Ciprofloxacin
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
Indications by Disease
| Disease | Dose | Context |
|---|---|---|
| Acute cystitis | 500mg BID x10-14d | Outpatient, Women Complicated |
| Acute cystitis | 250mg BID x3d | Outpatient, Women Uncomplicated |
| Acute cystitis | 500mg BID x10-14d | Men |
| Acute cystitis | 400mg IV q12hr | Inpatient |
| Acute diarrhea | 500mg PO BID x 5 days | Campylobacter |
| Acute diarrhea | 500mg PO BID x 5 days | Salmonella |
| Acute diarrhea | 500mg PO BID x 5 days | Shigella |
| Acute diarrhea | 500mg PO BID daily | Yersinia |
| Acute necrotizing ulcerative gingivitis | 500mg twice daily | Penicillin Allergy |
| Anthrax | 400mg IV q12hrs x 60 days | Inhalation or cutaneous with systemic illness; 1st line |
| Anthrax | 500mg PO q12hrs x 60 days | Cutaneous anthrax, not systemically ill |
| Anthrax | 500mg PO q12hrs x 60 days | Postexposure prophylaxis |
| Ascending cholangitis | 400mg IV q12hrs | Combined with metronidazole |
| Cellulitis | 500mg PO q12hrs x 10 days | Freshwater |
| Cellulitis | 400mg IV q12hrs x 10 days | Saltwater |
| Chancroid | 500mg PO q12h x 3 days | Chancroid |
| Corneal abrasion | 0.3% ophthalmic solution 2 drops q6 hours | No Contact Lens |
| Diabetic foot infection | 750mg PO q12hrs x 14 days | Moderate DFI |
| Diabetic foot infection | 400mg IV q12hrs | Inpatient DFI |
| Discitis | 400mg IV three times daily | Inpatient Therapy |
| Diverticulitis | 500mg PO BID x 5 days | Uncomplicated, Alternative |
| Endocarditis | 1000mg/day PO in 2 doses or 800 mg/day IV in 2 doses | MRSA Native Valve Endocarditis |
| Mammalian bites | 400mg IV q12hrs | Severe mammalian bite with Clindamycin |
| Mammalian bites | 500mg PO q12hrs x 7 days | Human bites with Clindamycin |
| Mammalian bites | 500mg PO q12hrs x 7 days | Cat and dog bites with Clindamycin |
| Neutropenic fever | 750mg PO q12hrs | Outpatient |
| Otitis externa | 4 drops in affected ear BID x 7 days | Topical (Ciprodex) |
| Otitis externa | 3 drops in affected ear BID x 7 days | Topical (Cipro HC) |
| Peritonitis | 400mg IV q12hrs | Primary |
| Peritonitis | 400mg IV q12hrs | Allergy/Prior exposure |
| Plague | 500mg (20mg/kg) PO q12hrs x 10 days | Active disease |
| Plague | 500mg (20mg/kg) PO q12hrs | Postexposure prophylaxis |
| Pneumonia (main) | 400mg q8h | HAP, High Risk |
| Pneumonia (main) | 400mg IV q8h | VAP, High Risk |
| Prostatitis | 500mg PO q12hrs x 28 days | Non-STD/Chronic |
| Pyelonephritis | 400mg IV q12hr | Adult Inpatient |
| Pyelonephritis | 500mg PO BID x7 days | Outpatient |
| 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 | Salmonella |
| Traveler's diarrhea | 750mg PO once daily x 1-3 days | Traveler's Diarrhea |
| Tularemia | 400mg (15mg/kg) IV q12hrs x 10 days | Active disease |
| Tularemia | 500mg PO q12hrs x 10 days | Postexposure prophylaxis |
| Typhoid fever | 400 mg IV q 12 hrs x 10 days | Quinolone Susceptible, Parenteral |
| Typhoid fever | 500-750 mg PO q 12 hrs x 14 days | Quinolone 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
Indications by Disease
| Disease | Dose | Context |
|---|---|---|
| Anthrax | 15mg/kg PO q12hrs x 60 days | Pediatric postexposure prophylaxis |
| Anthrax | 15mg/kg IV q12hrs | Pediatric inhalational/cutaneous, systemically ill; 1st line |
| Otitis externa | 3-4 drops in affected ear BID x 7 days | Pediatric Topical |
| Plague | 15mg/kg PO q12hrs (max 500mg/dose) | Pediatric Active Disease/Prophylaxis |
| Tularemia | 15mg/kg PO/IV q12hrs x 10 days (max 500mg PO / 400mg IV) | Pediatric Active Disease/Prophylaxis |
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 [1]
- 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[2]
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
- ↑ 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