed 10-14 days after surgery.During this period, it is recommended to treat the wound with a chlorhexidine solution or other antiseptic.

In the first month after the elimination of the coccyx cyst, any physical activity is prohibited. Experts advise not to sleep on your back or sit on hard surfaces. A return to a normal rhythm of life is possible after 5-6 weeks.

This neoplasm in the coccyx region is characterized by favorable prognosis. Surgical intervention usually excludes the likely occurrence of relapses, which is confirmed by positive patient reviews.

Complications

Complications of a coccyx cyst appear in extremely rare cases. These include:

• acute inflammation that has spread to healthy cellular tissues;
• purulent and inflammatory lesions of adjacent tissues;
• single or multiple fistulas;
• cutaneous eczema.

The practice knows cases when the development of pathology lasted more than 20 years and during this time the patients never asked for medical help.

Benefits of the “International Health Center”:

• General medical services.
• Help from highly qualified doctors trained in the Russian Federation and abroad.
• Survey on high-precision safety equipment.
• Comfortable environment for patients and their families.
• Price transparency. All required services are already included in the price.
• Respectful and friendly attitude of health professionals of all levels.
• Profitable special offers, discounts, promotions, installments, work with VHI policies.
• The level of quality of the services provided is confirmed by the international TUV certificate.
• Convenient location in the center of Moscow – at st. Oktyabrskaya, 2 (metro Dostoevskaya – 5 minutes on foot, metro Novoslobodskaya – 15 minutes on foot).

“International Center for Health Protection” carries out the removal of coccyx cysts in Moscow. Here you can undergo a comprehensive examination, laboratory and instrumental diagnostics, get advice from qualified doctors.

The price for this operation starts from RUB 8000 . For more information on the removal of a neoplasm, please contact our consultants. You can make an appointment by calling +7 (495) 681-23-45.

Epithelial coccygeal passage: symptoms, diagnosis, treatment without relapse

Epithelial coccygeal passage, or pilonidal cyst, is a disease in the sacrum and coccyx, with an exacerbation of which there is damage to the skin and subcutaneous fat.A pilonidal cyst is a capsule-shaped cavity that is located under the skin in the intergluteal fold. This cavity contains hair, sebum, bacteria accumulate. The cyst has a communication with the skin – fistulous passages in the fold between the buttocks.

Stages of pilonidal cyst formation

1. Several primary sinus tracts are located in the crease between the buttocks. Through them, the contents of the cyst are periodically excreted in small quantities. At this stage, the disease is asymptomatic.
2. As the subcutaneous cyst grows, larger secondary fistulous passages join the primary fistulous passages. Through these wide channels, the contents of the cyst come out to the outside in a larger volume.
3. Pilonidal abscess – cyst suppuration. It occurs when the existing fistulous passages are not enough for the release of pus to the outside. The acute form is characterized by soreness of the tissues in the area of ​​the cyst, an increase in temperature, an increase in the release of pus with an unpleasant odor, it is difficult for the patient to sit

Treatment of epithelial coccygeal passage both in the acute period and without exacerbation occurs only by surgery.

Diagnosis of epithelial coccygeal passage includes interrogation, visual examination of the patient by a proctologist and digital examination. This is usually enough to make a diagnosis. If it is necessary to clarify the diagnosis and exclude other diseases masquerading as symptoms of a pilonidal cyst, tomography of the lumbosacral spine, ultrasound of soft tissues, fistulography can be prescribed to determine the position of the fistulous passages and their connection with the cyst.

In the Odrex clinic, surgical treatment of the epithelial coccygeal passage is carried out using the marsupialization method. The technique shows good results both with uncomplicated cysts and with extensive cysts in the stage of acute inflammation. Removal of the epithelial coccygeal passage is carried out simultaneously, by excision of all pathological tissues: cysts, fistulous passages, old scars – to the periosteum. The postoperative wound is partially sutured. This is done to reduce the volume of the wound and speed up healing.Moreover, in comparison with the closed method of surgical treatment, the affected area is better cleared of possible remnants of necrotic tissue, hair follicles, and fragments of the epithelial passage.

And most importantly, this method minimizes the likelihood of complications and relapses of the disease.

The operation is performed under general or spinal (epidural) anesthesia. The duration of the operation is from half an hour to 1 hour.

After the operation, it is necessary to be in stationary conditions in a supine position for at least 5 days so that the stitches do not cut through.The stitches are removed on day 12. During this period, the patient comes to the hospital several times for medical supervision and planned dressings. Full recovery after surgery takes up to 1 month. At this time, the patient is advised to limit physical activity, avoid prolonged sitting.

In some cases, the operation can be divided into two stages. The decision is made by the doctor depending on the patient’s condition, the stage of the disease, the type of cyst and fistulous passages. Two-stage treatment is used in the case of advanced cyst abscesses with multiple fistulous tracts.First, measures are taken to eliminate the inflammatory process, and after a few months, a radical removal of the epithelial coccygeal passage and cysts is performed in a planned manner. By itself, opening an abscess does not cure the disease. If you do not eliminate the cavity in the subcutaneous fat, which is the cause of the disease, relapses of the disease will occur.

Causes of epithelial coccygeal passage

There are two main approaches to explain the occurrence of the epithelial coccygeal passage.It is assumed that it is associated with abnormalities in the developmental stage of the embryo. In this case, channels remain under the skin in the coccyx area, which appear on the skin as small holes, similar to enlarged pores. The canals are covered from the inside with epithelial tissue with hair follicles, sebaceous and sweat glands. Inflammation of the epithelial coccygeal passage usually occurs during puberty, when intense hair growth and sebum production begins. According to another theory, the epithelial coccygeal passage is formed due to the anatomical and hormonal characteristics of a particular person.Factors such as deep intergluteal fold, pronounced buttocks, excessive hair growth can lead to ingrowth of hair into the skin and the formation of an epithelial coccygeal passage.

Question – Answer

Does the epithelial coccygeal passage extend to bone tissue?

As a rule, the disease does not affect the bone, rectum and colon.

What external factors provoke inflammation of the epithelial coccygeal passage?

A patient may not be aware of the existence of a coccygeal cyst for a long time.Under unfavorable circumstances, such as trauma, hypothermia, decreased immunity, the pilonidal cyst becomes inflamed, and suppuration occurs. The disease is manifested by pain, redness. Pus can burst through the fistula. Symptoms of inflammation of the epithelial coccygeal passage may decrease, but this is a temporary improvement – until the next provoking situation.

Who is more likely to have a pilonidal cyst?

The disease is common among both men and women.Inflammation of the epithelial coccygeal passage in men occurs several times more often.

Can a coccyx cyst recur after surgery?

Recurrence of the disease may occur due to incomplete removal of the epithelial passage or re-ingrowth of hair into the healing wound. With the correct choice of the method of surgery and adherence to hygiene recommendations, the risk of recurrence is minimized.

Is it possible to treat the epithelial coccygeal passage without surgery?

It is impossible to recover without surgery.Moreover, if there is a constant tissue inflammation for a long time, the coccygeal cyst may degenerate into a malignant formation (sarcoma).

90,000 Proctology!

Definition:
Quite often there is a congenital pathology of the development of soft tissues in the region of the sacrum – the epithelial coccygeal passage.This disease in most cases is asymptomatic, and only in the presence of inflammation, patients go to the doctor. This pathology is most often seen in young men, most likely due to increased hair growth in this area. According to ICD 10, the disease is called a pilonidal cyst or pilonidal sinus. You can also find such designations of this condition as coccygeal fistula, coccyx cyst, epithelial coccygeal cyst. This is a congenital pathology and is characterized by the presence of a narrow channel in the subcutaneous tissue in the area of ​​the intergluteal fold.Usually this course looks like a narrow tube 2-3 centimeters long, and is directed towards the coccyx. But the canal is not connected with bone tissue, but ends blindly in the subcutaneous tissue. Inside it is the epithelium with hair follicles, sebaceous and sweat glands. The other end of the epithelial coccygeal passage opens with one or more holes just above the anus, usually between or just above the buttocks. According to these signs, three types of pilonidal cysts are distinguished: uncomplicated, which may not manifest itself in any way throughout a person’s life, acute and chronic inflammation.Suppuration of the canal goes through the stages of infiltration and abscess. If the abscess opens on its own, a secondary opening of the coccygeal passage forms. This usually leads to chronic inflammation. Then the suppuration recurs, causing the formation of fistulas.

Reasons for occurrence:
Now there are two theories regarding the cause of such a defect. Most scientists believe that this is a congenital pathology.Such a channel is formed even in the process of intrauterine development. The rudimentary tail, which is present in all embryos up to 5 weeks, for some reason remains in the form of a tube lined with epithelium inside. Such a defect occurs in newborns quite often. But abroad, doctors identify other causes of the pathology. Due to the fact that inflammation is very rare in a child, and most often such a defect develops with increased hair growth in the intergluteal region, it is called a hair cyst.It is believed that it appears due to abnormal growth or ingrowth of hair into the skin of the gluteal fold.

Clinical manifestations:

The only symptom may be a fossa or small holes in the gluteal fold.Only when hair growth begins, the active work of the sebaceous and sweat glands, certain signs of the disease may appear. This is most often a slight itching, discharge from the primary openings, increased humidity in the intergluteal fold, sometimes a bundle of hair grows from the canal. A suppurative epithelial passage has more pronounced symptoms. But patients often mistake them for the consequences of trauma, therefore, the correct treatment of the disease does not always begin on time. The following symptoms indicate the presence of inflammation:
1.Pain in the coccyx and sacrum, especially worse when sitting;
2. the skin around the canal becomes dense, redness and swelling are noticeable;
3. There is a discharge of ichor, and then pus from the holes of the passage;
4. Chronic, recurrent abscess occurs without treatment;
5. fistulas appear;

Treatment:
The only effective treatment for ECH is surgery.The operation is performed according to two methods: radical or palliative. In the first case, the surgeon completely removes the walls of the passage with the primary and secondary holes and the inflamed tissue adjacent to the passage, then sutures. In the second, the abscess is opened and drained. Radical removal is performed in a planned manner in the absence of acute inflammatory processes (uncomplicated form of ECC). The palliative method provides for the treatment of the epithelial coccygeal passage in two stages: curing abscess, abscesses by opening or local excision with subsequent removal general inflammation, then – the appointment of a planned radical surgery.In the proctology department of the Road Clinical Hospital at st. Irkutsk-Passenger uses surgical techniques aimed at the fastest possible rehabilitation of patients in the postoperative period. In the case of an uncomplicated form of the epithelial coccygeal passage, an operation is used – sinusectomy with the SURGITRON apparatus. The advantage of this type of surgical intervention is to minimize surgical trauma, the absence of deformation of the soft tissues of the intergluteal fold, which in turn leads to early rehabilitation and a good cosmetic result.For complicated secondary fistulas and recurrent forms of the epithelial coccygeal passage, the department uses a technique with excision of soft tissues in the intergluteal fold containing a fistula and the passage itself with plastic replacement of the soft tissue defect (Limberg plastic). This technique prevents the recurrence of the disease and provides a good functional result in comparison with traditional methods of surgical treatment.

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Lower back pain radiates to the right buttock

Root Causes

Sedentary work, sedentary lifestyle.In a sitting position, the main load falls on the pelvic region and the lumbar spine. If a person spends a lot of time without changing posture, blood circulation in the small pelvis is disturbed, oxygen starvation of the muscles occurs, and improper posture can cause diseases of the spine and pinching of nerve endings.

Contusion of the gluteal muscles after a fall or impact. In this case, the pains are quite intense, there is discomfort when sitting, touching the damaged area.Injury to the buttocks can also result from the injection. Sometimes an abscess may occur due to an incorrect injection. In this case, the pain, in the meantime, does not go away, but only intensifies, a seal is felt at the injection site or, on the contrary, tissue softening, the temperature may rise.

Chronic stress. Under stress, all muscles are tense, the body reflexively prepares for a blow. If this condition does not go away for a long time, muscle spasm occurs.

Excessive physical activity.In this case, the pain arises immediately after the traumatic movement, it is sharp, shooting, and can turn into a burning sensation.

Pregnancy. The growing fetus puts more stress on the spine and joints. If a woman does not follow the precautions: does not wear a prenatal bandage, puts on high heels, wears heavy things, the ilio-sacral joints may suffer.

Pilonidal cyst. It is a congenital pathology – epithelial coccygeal passage. It may not make itself felt for many years, but is at risk of infection and inflammation.In this case, an abscess is formed. Characterized by severe pain, an increase in body temperature, fistulas can form in the fold between the buttocks, through which pus is secreted.

Diseases of the musculoskeletal system. They can be divided into several large groups.

Spinal pathologies: osteochondrosis of the lumbar spine (aching pains that intensify with stress), intervertebral hernias (fraught with pinching of nerve endings, which causes constant severe pain), lumbar myelitis (inflammation of the spinal cord), spinal tumors and tailbone injury.

Inflammatory diseases of the hip joint (bursitis, coxarthrosis, arthritis).

Myositis – muscle inflammation. It can be caused by infections, injuries, autoimmune diseases. Characterized by constant severe pain, aggravated by exertion, weakening of muscle strength.

Trochanteritis – inflammation of the femoral muscles. Paroxysmal pain is characteristic.

Neuralgias, among which the most common is radiculitis (mainly in elderly patients), as well as sciatica – compression of the sciatic nerve.In this case, the pain captures the entire leg, the limb is limited in movement, the nature of the pain is acute.

Diseases of internal organs

The lower back and the right buttock often hurt with gynecological pathologies (fibroids, malignant neoplasms in the uterus, oncology or a cyst of the right ovary).

In case of urolithiasis, pain can radiate to the lower back with complete or partial blockage of the right ureter with a stone.

Diseases of the rectum (hemorrhoids, proctitis, colitis, malignant tumors) more often cause pain in the left buttock.

Treatment

If the lower back hurts on the right and gives it to the right buttock, most often this is a consequence of problems with the joints and the spine, therefore, first of all, it is advisable to consult an orthopedic doctor, neurologist or chiropractor. Treatment for the spine and joints usually includes massage, physical therapy, and remedial gymnastics. In advanced cases, for example, with herniated intervertebral discs, surgical intervention may be necessary.

It is also desirable to be examined by a gynecologist and proctologist.

Prevention of back pain:

• Regular exercises for the back and limbs, especially in sedentary work;
• Strengthening the back muscles by swimming;
• Relaxation of muscles with massage;
• Weight and posture control;
• Compliance with the correct technique for performing strength exercises in training;

But the most important thing in prevention is a timely appeal to a specialist if a problem has already appeared.Treatment of the back and spine will cost much less money and effort if it is started in the early stages of the disease.

90,000 Coccyx pain: possible causes and therapy

Coccyx pain is rare. Sometimes it causes severe discomfort and leads to a breakdown in the usual rhythm of life. There are times when the pain goes away on its own without serious complications. However, in most cases, this type of discomfort indicates serious pathological changes in the body.Pain in the tailbone area is a reason to see a therapist who will refer you to a neurologist or orthopedist and traumatologist.

Anatomy

The tailbone is the end of the spinal column. By means of a semi-movable joint, it is attached to the sacrum and is essentially considered a rudiment.

A person may often experience pain in the tailbone area when standing up. What does it mean?

This bone includes several vertebrae, called caudal, which are not separated by scientists and are perceived as a solid structure.The shape of the tailbone is similar to the sacrum, it forms the bowl of the human pelvis. In total, the anatomy distinguishes four configurations of the coccyx, the difference between which is in the direction and angle between the coccyx and the sacrum. It is believed that for the most part idiotic pains, that is, those that appear without specific and obvious reasons, fall on the last, fourth type.

Contrary to its rudimentary origin, the tailbone has a number of functions. For example, tendons, muscles and ligaments are attached to it, the functionality of which includes support of internal organs and the formation of the pelvic floor.In addition, while sitting, a person’s weight is distributed to the tailbone and ischial bones.

Symptoms

Coccygodynia or coccyx pain most often occurs in people over 40. In women, this phenomenon occurs much more often than in men. The following symptoms are characteristic of coccygodynia:

1. Feeling of discomfort during intercourse.
2. Difficulty defecation occurs in rare cases.
3. Leaning forward while seated provides pain relief.
4. The pain becomes more intense when getting up from a place and when sitting on a hard surface for a long time.
5. Palpation of the coccyx area is painful.
6. Pain syndrome is clearly localized and focused on the coccyx.

There are other symptoms and signs of this syndrome, but they differ depending on what caused the pain in the coccygeal bone. In any case, if pain occurs in the coccyx area, you should consult a doctor, as this may indicate the presence of a serious pathology of the spine.

Trauma as a cause of coccygodynia

Trauma to the coccyx is the most common cause of pain. The following types of injuries can cause the syndrome:

1. Injuries during childbirth.
2. Exposure to the coccyx of a chronic nature, such as when cycling.
3. Blow directly to the coccyx. This can happen during martial arts training.
4. Fall on the coccygeal bone in a sitting position.

Time after injury

It can take a long time between a fall or impact and the first symptoms of coccygodynia.For this reason, it is often difficult to correlate existing complaints with the trauma that has occurred. In most cases, the fracture is the result of a strong blow to the coccyx, and subluxation occurs most often during childbirth.

Difficult childbirth

When childbirth proceeds normally, the tailbone moves backward as the baby moves along the birth canal. This allows the pelvic bones to expand to facilitate the release of the fetus. However, in the case of difficult labor, the tip may cross existing boundaries, resulting in a dislocation.At the same time, the bone becomes too mobile and delivers painful sensations when sitting and standing up.

When is coccyx pain in women possible?

During pregnancy

Pain in the coccygeal bone may also occur during pregnancy, but this phenomenon is considered physiological and should not cause concern. The woman’s ligaments during this period are in constant tension and in a state of high stress, which leads to coccygodynia. Such sensations go away on their own, but it is necessary to tell the doctor about them, since pain may indicate the presence of a tumor, cyst or hemorrhoid.

What are other possible causes of pain in the coccyx while sitting?

Pilonidal disease

Pilonidal cyst or epithelial coccygeal passage is a pathological process that begins in the hair follicle on the skin of the back in the coccyx region. Hair that has grown under the skin allows bacteria to penetrate into the hole. This process provokes the development of a cyst, which can rupture and come out in the form of pus. This disease is very uncomfortable.However, sometimes the disease passes latently and is detected randomly with complaints of back pain in the coccyx area.

It is believed that a genetic predisposition to cyst formation plays an important role in the formation of cysts. Other factors that can lead to pilonidal disease are overweight, inadequate personal hygiene, a sedentary lifestyle, and profuse body hair growth. In America, this disease is called jeep disease, which is associated with complaints of American soldiers about ruptured abscesses after a long off-road jeep ride.After all, pain in the coccyx in men often goes unnoticed.

Signs

Signs of pilonidal disease are:

1. Soreness in the area of ​​cyst formation.
2. Swelling and redness of the skin around the affected area.
3. Visualization of passages and holes after cyst breakthrough.
4. Increased body temperature.

Ultrasound and X-ray examinations are performed to confirm the diagnosis.Sometimes a cytological examination of the contents of the cyst is carried out. Therapy for suppuration consists in opening the abscess surgically and cleansing the resulting wound from pus. If there are several fistulous passages, then during the preoperative preparation, a special dye is injected into them. During the surgical intervention, all passages are excised, and after cleansing, a sterile bandage is applied. If necessary, after the operation, drugs from a number of antibiotics can be prescribed. Quite often, pilonidal disease reappears.The causes of pain in the coccyx area should be identified in a timely manner.

Diagnostic methods

There are several methods to identify the cause of pain in the coccygeal bone. The most common are:

1. Palpation. This is the first thing the doctor does when examining. Palpation is performed to determine the localization of pain. It is checked whether the pain increases with pressure on the coccyx. The affected area can be up to 6 centimeters around the tail bone.Feeling the coccyx during a rectal examination is also a very informative diagnostic method. This procedure makes it possible to assess the mobility of bones and exclude the presence of a tumor in the rectum or vagina.
2. X-ray examination. Allows you to determine the presence of fresh or even old injuries that can cause pain. It should be borne in mind that in many people, the structure of the tailbone may have individual characteristics and they are not always pathological.Therefore, X-ray is not a highly accurate diagnostic method.
3. MRI and ultrasound. The latter study makes it possible to exclude the presence of inflammatory diseases or neoplastic neoplasms. Magnetic resonance therapy allows for differential diagnosis in order to exclude diseases of the spinal column, including hernias. Also, MRI helps to exclude pathologies of the bladder and the female reproductive system.
4. Bone scintigraphy. It is carried out in case of suspicion of spinal metastasis.During the study, a radioactive isotope is introduced into the body with further registration of its radiation.

Treatment

Therapy for pain in the coccyx area is carried out depending on the cause that caused it. If this is an inflammatory process, then antibacterial therapy is prescribed, as well as anti-inflammatory drugs. Neoplasms of a benign or malignant type imply chemotherapy and surgery. A fracture or dislocation may require reduction.

Standard therapy

If coccygodynia is diagnosed, the standard therapy is as follows:

• Non-steroidal anti-inflammatory drugs. This is symptomatic treatment. It is performed to relieve pain in order to improve the patient’s standard of living. All drugs in this series have similar contraindications and side effects. It is not recommended to use them for more than 5 days.
• Laxatives. Appointed if coccygodynia provoked problems with bowel movements.This is a psychological problem caused by the need to push, which can cause severe pain.
• Local anesthesia. It is used in cases where oral administration of pain medications does not give a result. Most often, the injection is made directly into the area of ​​the coccygeal bone.
• Orthopedic pillows. They are special pillows in the shape of a donut or wedge. These devices allow you to take the load off the tailbone and avoid contact with a hard surface.

• Physiotherapy will help relieve lower back pain in the coccyx area. Prescribed after the removal of inflammation. This can be either magnetic, laser or ultraviolet treatment, or paraffin applications, etc. The purpose of the procedures is to relieve muscle spasms.
• Surgical removal of the tailbone. It is used very rarely. The operation is called coccycotomy. It is prescribed in cases where other methods of treatment are ineffective. Postoperative rehabilitation takes quite a long time, and the risk of complications is quite high, so this method is used only with the worst prognosis for the patient.

Only a comprehensive treatment under the supervision of a doctor will help to get rid of back problems forever.

Tsiprolet instructions for use, price in pharmacies in Ukraine, analogues, composition, indications | Ciprolet film-coated tablets from Dr. Reddy’s Laboratories Ltd “

Pharmacodynamics. Tsiprolet is an antimicrobial drug of the fluoroquinolone group. The mechanism of action of ciprofloxacin is associated with the effect on the DNA gyrase (topoisomerase) of bacteria, which plays an important role in the reproduction of bacterial DNA.Tsiprolet has a fast bactericidal effect on microorganisms that are both at rest and reproducing.

The spectrum of action of the Ciprolet drug includes the following types of gram-negative and gram-positive microorganisms: E. coli, Shigella, Salmonella, Citrobacter, Klebsiella, Enterobacter, Serratia, Hafnia, Edwardsiella, Proteus (indole-positive and indole-negative), Morganella, Provincia , Vibrio, Aeromonas, Plesiomonas, Pasteurella, Haemophilus, Campylobacter, Pseudomonas, Legionella, Neisseria, Moraxella, Branhamella, Acinetobacter, Brucella, Staphylococcus, Streptococcus agalactiae, Listeria, Corynebacter 37 forms of bacteria. Gardnerella, Flavobacterium, Alcaligenes, Streptococcus pyogenes, Streptococcus pneumoniae, Streptococcus viridans, Mycoplasma hominès, Mycobacterium tuberculosis, Mycobacterium fortuitum show different sensitivity. Anaerobes, with some exceptions, are moderately sensitive ( Peptococcus, Peptostreptococcus ) or resistant ( Bacteroides ). Tsiprolet is effective against β-lactamase-producing bacteria. Tsiprolet is active against pathogens resistant to almost all antibiotics, sulfa and nitrofuran drugs.More often resistant: Streptococcus faecium, Ureaplasma uralyticum, Nocardia asteroides, Treponema pallidum . Resistance to the drug Tsiprolet develops slowly and gradually.

Pharmacokinetics. Tsiprolet is rapidly and well absorbed after taking the drug (bioavailability is 50–85%). C _max in blood plasma is reached after 60–90 minutes. The volume of distribution is 2-3 l / kg of body weight. Plasma protein binding is insignificant (20-40%). Tsiprolet well penetrates organs and tissues, bones.In ≈2 hours after ingestion, it is distributed in tissues and body fluids in concentrations many times higher than its concentration in blood plasma.

Tsiprolet is excreted from the body mainly unchanged: mainly by the kidneys (50–70%). T _½ from blood plasma after oral administration is from 3 to 5 hours. A significant amount of the drug is also excreted in the bile and feces (up to 30%), therefore only significant renal dysfunction leads to a slowdown in excretion.

Tsiprolet is indicated for the treatment of the following infections (see SPECIAL INSTRUCTIONS and PHARMACOLOGICAL PROPERTIES). Before starting therapy, special attention should be paid to all available information on ciprofloxacin resistance.

Official guidelines for the proper use of antibacterial drugs should be considered.

Adults

• Lower respiratory tract infections caused by gram-negative bacteria:

– Exacerbation of COPD.

– Bronchopulmonary infections with cystic fibrosis or bronchiectasis.

– Pneumonia.

• Chronic suppurative otitis media.
• Exacerbation of chronic sinusitis, especially if it is caused by gram-negative bacteria.
• Urinary tract infections.
• Gonococcal urethritis and cervicitis.
• Orchoepididymitis, in particular caused by Neisseria gonorrhoeae .
• Inflammatory diseases of the pelvic organs, in particular caused by Neisseria gonorrhoeae .

For the above genital tract infections, when Neisseria gonorrhoeae is known or suspected of being the causative agent, it is especially important to obtain local information on ciprofloxacin resistance and confirm susceptibility based on laboratory tests.

• Gastrointestinal tract infections (eg traveler’s diarrhea).
• Intra-abdominal.
• Skin and soft tissue infections caused by gram-negative bacteria.
• Severe otitis media of the external ear.
• Infections of bones and joints.
• Treatment of infections in neutropenic patients.
• Prevention of infections in neutropenic patients.
• Prevention of invasive infections caused by Neisseria meningitidis .
• Pulmonary anthrax (post-exposure prophylaxis and radical treatment).

Children and adolescents

• Bronchopulmonary infections in cystic fibrosis caused by Pseudomonas aeruginosa ( Pseudomonas aeruginosa ).
• Complicated urinary tract infections and pyelonephritis.
• Pulmonary anthrax (post-exposure prophylaxis and radical treatment).

Ciprofloxacin can be used to treat severe infections in children and adolescents when deemed necessary by a physician.

Treatment should only be initiated by a physician experienced in the treatment of cystic fibrosis and / or severe infections in children and adolescents (see SPECIAL INSTRUCTIONS and PHARMACOLOGICAL PROPERTIES).

the dose is determined according to the indications, the severity and site of infection, the sensitivity of the organism (organisms) – the causative agent (s) to ciprofloxacin, the patient’s renal function, and in children and adolescents – by body weight.

The duration of treatment depends on the severity of the disease, the characteristics of the clinical picture and the type of pathogen.

Treatment of infections caused by certain bacteria (eg Pseudomonas aeruginosa, Acinetobacter or Staphylococci ) may require high doses of ciprofloxacin and other necessary antibacterial drugs.

Treatment of certain infections (eg, pelvic inflammatory disease, intra-abdominal infections, infections in neutropenic patients, bone and joint infections) may require concomitant administration of other necessary antibacterial drugs, depending on the type of pathogen identified.

Adults

Children and adolescents

Readings

Daily dose, mg

Duration of treatment (may include initial parenteral administration of ciprofloxacin)

Cystic fibrosis

20 mg / kg body weight 2 times a day with a maximum dose of 750 mg

10-14 days

Complicated urinary tract infections and pyelonephritis

10-20 mg / kg body weight 2 times a day with a maximum dose of 750 mg

10-21 days

Other serious infections

20 mg / kg 2 times a day at a maximum dose of 750 mg

According to the type of infection

Elderly patients

Elderly patients are prescribed the drug in a dose, according to the severity of the infection and the patient’s creatinine clearance.

Renal and hepatic failure

Recommended starting and maintenance doses for patients with impaired renal function:

In patients with hepatic impairment, there is no need to change the dosage of ciprofloxacin.

No studies have been conducted on the dosing of ciprofloxacin for children with impaired renal and / or hepatic function.

Method of application

Tablets should be swallowed without chewing and washed down with liquid. They can be taken with or without food. When taken on an empty stomach, the active substance is absorbed faster. Ciprofloxacin tablets should not be taken with dairy products (e.g. milk, yoghurt) or fruit juices with added minerals (e.g. calcium-fortified orange juice) (seeINTERACTIONS).

In severe cases or if the patient is unable to take pills (in particular with enteral nutrition), it is recommended to start therapy with the on / in the route of administration of ciprofloxacin until it is possible to switch to oral administration.

the drug should not be used in case of hypersensitivity to the active substance – ciprofloxacin or to other drugs of the fluoroquinolone group, or to any of the auxiliary substances of the drug. The simultaneous use of ciprofloxacin and tizanidine is contraindicated (see.INTERACTIONS).

more often reported adverse reactions to the drug, such as nausea and diarrhea.

Data on adverse reactions to the drug Tsiprolet obtained in clinical trials and post-marketing surveillance (oral, parenteral and sequential administration) are given below.

When analyzing the frequency, data from the oral and intravenous routes of ciprofloxacin are taken into account.

* These reactions were recorded during the post-marketing period and were observed mainly in patients with risk factors for prolongation of the Q – T interval (see.SPECIAL INSTRUCTIONS).

Use in children

The incidence of the above arthropathy is based on data obtained from studies involving adult patients. In children, arthropathy is noted more often (see SPECIAL INSTRUCTIONS).

Also, adverse reactions to the drug have been reported such as allergic edema, decreased appetite and food intake, hypoglycemia, behavioral disturbances, suicidal thoughts, suicide attempt, hyperesthesia, vesicles, acute generalized exanthematous pustulosis, feeling unwell, gait disturbance, increased international normalized attitude (INR) in patients taking vitamin K antagonists, temporary liver dysfunction, pain, increased heart rate, atrial flutter, ventricular ectopia, hypertension, angina pectoris, myocardial infarction, cardiac arrest, cerebral thrombosis, phlebitis, insomnia, manic reaction, ataxia , lethargy, drowsiness, weakness, malaise, phobia, depersonalization, soreness of the oral mucosa, candidiasis of the oral mucosa, dysphagia, intestinal perforation, gastrointestinal bleeding, lymphadenopathy, increased lipase levels, joint disorders, exacerbation of gout, nephritis, polyuria, urinary disorders, bleeding from the urethra, vaginitis, acidosis, breast pain, epistaxis, pulmonary or laryngeal edema, hiccups, hemoptysis, bronchospasm, pulmonary embolism, phototoxic reactions, hot flashes, chills, edema of the face, neck, lips, conjunctiva , hands, cutaneous candidiasis, hyperpigmentation, sweating, decreased visual acuity, double vision, eye pain, taste disturbance, achromatopsia.

Adverse reactions to the drug Tsiprolet registered during post-marketing observation included: agitation, exfoliative dermatitis, erythema, hyperesthesia, hypertension, methemoglobinemia, increased INR in patients taking vitamin K antagonists, candidiasis (oral, gastrointestinal, vaginal) , nystagmus, polyneuropathy, hyperkalemia, changes in prothrombin time, psychosis, increased levels of triglycerides, blood gamma-glutamyltransferase, uric acid, decreased hemoglobin levels, hemorrhagic diathesis, increased monocyte levels, leukocytosis, cylindruria.

severe infections and / or mixed infections caused by gram-positive or anaerobic bacteria

Ciprofloxacin is not used as monotherapy for the treatment of severe infections and infections caused by gram-positive or anaerobic bacteria.

For the treatment of severe infections, infections caused by staphylococci or anaerobic bacteria, ciprofloxacin should be used in combination with appropriate antibacterial agents.

Streptococcal infections (including Streptococcus pneumoniae)

Ciprofloxacin is not recommended for the treatment of streptococcal infections due to insufficient efficacy.

Urinary tract infections

Orchiepididymitis and pelvic inflammatory disease can be caused by fluoroquinolone-resistant Neisseria gonorrhoeae . Ciprofloxacin should be administered concurrently with other appropriate antibacterial drugs, except in clinical situations when the presence of ciprofloxacin-resistant strains Neisseria gonorrhoeae is excluded.If clinical improvement does not occur after 3 days, therapy should be reviewed.

Intra-abdominal infections

Data on the effectiveness of ciprofloxacin in the treatment of postoperative intra-abdominal infections are limited.

Traveler’s diarrhea

When choosing a drug, one should take into account information on the resistance to ciprofloxacin of pathogens in the countries visited.

Bone and joint infections

Ciprofloxacin should be used in combination with other antimicrobial agents, depending on the results of microbiological research.

Pulmonary anthrax

Human use is based on in vitro susceptibility testing , animal studies and limited human use data. The physician should act in accordance with national and / or international anthrax treatment protocols.

Antibiotic-associated diarrhea due to Clostridium difficile

Cases of antibiotic-associated diarrhea caused by Clostridium difficile are known, which can vary in severity from mild diarrhea to fatal colitis, with the use of almost all antibacterial drugs, including the use of the drug Tsiprolet.Treatment with antibacterial drugs alters the normal flora of the colon, which in turn leads to an overgrowth of Clostridium Difficile .

Clostridium difficile produces toxins A and B, which contribute to the development of antibiotic-associated diarrhea. Clostridium difficile produces a large amount of toxin, causes an increase in morbidity and mortality due to the possible resistance of the pathogen to antimicrobial therapy and the need for colectomy.It should be remembered about the possibility of antibiotic-associated diarrhea caused by Clostridium difficile in all patients with diarrhea after antibiotic use. Careful collection of medical history is required, since antibiotic-associated diarrhea caused by Clostridium difficile is possible within 2 months after the administration of antibacterial drugs. If the diagnosis of antibiotic-associated diarrhea due to Clostridium difficile is under consideration or has already been confirmed, antibiotics that do not work on Clostridium difficile may need to be discontinued.Depending on the clinical data, it is required to correct the water-electrolyte balance, consider the need for additional administration of protein preparations, apply antibacterial drugs to which Clostridium difficile is sensitive . There may also be a need for surgery.

Children and adolescents

The use of ciprofloxacin in children and adolescents should be carried out in accordance with current official recommendations.Treatment with ciprofloxacin is carried out only by a physician with experience in managing children and adolescents with cystic fibrosis and / or with severe infections.

Ciprofloxacin caused arthropathy of supporting joints in immature animals. Safety data from a randomized, double-blind study of ciprofloxacin in children (ciprofloxacin: n = 335, mean age 6.3 years; control group: n = 349, mean age 6.2 years; age range 1 year or more) up to 17 years), showed the incidence of arthropathy, which is probably associated with the use of the drug (differs from the clinical signs and symptoms associated with damage to the joints themselves), on the 42nd day from the start of drug use, within 7.2 and 4, 6% for the main and control groups, respectively.The incidence of drug-associated arthropathy after 1 year of follow-up was 9% and 5.7%, respectively. The increase in the number of cases of arthropathies associated with the use of the drug was statistically insignificant. However, treatment with ciprofloxacin in children and adolescents can only be started after a careful assessment of the benefit / risk ratio due to the risk of developing adverse reactions associated with the joints and / or surrounding tissues.

Bronchopulmonary infections with cystic fibrosis

The clinical trials included children and adolescents aged 5–17 years.More limited experience in treating children 1 to 5 years of age.

Complicated urinary tract infections and pyelonephritis

Treatment of urinary tract infections with ciprofloxacin should be considered when no other treatment is possible. Therapy should be based on the results of a microbiological study.

According to clinical studies, the use of ciprofloxacin in children and adolescents aged 1–7 years was evaluated.

Other specific severe infections

The use of ciprofloxacin may be justified based on the results of microbiological testing for other infections according to official recommendations or after a careful assessment of the benefit / risk ratio, when no other treatment can be applied, or when conventional therapy has failed.

The use of ciprofloxacin for specific severe infections other than the above has not been evaluated in clinical trials, and clinical experience is limited. Therefore, caution is advised when treating patients with such infections.

Hypersensitivity to the drug

In some cases, hypersensitivity and allergic reactions are possible after the first dose of ciprofloxacin (see ADVERSE REACTIONS), which should be reported to the doctor immediately.

In isolated cases, anaphylactic / anaphylactoid reactions can progress to a state of shock that threatens the patient’s life. Sometimes they are observed after the first dose of ciprofloxacin. In this case, the administration of ciprofloxacin must be stopped and drug treatment must be carried out immediately (treatment for anaphylactic shock).

Musculoskeletal system

In general, ciprofloxacin should not be used in patients with a history of tendon diseases / disorders associated with the use of quinolones.Despite this, in rare cases, after a microbiological study of the pathogen and an assessment of the benefit / risk ratio, these patients can be prescribed ciprofloxacin for the treatment of certain severe infectious processes, namely in the case of ineffectiveness of standard therapy or bacterial resistance, when the results of microbiological studies justify the use of ciprofloxacin. When using ciprofloxacin, tendonitis or tendon rupture (especially the Achilles tendon), sometimes bilateral, may occur in the first 48 hours of treatment.The risk of tendinopathy may be increased in elderly patients or in persons concomitantly using GCS (see ADVERSE REACTIONS). If any signs of tendinitis occur (such as painful swelling, inflammation), the use of ciprofloxacin should be discontinued. The affected limb should be kept at rest.

Ciprofloxacin is used with caution in patients with myasthenia gravis (see ADVERSE REACTIONS).

Photosensitivity

Ciprofloxacin has been shown to induce photosensitivity reactions.Patients taking ciprofloxacin are advised to avoid direct sunlight or UV radiation during treatment (see ADVERSE REACTIONS).

CNS

Quinolones cause seizures or lower the seizure threshold. Ciprofloxacin is used with caution in patients with CNS disorders who may be prone to seizures. If seizures occur, the use of ciprofloxacin is discontinued (see ADVERSE REACTIONS). Even after the first dose of ciprofloxacin, psychotic reactions can occur.In rare cases, depression or psychosis can progress to suicidal thoughts and actions, such as suicide or attempted suicide. In these cases, the administration of ciprofloxacin is stopped and the measures necessary in this clinical situation are taken.

Cases of polyneuropathy (based on neurological symptoms such as pain, burning, sensory disturbances or muscle weakness, alone or in combination) have been reported in patients taking ciprofloxacin. Taking ciprofloxacin should be discontinued for persons with symptoms of neuropathy, in particular pain, burning, discomfort, numbness and / or weakness, in order to prevent the development of irreversible conditions (see.ADVERSE REACTIONS).

Heart disorders

The use of ciprofloxacin is associated with cases of prolongation of the interval Q – T (see ADVERSE REACTIONS).

Since women tend to have a longer Q – T interval _from compared to men, they may be more sensitive to drugs, leading to a lengthening of the Q – T interval _from . Elderly patients may also be more sensitive to the effects of drugs on the duration of the Q – T interval.Care must be taken when prescribing Ciprolet and drugs that can lead to a prolongation of the Q-T interval (such as class IA and III antiarrhythmics, tricyclic antidepressants, macrolides, antipsychotics) (see INTERACTIONS), or in patients with risk factors for lengthening the Q-T interval or developing bidirectional fusiform ventricular tachycardia (eg, congenital long Q-T syndrome, uncorrected electrolyte disorders such as hypokalemia or hypomagnesemia, and heart disease, such as heart failure, myocardial infarction) or …

GIT

If severe and persistent diarrhea occurs during or after treatment (even several weeks after treatment), the doctor should be informed about it, as this symptom can mask a severe gastrointestinal disease (for example, pseudomembranous colitis, which can be fatal), requiring immediate treatment (see ADVERSE REACTIONS). In such cases, ciprofloxacin should be discontinued and appropriate therapy initiated (for example, vancomycin 250 mg orally 4 times a day).Medicines that suppress peristalsis are contraindicated.

Kidneys and urinary system

Crystalluria associated with the use of ciprofloxacin has been reported (see ADVERSE REACTIONS). Patients taking ciprofloxacin should receive adequate fluids. Excessive alkalization of urine should be avoided.

Hepatobiliary system

When taking ciprofloxacin, cases of liver necrosis and liver failure with a threat to the patient’s life were reported (see.ADVERSE REACTIONS). If any signs and symptoms of liver disease appear (such as anorexia, jaundice, dark urine, itching or tightness of the anterior abdominal wall), treatment should be discontinued. It is also possible a temporary increase in the level of transaminases, alkaline phosphatase, the development of cholestatic jaundice, especially in patients with previous liver damage who received Tsiprolet (see ADVERSE REACTIONS).

Glucose-6-phosphate dehydrogenase deficiency

When taking ciprofloxacin, a hemolytic reaction has been reported in patients with glucose-6-phosphate dehydrogenase deficiency.The use of ciprofloxacin in these patients should be avoided, unless the potential benefit outweighs the potential risk. In this case, the possible appearance of hemolysis should be monitored.

Resistance

During or after a course of ciprofloxacin treatment, resistant bacteria may be isolated with or without clinically detectable superinfection. There is a certain risk of excretion of ciprofloxacin-resistant bacteria during long courses of therapy and in nosocomial infections and / or infections caused by Staphylococcus and Pseudomonas species.

Cytochrome P450

Ciprofloxacin moderately suppresses CYP 1A2 and therefore can cause an increase in plasma concentration of simultaneously intended substances that are also metabolized by this enzyme (for example, theophylline, methylxanthine, caffeine, duloxetine, clozapine, olanzapine, ropinirole, tizanidine). The simultaneous use of ciprofloxacin and tizanidine is contraindicated. The increase in plasma concentrations associated with drug-specific adverse reactions is determined by the inhibition of their metabolic clearance by ciprofloxacin.Therefore, patients using these substances simultaneously with ciprofloxacin require monitoring regarding the possible occurrence of clinical signs of overdose. It may also be necessary to determine plasma concentrations (eg theophylline) (see INTERACTIONS).

Methotrexate

The simultaneous use of ciprofloxacin and methotrexate is not recommended (see INTERACTIONS).

Influence on laboratory test results

Ciprofloxacin in vitro may interfere with culture on Mycobacterium spp. . by inhibiting the growth of mycobacterial culture, which can lead to false negative culture results in individuals taking ciprofloxacin.

Use during pregnancy or lactation

Pregnancy period. Data on the use of ciprofloxacin in pregnant women show no development of malformations or fetal / neonatal toxicity. Animal studies do not indicate direct or indirect toxic effects on reproductive function.In young animals and animals exposed to quinolones before birth, an effect on immature cartilage has been observed, so it cannot be ruled out that the drug may be harmful to the articular cartilage of the newborn / fetus. Therefore, during pregnancy, for a warning, it is better to avoid taking ciprofloxacin.

Breastfeeding period. Ciprofloxacin passes into breast milk. Due to the potential risk of damage to articular cartilage in newborns, ciprofloxacin should not be used during breastfeeding.

Children. The use of ciprofloxacin in children and adolescents should be carried out in accordance with current official guidelines. Treatment with ciprofloxacin should only be performed by a physician experienced in the management of children and adolescents with cystic fibrosis and / or severe infections.

Ciprofloxacin caused arthropathy of the supporting joints in immature animals. Safety data from a randomized, double-blind study of the use of ciprofloxacin in children (ciprofloxacin: n = 335, mean age 6.3 years; control group: n = 349, mean age 6.2 years; age range from 1 year up to 17 years), showed the incidence of arthropathy, which is probably associated with the use of the drug (differs from the clinical signs and symptoms associated with damage to the joints themselves), on the 42nd day from the start of the drug, within 7.2 and 4, 6% for the main and control comparison groups, respectively.The incidence of drug-associated arthropathy after 1 year of follow-up was 9% and 5.7%, respectively. The increase in the number of cases of arthropathies associated with the use of the drug was statistically insignificant. However, treatment with ciprofloxacin in children and adolescents should be started only after a careful assessment of the benefit / risk ratio due to the risk of developing adverse reactions associated with the joints and / or surrounding tissues.

The ability to influence the reaction rate when driving or working with other mechanisms

Fluoroquinolones, which include ciprofloxacin, can interfere with the patient’s ability to drive vehicles and operate machinery due to a reaction from the central nervous system (see.ADVERSE REACTIONS). Therefore, the ability to drive vehicles and work with mechanisms may be impaired.

Effect of other drugs on ciprofloxacin

Formation of a chelate complex

With the simultaneous use of ciprofloxacin (oral) and drugs containing multivalent cations, mineral supplements (for example, calcium, magnesium, aluminum, iron), phosphate-binding polymers (for example sevelamer), sucralfate or antacids, as well as drugs with a large buffer capacity (such as didanosine tablets) containing magnesium, aluminum or calcium, the absorption of ciprofloxacin is reduced.Therefore, ciprofloxacin should be taken 1–2 hours before or at least 4 hours after taking these drugs.

This limitation does not apply to antacids belonging to the class of H ₂ -histamine receptor blockers.

Food and dairy products

Calcium in food products has little effect on absorption. However, concomitant use of ciprofloxacin and dairy or mineral-fortified foods (such as milk, yogurt, orange juice with a high calcium content) should be avoided, since absorption of ciprofloxacin may be reduced.

Probenecid

Probenecid affects the renal secretion of ciprofloxacin. The simultaneous use of drugs containing probenecid and ciprofloxacin leads to an increase in the concentration of ciprofloxacin in the blood plasma.

Effect of ciprofloxacin on other medicinal products

Tizanidine

Tizanidine should not be used concomitantly with ciprofloxacin (see CONTRAINDICATIONS). In a clinical study with the participation of healthy volunteers with the combined use of ciprofloxacin and tizanidine, an increase in the concentration of tizanidine in blood plasma was revealed (an increase in C _max by 7 times, range – 4–21 times, increase in AUC – 10 times, range – 6– 24 times).Hypotensive and sedative side reactions are associated with an increase in the concentration of tizanidine in the blood plasma.

Methotrexate

With the simultaneous use of ciprofloxacin, it is possible to slow down the tubular transport (renal metabolism) of methotrexate, which can lead to an increase in the concentration of methotrexate in the blood plasma. This may increase the likelihood of adverse toxic reactions caused by methotrexate. Combined use is not recommended (see.SPECIAL INSTRUCTIONS).

Theophylline

The simultaneous use of ciprofloxacin and drugs containing theophylline can lead to an undesirable increase in the concentration of theophylline in the blood plasma, which in turn can lead to the development of adverse reactions. In rare cases, these adverse reactions can be life threatening or fatal. If the simultaneous use of these drugs cannot be avoided, the concentration of theophylline in the blood plasma should be monitored and its dose should be adequately reduced (see.SPECIAL INSTRUCTIONS).

Other xanthine derivatives

After the simultaneous use of ciprofloxacin and agents containing caffeine or pentoxifylline (oxpentifiline), an increase in the concentration of these xanthines in blood plasma has been reported.

Phenytoin

The combined use of ciprofloxacin and phenytoin can lead to an increase or decrease in the concentration of phenytoin in the blood plasma, therefore monitoring of the drug level is recommended.

Vitamin K antagonists

With the simultaneous use of ciprofloxacin and vitamin K antagonists, their anticoagulant effect may increase. An increase in the activity of oral anticoagulants has been reported in individuals using antibacterial drugs, in particular fluoroquinolones. The degree of risk may vary depending on the main type of infection, age, general condition of the patient, therefore, it is difficult to accurately assess the effect of ciprofloxacin on increasing the INR value.Frequent monitoring of INR should be carried out during and immediately after the simultaneous administration of ciprofloxacin and vitamin K antagonists (for example, warfarin, acenocoumarol, phenprocoumon, fluindione).

Ropinirole

In the course of clinical studies, it was revealed that the simultaneous use of ropinirole with ciprofloxacin, an inhibitor of the isoenzyme CYP 1A2 of moderate action, leads to an increase in AUC and C _max ropinirole by 60 and 84%, respectively. Monitoring of ropinirole side effects and appropriate dose adjustments is recommended during and immediately after co-administration with ciprofloxacin (see.SPECIAL INSTRUCTIONS).

Clozapine

After the simultaneous use of 250 mg of ciprofloxacin with clozapine for 7 days, the concentration of clozapine and N-desmethylclozapine in the blood serum was increased by 29 and 31%, respectively. Clinical supervision and appropriate dose adjustment of clozapine are recommended during and immediately after combined use with ciprofloxacin (see SPECIAL INSTRUCTIONS).

Drugs that lengthen the Q – T interval

Ciprolet, like other fluoroquinolones, should be prescribed with caution to patients receiving drugs that prolong the Q-T interval (for example, class IA and III antiarrhythmics, tricyclic antidepressants, macrolides, antipsychotics) (see.SPECIAL INSTRUCTIONS).

Metoclopramide

Metoclopramide accelerates the absorption of ciprofloxacin, as a result of which the achievement of C _max in the blood plasma is faster. There was no effect on the bioavailability of ciprofloxacin.

Omeprazole

The simultaneous use of ciprofloxacin and drugs containing omeprazole leads to a slight decrease in C _max and AUC of ciprofloxacin.

Lidocaine

It has been shown that in healthy individuals the simultaneous use of ciprofloxacin, a moderate inhibitor of cytochrome P450 1A2 isoenzymes, and drugs containing lidocaine, reduces the clearance of iv lidocaine by 22%.Despite the normal tolerance of lidocaine treatment, interaction with ciprofloxacin is possible, which is associated with adverse reactions and can develop with the combined use of these drugs.

Sildenafil

C _max and AUC of sildenafil increased ≈2 times in healthy volunteers after oral administration of 50 mg of sildenafil and combined 500 mg of ciprofloxacin. Therefore, caution should be exercised while prescribing Ciprolet with sildenafil and the risk / benefit ratio should be taken into account.

Oral hypoglycemic agents

With the simultaneous use of the drug Ciprolet and oral hypoglycemic drugs, especially the sulfonylurea group (for example, glibenclamide, glimepiride), hypoglycemia was reported, probably associated with the potentiation of the action of oral antidiabetic agents by ciprofloxacin (see ADVERSE REACTIONS).

Duloxetine

Clinical studies have shown that the simultaneous use of duloxetine with strong inhibitors of CYP 1A2, such as fluvoxamine, can lead to an increase in AUC and Cmax _max duloxetine.Despite the lack of clinical data on a possible interaction with ciprofloxacin, similar effects can be expected with the combined use of these drugs (see SPECIAL INSTRUCTIONS).

NSAID

Animal studies have shown that the combination of very high doses of quinolones (gyrase inhibitors) and certain NSAIDs (with the exception of acetylsalicylic acid) can provoke seizures.

Cyclosporin

Determined a transient increase in blood plasma creatinine with the simultaneous use of ciprofloxacin and drugs containing cyclosporine.Therefore, frequent (2 times a week) monitoring of plasma creatinine concentration in these patients is necessary.

it was reported that an overdose due to the intake of 12 g of the drug led to symptoms of moderate toxicity. Acute overdose at a dose of 16 g led to the development of acute renal failure.

Overdose symptoms included dizziness, tremors, headache, fatigue, seizures, hallucinations, confusion, abdominal discomfort, renal and hepatic impairment, and crystalluria and hematuria.Reversible nephrotoxicity has also been reported.

In addition to the usual emergency measures carried out in case of an overdose, it is recommended to monitor kidney function, including determining the pH of urine and, if necessary, increasing its acidity to prevent crystalluria. Patients should receive adequate fluid intake.

Only a small amount of ciprofloxacin (<10%) is eliminated by hemodialysis or peritoneal dialysis.

out of the reach of children, dry, protected from light at a temperature not exceeding 25 ° C.

Ciprolet (INN – ciprofloxacin) is a synthetic antibiotic belonging to the 2nd generation fluoroquinolones.

Ciprolet is available in tablet form: 250 mg, 500 mg.

The active ingredient is ciprofloxacin (1-cyclopropyl-6-fluoro-4-oxo-7-piperazin-1-yl-quinoline-3-carboxylic acid). Ciprofloxacin was synthesized and patented in 1983 by Bayer specialists (Tony Thai; Patrick M. Zito, 2018). It is one of the most effective and popular fluoroquinolones.

Tsiprolet is active against the following microorganisms:

• gram-negative: Escherichia coli, some types of Salmonella, Shigella, Citrobacter, Klebsiella, Enterobacteriaceae, Proteus, Serration Marcescens, Providence species, Morganella of blinking, Vibrio species, Yersinia, Pseudomonas, Gonococcus Neisseria T. , Mycobacterium tuberculosis …

• gram-positive: some species of staphylococcus ( Staphylococcus aureus, Staphylococcus haemolyticus , etc.)streptococcus ( Streptococcus pyogenes, Streptococcus agalactiae ).

Research

Ciprofloxacin – the active ingredient of the drug Ciprolet , has found wide application in many branches of medicine. One of its important advantages as an antibiotic is the ability to prescribe to children.

Many modern studies are devoted to the possibility of using ciprofloxacin in those branches of medicine where it was not previously used, for example, in oncology.

In 2012, a study was conducted that confirmed the ability of ciprofloxacin to inhibit topoisomerase II in the treatment of non-small cell lung cancer. As a material for the study, we used several cell lines cultured on various substrates: non-small cell lung cancer, rat glioblastoma, and mouse melanoma. Ciprofloxacin had no visible effect on glioblastoma and melanoma cells. On the culture of human cells of non-small cell lung cancer, the drug had a pronounced cytotoxic effect.It is assumed that ciprofloxacin is able to block topoisomerase II, an enzyme necessary for the division of cancer cells, as well as accumulate in lung tissue. So, the data of the above study allow us to consider ciprofloxacin for experimental treatment of lung cancer, as well as an antibiotic in the treatment of lung cancer with concomitant inflammation (Kloskowski T. et al., 2012).

The topic of antibiotic use in women during breastfeeding remains topical.About 3% of women in labor are faced with diseases of the urinary system (Axelsson D. et al., 2014). Ciprofloxacin is active against infections resistant to penicillins, cephalosporins and aminoglycosides, therefore it often becomes the drug of choice (Koestner J.A., 1989).

The authors of the study (Kaplan Y.C., Koren G., 2015) reviewed the literature describing the effect of ciprofloxacin on the body of a breastfed baby during the period of time when the antibiotic was prescribed to his mother.

The article presents a study involving 10 women who took ciprofloxacin orally 3 r / day, 750 mg each. The highest antibiotic level in breast milk was recorded after 1 hour and was 3.79 mg / L. According to doctors’ calculations, infants received an average maximum dose of 0.57 mg / kg / day. The maximum relative dose for an infant was 2.7%, while a relative dose of up to 10% is considered safe.

We also reviewed evidence of side effects in infants whose mothers were taking ciprofloxacin.

Pseudomembranous colitis has been reported in a 2 month old baby (Koestner J.A. et al., 2005).

A long-term follow-up of 6 children whose mothers have had long-term treatment for tuberculosis and who have been observed to be resistant to many classes of antibiotics provides the following data. Children of all 3 women who took ciprofloxacin during gestation and during lactation had no side effects from the use of the drug by the mothers (children age 1.25, 1.8 and 3.9 years) (Drobac P.et al., 2005).

The reviewer concludes that although the manufacturer does not recommend taking ciprofloxacin during lactation, there is no definitive evidence in favor of withdrawal from the drug and cessation of feeding, although the child’s gastrointestinal tract should be closely monitored, as with any other antibiotic.

Therapy

Tsiprolet has a lot of indications for use.

Lower respiratory tract infections caused by gram-negative microflora: chronic obstructive pulmonary disease, pneumonia.

Chronic obstructive pulmonary disease is accompanied by a violation of the passage of air in the lungs associated with a chronic inflammatory process. Normal lung tissue can be replaced by fibrous tissue. The patient may be disturbed by coughing, shortness of breath, sputum production. Tsiprolet is usually prescribed for exacerbations.

Pneumonia is an inflammatory process in the lungs (often of bacterial origin), involving mainly the parenchyma – the alveoli. Most often, pneumonia is a complication of bronchitis.It usually proceeds with an increase in body temperature, the appearance of purulent sputum, and a cough. The final diagnosis is made after radiography.

Tsiprolet can be prescribed only if the bacterial etiology of the disease is confirmed.

Also, the drug can be prescribed for the following diseases.

Purulent otitis media – inflammation of the middle ear, accompanied by the appearance of purulent discharge. The patient is worried about pain, fever and hearing impairment.

Chronic sinusitis is a chronic inflammatory process in the paranasal sinuses (frontal, maxillary or ethmoid labyrinth cells). Outside of exacerbations, the patient may not be bothered by the disease. With exacerbations, there may be an increase in body temperature, deterioration of the general condition, pain in the projection area of ​​the affected sinus, and headache.

Tsiprolet is effective against infections caused by gram-negative microflora.

Orchoepididymitis – inflammation of the testicles and epididymis.It is accompanied by pain in the testicles, swelling of the scrotum, soreness and burning sensation, the appearance of blood or other secretions in the seminal fluid. Tsiprolet should be used if the infectious etiology of the disease is precisely determined, since with viral etiology, the use of Tsiprolet is meaningless.

Infectious diseases of the gastrointestinal tract include pathological processes in the small and large intestines. Pathology is manifested by various dyspeptic disorders: nausea, vomiting, diarrhea, abdominal syndrome, the appearance of disorders of the general condition. Ciprolet is prescribed when it is established that the disease is caused by a pathogenic microorganism sensitive to ciprofloxacin.

Infectious diseases of the musculoskeletal system, for the treatment of which ciprofloxacin is prescribed, include a group of arthritis and osteomyelitis caused by gram-negative microflora. Diseases are characterized by the appearance of painful sensations in the area of ​​the damaged area of ​​the bone or joint. History may include trauma, fracture.With an exacerbation of the disease, the body temperature may rise, and the state of health may deteriorate significantly.

Infectious processes in the urinary tract include infections of the urethra, bladder, and pyelonephritis. The acute period is accompanied by an increase in body temperature, malaise, sharp pain associated with urination, the appearance of blood and exudate in the urine.

Pulmonary anthrax. Anthrax is caused by Bacillus anthracis , an extremely dangerous disease.The pulmonary form is rare. Symptoms are similar to those of bronchitis and pneumonia: cough, shortness of breath, sputum production. In a severe course of the disease, death can occur on the second day.

Also, the drug can be prescribed for the prevention of infection Neisseria meningitidis and infection of patients with neutropenia.

Cases when the appointment of the drug is contraindicated:

• hypersensitivity to ciprofloxacin or other fluoroquinolones;

90,020 undergoing thiazide therapy;

• hypersensitivity to excipients of the drug Tsiprolet ;
• diseases caused by pathogens insensitive to ciprofloxacin.

Application features

There are a number of drugs with which Ciprolet should not be taken simultaneously, namely:

• drugs that can lengthen the QT interval;
• methotrexate;
• aminophylline.

The combination of these drugs with ciprofloxacin leads to unwanted side effects.

Tsiprolet enhances the effect of warfarin, glibenclamide.

The combined use of NSAIDs and fluoroquinolones can in rare cases lead to seizures.

Tsiprolet potentiates the effect of vitamin K antagonists, enhancing the anticoagulant effect.

The consumption of dairy products reduces the absorption of ciprofloxacin.

Mechanism of action

Ciprofloxacin has a fast bactericidal effect, that is, it destroys bacteria that are both dormant and multiplying.The destruction of the bacterial cell occurs due to the blockade of bacterial DNA topoisomerase and DNA gyrase. These enzymes ensure the correct viable configuration of bacterial DNA. The result of the blockade of enzymes is the cessation of the synthesis of DNA, proteins, the destruction of the cell, the cessation of its division.

Pharmacokinetics

The half-life of ciprofloxacin is 3.3-6.8 hours in older people and 3-4 hours in younger people. Ciprofloxacin passes into breast milk, but in small amounts, insufficient to cause side effects (LeBel M., 1988).

Dose selection

In adults, the dose of the drug is determined by the disease, its severity, the sensitivity of microorganisms to ciprofloxacin. In children, the dose is calculated based on the child’s body weight.

Adults Tsiprolet can be administered at a dose of 250–750 mg 2 r / day.

For children, the dose is calculated based on the norm of 10–20 mg / kg of body weight. The duration of therapy is determined by the disease, the severity of the course. On average, the course lasts 7-14 days.

Side effects

Most of the side effects are associated with disruption of the gastrointestinal tract. Patients may experience nausea, diarrhea.

Less commonly reported on the occurrence of eosinophilia in the blood, poor appetite, vomiting, abdominal pain, fungal infection, sleep disorders, increased anxiety, headache and dizziness, muscle and bone pain, rash, and kidney problems.

Conclusion

Ciprofloxacin preparations are prescribed all over the world with great popularity due to their wide spectrum of bactericidal activity.Resistance to ciprofloxacin treatment of urinary tract infections caused by E. coli has been noted (Fasugba O., Gardner et al., 2015).

Ciprofloxacin is of particular interest to the scientific community due to its apoptotic and antiproliferative activity against several types of cancer (Herold C., Ocker M. et al. 2002).

In studies in vitro ciprofloxacin can inhibit the growth of carcinoma cells, osteosarcoma (Aranha O., Wood D.P. Jr., Sarkar F.H., 2000).

With adequate use, ciprofloxacin preparations in oncological practice may be less expensive and more cost-effective.

Added date: 19.10.2021

How to treat a pilonidal cyst without abscesses?

A pilonidal cyst is a hollow formation that forms under the skin on the tailbone. For a long time, the disease proceeds latently, the cyst does not manifest itself in any way. The patient does not feel pain or discomfort.
After hypothermia of the body, the pilonidal cyst may become inflamed.If an infection joins, then the process becomes purulent and an abscess forms at the site of the cyst.
So. a pilonidal cyst can proceed quite calmly, without abscesses, or it can be accompanied by purulent inflammation and abscess.
Suppuration of the pilonidal cyst is characterized by severe pain and an increase in body temperature up to 40 degrees.

Click to view photos.
Attention! Profile surgical photo, 18+.

Fig. 1. A pilonidal cyst without abscesses is characterized by the formation of fistulous passages

Causes of the appearance of a pilonidal cyst

The pilonidal cyst is now thought to be caused by ingrowth of hair into the skin.
The appearance of a pilonidal cyst with an abscess may be associated with back injuries and hypothermia.

How to recognize a pilonidal cyst?

Finding a pilonidal cyst without abscesses can be difficult. To do this, you should take a good look at the area between the buttocks. In the presence of a cyst, you can see enlarged skin pores located along the midline – these are fistulas. Palpation of the place where the pilonidal cyst is located causes pain and discomfort. Sometimes, when pressing on the affected area, you can see transparent discharge from the fistulous passages.
A pilonidal cyst with abscess formation has more striking symptoms. A large abscess appears in the area between the buttocks, which is accompanied by severe pain and high body temperature.

Click to view photos.
Attention! Profile surgical photo, 18+.

Fig. 2. A pilonidal cyst with an abscess is accompanied by purulent inflammation

Treatment of a pilonidal cyst

Treatment of a pilonidal cyst without abscesses is more simple.The results of the surgery are always better and the healing is faster.

With a pronounced purulent process, it is often necessary to perform an operation in two stages:

• Stage 1.