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# Ciproxin (ciprofloxacin)
## Overview
Fluoroquinolone antibiotic with broad-spectrum bactericidal activity, primarily against Gram-negative aerobes, some Gram-positive organisms, and atypicals.
## Primary Indications
- Urinary tract infections (complicated/uncomplicated)
- Intra-abdominal infections (combination therapy)
- Bone and joint infections
- Nosocomial pneumonia
- Prostatitis
- Anthrax (inhalational)
- Typhoid fever
## Adult Dosing
- **Oral:** 250–750 mg every 12 hours (depending on infection severity)
- **IV:** 200–400 mg every 8–12 hours, infused over 60 minutes
- **Maximum daily dose:** 1.5 g (oral; limited evidence for higher)
## Pediatric Dosing
- Used only for specific indications (e.g., complicated UTI, pyelonephritis, anthrax, pseudomonal infection in cystic fibrosis); risk of arthropathy limits routine use
- **Oral:** 10–20 mg/kg/dose every 12 hours (max 750 mg/dose)
- **IV:** 10 mg/kg/dose every 8 hours (max 400 mg/dose)
## Dose Adjustments
- **Renal impairment** (CrCl 30–50 mL/min): standard dose every 12 hours; (CrCl <30 mL/min): reduce dose by 50% or extend interval to 24 hours
- **Hepatic impairment:** no specific adjustment
## Contraindications
- Hypersensitivity to fluoroquinolones
- Avoid in children (except specific indications), pregnancy, lactation (use only if no safer alternative)
- History of tendinopathy with fluoroquinolones
## Adverse Effects
- **Tendonitis/tendon rupture** (increased risk with age, corticosteroids, renal failure)
- **CNS:** dizziness, headache, confusion, seizures (rare)
- **GI:** nausea, diarrhea, C. difficile infection
- **QT prolongation** (rare, risk with electrolyte disturbances or other QT-prolonging drugs)
- **Photosensitivity**
- Peripheral neuropathy (rare, may be irreversible)
## Key Drug Interactions
- **NSAIDs:** increased risk of CNS stimulation and seizures
- **Warfarin:** enhanced anticoagulant effect (monitor INR)
- **Theophylline/caffeine:** decreased clearance, increased toxicity
- **QT-prolonging agents:** additive risk
- **Multivalent cations (e.g., antacids containing Mg/Al, sucralfate, iron, zinc):** markedly reduce absorption—administer ciprofloxacin 2 hours before or 6 hours after
## Monitoring
- Renal function (baseline and periodic)
- Signs of tendon pain or inflammation—advise patient to discontinue immediately if occurs
- Blood glucose (in diabetic patients; risk of dysglycemia)
- INR (if on warfarin)
## Clinical Pearls
- Ciprofloxacin is **not** first-line for uncomplicated UTIs unless local resistance patterns dictate; avoid in community-acquired pneumonia due to poor pneumococcal coverage.
- Oral bioavailability is ~70–80%; IV to oral conversion is appropriate when able.
- Avoid grapefruit juice with oral doses (may reduce absorption).
- Do **not** take with dairy products alone—calcium can chelate; may take with a meal.
- For anthrax post-exposure: 500 mg PO every 12 hours for 60 days (adult); 15 mg/kg/dose every 12 hours (pediatric).
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*This information is for educational purposes only. Exact dosing, indications, and warnings may vary by local protocols and guidelines. Always verify against current prescribing information and consult a clinical pharmacist for individual patient management.*
