Ciprofloxacin: Difference between revisions

(Replace manual dosing with dynamic SMW tables (Adult + Pediatric))
(Restore original dosing content alongside dynamic SMW tables)
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==Adult Dosing==
==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]]<ref>Sanford 2014</ref>===
*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 recommended for perforation since non-sterile preparation
*Ciprodex: 4 drops in affected ear BID x 7 days
**Similar to Cipro HC but contains [[dexamethasone]]
**Safe with perforation
**More expensive and not covered by many insurance companies
===Indications by Disease===
===Indications by Disease===
{{#ask: [[Has DrugName::Ciprofloxacin]] [[Has Population::Adult]]
{{#ask: [[Has DrugName::Ciprofloxacin]] [[Has Population::Adult]]
|?Treats disease=Disease
|?Treats disease=Disease
|?Has Dose=Dose
|?Has Dose=Dose
|?Has Context=Context
|?Has Context=Context
|format=table
|format=table
|limit=50
|limit=50
|mainlabel=-
|mainlabel=-
|headers=show
|headers=show
|sort=Treats disease
|sort=Treats disease
}}
}}


==Pediatric Dosing==
==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
===Indications by Disease===
===Indications by Disease===
{{#ask: [[Has DrugName::Ciprofloxacin]] [[Has Population::Pediatric]]
{{#ask: [[Has DrugName::Ciprofloxacin]] [[Has Population::Pediatric]]
|?Treats disease=Disease
|?Treats disease=Disease
|?Has Dose=Dose
|?Has Dose=Dose
|?Has Context=Context
|?Has Context=Context
|format=table
|format=table
|limit=50
|limit=50
|mainlabel=-
|mainlabel=-
|headers=show
|headers=show
|sort=Treats disease
|sort=Treats disease
}}
}}


Revision as of 02:37, 20 March 2026

General

  • Type: 2nd generation 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 recommended for perforation since non-sterile preparation
  • Ciprodex: 4 drops in affected ear BID x 7 days
    • Similar to Cipro HC but contains dexamethasone
    • Safe with perforation
    • More expensive and not covered by many insurance companies


Indications by Disease

DiseaseDoseContext
Acute cystitis500mg BID x10-14dOutpatient, Women Complicated
Acute cystitis250mg BID x3dOutpatient, Women Uncomplicated
Acute cystitis500mg BID x10-14dMen
Acute cystitis400mg IV q12hrInpatient
Acute diarrhea500mg PO BID x 5 daysCampylobacter
Acute diarrhea500mg PO BID x 5 daysSalmonella
Acute diarrhea500mg PO BID x 5 daysShigella
Acute diarrhea500mg PO BID dailyYersinia
Acute necrotizing ulcerative gingivitis500mg twice dailyPenicillin Allergy
Anthrax400mg IV q12hrs x 60 daysInhalation or cutaneous with systemic illness; 1st line
Anthrax500mg PO q12hrs x 60 daysCutaneous anthrax, not systemically ill
Anthrax500mg PO q12hrs x 60 daysPostexposure prophylaxis
Ascending cholangitis400mg IV q12hrsCombined with metronidazole
Cellulitis500mg PO q12hrs x 10 daysFreshwater
Cellulitis400mg IV q12hrs x 10 daysSaltwater
Chancroid500mg PO q12h x 3 daysChancroid
Corneal abrasion0.3% ophthalmic solution 2 drops q6 hoursNo Contact Lens
Diabetic foot infection750mg PO q12hrs x 14 daysModerate DFI
Diabetic foot infection400mg IV q12hrsInpatient DFI
Discitis400mg IV three times dailyInpatient Therapy
Diverticulitis500mg PO BID x 5 daysUncomplicated, Alternative
Endocarditis1000mg/day PO in 2 doses or 800 mg/day IV in 2 dosesMRSA Native Valve Endocarditis
Mammalian bites400mg IV q12hrsSevere mammalian bite with Clindamycin
Mammalian bites500mg PO q12hrs x 7 daysHuman bites with Clindamycin
Mammalian bites500mg PO q12hrs x 7 daysCat and dog bites with Clindamycin
Neutropenic fever750mg PO q12hrsOutpatient
Otitis externa4 drops in affected ear BID x 7 daysTopical (Ciprodex)
Otitis externa3 drops in affected ear BID x 7 daysTopical (Cipro HC)
Peritonitis400mg IV q12hrsPrimary
Peritonitis400mg IV q12hrsAllergy/Prior exposure
Plague500mg (20mg/kg) PO q12hrs x 10 daysActive disease
Plague500mg (20mg/kg) PO q12hrsPostexposure prophylaxis
Pneumonia (main)400mg q8hHAP, High Risk
Pneumonia (main)400mg IV q8hVAP, High Risk
Prostatitis500mg PO q12hrs x 28 daysNon-STD/Chronic
Pyelonephritis400mg IV q12hrAdult Inpatient
Pyelonephritis500mg PO BID x7 daysOutpatient
SalmonellaAcute; 500-750mg PO q12h x 3-7 days; Extend treatment x 1 week if immunocompromised; Chronic Carrier; 750mg PO q12h x 1 monthSalmonella
Traveler's diarrhea750mg PO once daily x 1-3 daysTraveler's Diarrhea
Tularemia400mg (15mg/kg) IV q12hrs x 10 daysActive disease
Tularemia500mg PO q12hrs x 10 daysPostexposure prophylaxis
Typhoid fever400 mg IV q 12 hrs x 10 daysQuinolone Susceptible, Parenteral
Typhoid fever500-750 mg PO q 12 hrs x 14 daysQuinolone Susceptible, Oral

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


Indications by Disease

DiseaseDoseContext
Anthrax15mg/kg PO q12hrs x 60 daysPediatric postexposure prophylaxis
Anthrax15mg/kg IV q12hrsPediatric inhalational/cutaneous, systemically ill; 1st line
Otitis externa3-4 drops in affected ear BID x 7 daysPediatric Topical
Plague15mg/kg PO q12hrs (max 500mg/dose)Pediatric Active Disease/Prophylaxis
Tularemia15mg/kg PO/IV q12hrs x 10 days (max 500mg PO / 400mg IV)Pediatric Active Disease/Prophylaxis

Special Populations

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

Pharmacology

  • Half-life: 4 hours
  • Metabolism: Liver
  • Excretion: Urine, Feces
  • Mechanism of Action: Bactericidal. Inhibits DNA gyrase

Antibiotic Sensitivities[3]

Group Organism Sensitivity
Gram Positive Strep. Group A, B, C, G I
Strep. Pneumoniae I
Viridans strep R
Strep. anginosus gp R
Enterococcus faecalis U
Enterococcus faecium R
MSSA S
MRSA R
CA-MRSA I
Staph. Epidermidis S
C. jeikeium R
L. monocytogenes S
Gram Negatives N. gonorrhoeae I
N. meningitidis S
Moraxella catarrhalis S
H. influenzae S
E. coli S
Klebsiella sp S
E. coli/Klebsiella ESBL+ S
E coli/Klebsiella KPC+ R
Enterobacter sp, AmpC neg S
Enterobacter sp, AmpC pos S
Serratia sp S
Serratia marcescens X1
Salmonella sp S
Shigella sp S
Proteus mirabilis S
Proteus vulgaris S
Providencia sp. S
Morganella sp. S
Citrobacter freundii S
Citrobacter diversus S
Citrobacter sp. S
Aeromonas sp S
Acinetobacter sp. I
Pseudomonas aeruginosa S
Burkholderia cepacia R
Stenotrophomonas maltophilia R
Yersinia enterocolitica S
Francisella tularensis X1
Brucella sp. X1
Legionella sp. S
Pasteurella multocida S
Haemophilus ducreyi X1
Vibrio vulnificus X1
Misc Chlamydophila sp S
Mycoplasm pneumoniae S
Rickettsia sp X1
Mycobacterium avium X1
Anaerobes Actinomyces R
Bacteroides fragilis R
Prevotella melaninogenica R
Clostridium difficile R
Clostridium (not difficile) I
Fusobacterium necrophorum X1
Peptostreptococcus sp. I

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

  1. ↑ Sanford 2014
  2. ↑ 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.
  3. ↑ Sanford Guide to Antimicrobial Therapy 2014
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