Ciprofloxacin is an antibiotic used to treat a number of bacterial infections. Such as bone and joint infections, intra abdominal infections, certain type of infectious diarrhea, respiratory tract infections, skin infections, typhoid fever, and urinary tract infections.
Class of Drug
Broad-spectrum quinolone antibiotic.
Mechanism of Action
Inhibits DNA gyrase, thereby blocking bacterial DNA replication.
Susceptible organisms in vivo: Campylobacter sp, Citrobacter sp, Enterobacter, Escherichia coli, Hemophilus influenzae, Hemophilus parainfluenzae, Klebsiella pneumoniae, Morganella morganii, Proteus mirabilis, Proteus vulgaris, Providencia rettgeri, Providencia stuartii, Pseudomonas aeruginosa, Serratia,
Marcescens, Shigella sp, Staphylococcus aureus, Staphylococcus epidermidis, Legionella, Mycoplasma pneumoniae, Mycobacterium tuberculosis, Mycobacterium chelonae, Mycobacterium kansasii, Mycobacterium fortuitum.
Indications / Dosage / Route
Routes of Administration: Oral and IV.
Condition: Acute sinusitis
Dose: Adults: 500 mg q12h.
Condition: Lower respiratory tract infections, COPD exacerbations
Dose: Adults: 500 mg q12h. Severe or more complicated infections
(nosocomial): 750 mg q12h.
Condition: Severe, complicated UTIs, 7-14 days
Dose: Adults: 500 mg q12h.
Condition: Mild to moderate UTIs, 7-14 days
Dose: Adults: 250 mg q12h.
Condition: Acute, uncomplicated cystitis
Dose: Adults, female: 100 mg q12h, 3 days.
Condition: Chronic bacterial prostatis
Dose: Adults: 500 mg q12h
Condition: Complicated intraabdominal infections (combination therapy)
Dose: Adults: 500 mg q12h plus metronidazole (given according to product labeling).
Condition: Bone and joint infections, infectious diarrhea, typhoid fever
Dose: Adults: 500 mg q12h.
Condition: Uncomplicated urethral and cervical gonococcal infections
Dose: Adults: single 250-mg dose.
Condition: Mild to moderate UTIs.
Dose: Adults: 200 mg q12h
Condition: Severe or complicated UTIs, lower respiratory tract infections, skin and skin structure infections, bone and joint infections (mild to moderate).
Dose: Adults: 400 mg 8-12h
Condition: Severe or complicated lower respiratory tract, infections, skin and skin structure infections, bone and joint infections, nosocomial pneumonia (mild, moderate, or severe).
Dose: Adults: 400 mg q8h.
Condition: Complicated intraabdominal infections
Dose: Adults: 400 mg q8h plus IV metronidazole.
Condition: Empirical therapy of febrile neutropenia
Dose: Adults: 400 mg q8h plus piperacillin 50 mg/kg IV q4h. Maximum: 24 g/d, 7-14 days.
Adjustment of Dosage
Kidney disease: Creatinine clearance >30 mL/min: usual dosages; creatinine clearance 5-29 mL/min: 20CM100 ql8-24h.
Liver disease: None.
Pediatric: Safety and efficacy have not been established in children <18 years.
Food and Drug Interactions
Food: Take 1 hour before or 2 hours after meals with a glass of water.
Pregnancy: Category C.
Lactation: Appears in breast milk. Potentially toxic to infant. Avoid breastfeeding.
Contraindications: Hypersensitivity to fluoroquinolone antibiotics or quinolone antibiotics, eg, cinoxacin, nalidixic acid.
Warnings / Precautions
> Use with caution in patients with the following conditions: CNS disorders (epilepsy).
> Therapy should be continued for 2-1 days after symptoms have disappeared.
> Rupture of Achilles and other tendons has occurred in patients taking fluoroquinolones.
> Serious and even fatal hypersensitivity reactions have occurred with these drugs, even after the first dose.
> This drug is recommended as an alternative to aminoglyco sides when clinically relevant.
> Reserve use of this drug for infections that are difficult to treat by other means.
Clinically Important Drug Interactions
> Drugs that increase effects/toxicity of fluoroquinolones: cyclosporine, probenecid.
> Drugs that decrease effects/toxicity of fluoroquinolones: antacids, antineoplastic agents, didanosine, sucralfate, iron salts, zinc salts, caffeine.
> Fluoroquinolones increase effects/toxicity of following drugs: oral anticoagulants, theophylline, caffeine
> Common: None.
> Serious: Hypersensitivity reaction (anaphylaxis), seizures, pseudomembraneous colitischolestatic jaundice, renal failure, pulmonary edema, pulmonary embolism, cardiovascular collapse, pharyngeal edema.
Parameters to Monitor
> Renal, hepatic, and hemopoietic systems should be monitored periodically during prolonged therapy.
> Intake of fluids and urinary and other fluid output to minimize renal toxicity. Increase fluid intake if inadequate. Closely monitor electrolyte levels.
> Signs of hypersensitivity reactions.
> Signs and symptoms of antibiotic-induced bacterial or fungal superinfection: Use of yogurt (4 oz/d) may be helpful in prevention of superinfection.
> Signs and symptoms of tendon pain. These may be an indication of tendon rupture.
> Evidence of development of microbial resistance: loss of effectiveness.
Advice to Patient
> Limit intake of caffeinated products including coffee, tea and colas.
> Drink a great deal of fluids during therapy with this drug.
> Do not undertake strenuous exercise while taking this drug.
> To minimize possible photosensitivity reaction, apply adequate sunscreen and use proper covering when exposed to strong sunlight.
Further Useful Info
Ciprofloxacin has excellent potency for gram negative aerobes, including Pseudomonas and is the best quinolone for gram negative coverage. As with quinolones, ciprofloxacin is not appropriate monotherapy for community acquired pneumonia because of poor activity against Streptococcus pneumoniae. These drugs are also not recommended for sinusitis or otitis media. Quinolones are very effective agents against atypical pneumonias and are used as treatments for GU infections.