Ciprofloxacin
General
- Type: Fluoroquinolones
- Dosage Forms: IV; PO (Standard: 100, 250, 500; ER 500, 1000)
- Common Trade Names: Cipro, Ciloxan (ophthalmic)
Given the multiple adverse effects listed below, there has been a recent move away from prescribing this and other fluoroquinolones as first line antibiotics for many indications (such as UTI or pneumonia).
Adult Dosing
General
- PO
- 250-750mg PO q12h
- First Dose: 250-750mg PO x1
- IV
- 200-400mg IV q12
- First Dose: 400mg IV x 1
- Alt: 400mg IV q8h
UTI
- Uncomplicated
- 500mg ER PO q24h x 3 days
- Alt: 250mg PO q12h x 3 days
- Complicated
- IV: 400mg IV q12h x 7-14 days
- PO: 1000mg ER PO q24h x 7-14 days
- Alt: 500mg PO q12h x 7-14 days
Anthrax
- Inhalational, GI, Oropharyngeal
- 400mg IV q12h OR 500mg PO q12 x 60 days
- First dose: 400mg IV + 1-2 additional antibiotics
- Cutaneous
- 400mg IV q12h OR 500mg PO q12 x 7-10 days
- Info: Give x 60 days if bioterrorism suspected
- Post-Exposure Prophylaxis
- 500mg PO q12h x 60 days (or exposure excluded)
Traveler's Diarrhea[1]
- 750mg PO BID x 1-3 days
Typhoid Fever
- 500mg PO q12h x 2 weeks
Chancroid
- 500mg PO q12h x 3 days
Salmonella
- Acute
- 500-750mg PO q12h x 3-7 days
- Extend treatment x 1 week if immunocompromised
- Chronic Carrier
- 750mg PO q12h x 1 month
Otitis externa
- Cipro HC otic: 3 drops in affected ear BID x 7 days
- Contains hydrocortisone
- Not safe with perforation
- Ciprodex: 4 drops in affected ear BID x 7 days
- Similar to cipro HC but contains dexamethasone
- Not covered by many insurance companies
Pediatric Dosing
General
- PO
- 20-30mg/kg/day PO divided q12h
- First Dose: 10-15mg/kg PO x 1
- Max: 750mg/dose PO
- IV
- 15-30mg/kg/day IV divided q8-12h
- First Dose: 5-15mg/kg IV x 1
- Max: 400mg/dose IV
Anthrax
Max (All): 400mg/dose IV or 500mg/dose PO
- Inhalational, GI, Oropharyngeal
- 20-30mg/kg/day IV/PO divided q12h x 60 days
- First Dose: 10-15mg/kg IV x 1 (give with 1-2 additional antibiotics)
- Cutaneous
- 20-30mg/kg/day IV/PO divided q12h x 7-10 days
- First Dose: 10-15mg/kg IV/PO x 1
- Info: Give x 60 days if bioterrorism suspected
- Post-Exposure Prophylaxis
- 20-30mg/kg/day PO divided q12h x 60 days (or exposure excluded)
- First Dose: 10-15mg/kg PO x 1
UTI, Complicated (1-17 Years Old)
Not first line given adverse effects
- IV
- 6-10mg/kg IV q8h
- First Dose:
- Max: 400mg/dose IV
- PO
- 10-20mg/kg PO q12h
- First Dose:
- Max: 750mg/dose PO
Special Populations
- Drug ratings in pregnancy: C (but indicated for anthrax)
- Lactation risk categories: Probably safe
- Renal Dosing
- Adult: renal impairment less than creatinine clearance 30 mL/min, q24hrs instead of q12hrs
- Pediatric
- Hepatic Dosing - no dose adjustments needed
Contraindications
- Allergy to class/drug
- Administration with Tizanidine
Adverse Reactions
Serious
- Prolonged QT interval and Syncope/Torsades de pointes
- Photosensitivity
- Stevens-Johnson syndrome/Toxic epidermal necrolysis
- Clostridium difficile diarrhea, Pseudomembranous enterocolitis
- Tendonitis or tendon rupture (black box warning) - increased risk in age >60, immunosuppressed, corticosteroid use
- peripheral neuropathy
- severe hypoglycemia [2]
- mental health effects
Common
- Rash
- Diarrhea/Nausea/Vomiting
Pharmacology
- Half-life: 4 hours
- Metabolism: Liver
- Excretion: Urine, Feces
- Mechanism of Action: Bactericidal. Inhibits DNA gyrase
Antibiotic Sensitivities[3]
Key
- S susceptible/sensitive (usually)
- I intermediate (variably susceptible/resistant)
- R resistant (or not effective clinically)
- S+ synergistic with cell wall antibiotics
- U sensitive for UTI only (non systemic infection)
- X1 no data
- X2 active in vitro, but not used clinically
- X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
- X4 active in vitro, but not clinically effective for strep pneumonia
See Also
References
- Sanford 2014
- FDA updates warnings for fluoroquinolone antibiotics on risks of mental health and low blood sugar adverse reactions. US Food and Drug Administration. https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm612995.htm. Updated July 10, 2018. Accessed Oct 22, 2018.
- Sanford Guide to Antimicrobial Therapy 2014
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