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# Ciproxin (ciprofloxacin)
## Overview
Ciprofloxacin is a broad-spectrum second-generation fluoroquinolone antibiotic that inhibits bacterial DNA gyrase and topoisomerase IV, preventing DNA replication. It is highly effective against aerobic Gram-negative bacilli (including *Pseudomonas aeruginosa*) but has limited activity against *Streptococcus pneumoniae* and anaerobes.
## Primary Indications
* Urinary tract infections (UTIs)
* Acute uncomplicated cystitis
* Complicated intra-abdominal infections (in combination with metronidazole)
* Infectious diarrhea
* Bone and joint infections
* Anthrax (post-exposure prophylaxis/treatment)
* Lower respiratory tract infections (if indicated by susceptibility)
## Adult Dosing
* **Uncomplicated UTI:** 250 mg orally every 12 hours for 3 days.
* **Complicated UTI/Pyelonephritis:** 500 mg orally or 400 mg IV every 12 hours for 7–14 days.
* **Infectious Diarrhea:** 500 mg orally every 12 hours for 1–3 days.
* **Bone/Joint Infections:** 500–750 mg orally or 400 mg IV every 12 hours for 4–6 weeks.
* **Anthrax (Prophylaxis/Treatment):** 500 mg orally or 400 mg IV every 12 hours for 60 days.
## Pediatric Dosing
*Note: Use is generally restricted to specific indications (e.g., complicated UTIs, pyelonephritis, post-exposure anthrax) due to potential cartilage damage.*
* **Complicated UTI/Pyelonephritis:** 10–20 mg/kg/dose (max 750 mg) every 12 hours.
* **Anthrax (Prophylaxis/Treatment):** 15 mg/kg/dose (max 500 mg) every 12 hours.
## Dose Adjustments
* **Renal Impairment:** Adjust for CrCl < 50 mL/min. If CrCl 30–50 mL/min, 250–500 mg every 12 hours. If CrCl < 30 mL/min, 250–500 mg every 18–24 hours.
* **Hepatic Impairment:** No dose adjustment required, but use with caution in severe disease.
## Contraindications
* Hypersensitivity to fluoroquinolones.
* Concomitant use of tizanidine.
* History of myasthenia gravis (may exacerbate muscle weakness).
## Adverse Effects
* **Common:** Nausea, diarrhea, vomiting, dizziness, insomnia.
* **Serious/Black Box Warnings:** Tendonitis/tendon rupture (risk increased in >60 years or corticosteroid use), peripheral neuropathy, CNS effects (seizures, psychosis), QTc prolongation, and dysglycemia.
## Key Drug Interactions
* **Cations:** Antacids, iron, calcium, magnesium, aluminum, and zinc decrease oral absorption; separate doses by at least 2 hours before or 6 hours after.
* **Warfarin:** May increase INR/bleeding risk; monitor closely.
* **QTc Prolonging Agents:** Additive risk of arrhythmia (e.g., amiodarone, ondansetron).
* **Theophylline:** Ciprofloxacin inhibits CYP1A2, significantly increasing theophylline levels.
## Monitoring
* Renal function (BUN/SCr).
* Signs of tendon pain or joint inflammation.
* Blood glucose (especially in diabetic patients).
* ECG if risk factors for QTc prolongation are present.
## Clinical Pearls
* Ciprofloxacin has no significant activity against *Streptococcus pneumoniae*; it should not be used as monotherapy for community-acquired pneumonia.
* Encourage adequate fluid intake to prevent crystalluria.
* Avoid sunlight exposure (photosensitivity) during treatment.
* In the absence of local antibiograms or institutional protocols, empirical therapy should be guided by clinical severity and local resistance patterns.
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**Educational Disclaimer:** This information is for educational purposes only. Always verify dosages, contraindications, and drug interactions using current, institutional-specific prescribing information or electronic medical record clinical decision support tools before prescribing or administering medication.
