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# Ciproxin (ciprofloxacin)
## Overview
Ciprofloxacin is a broad-spectrum fluoroquinolone antibiotic that inhibits bacterial DNA gyrase and topoisomerase IV. It is active against many Gram-negative organisms (including *Pseudomonas aeruginosa*) and some Gram-positive bacteria.
## Primary Indications
* Urinary tract infections (UTIs)
* Respiratory tract infections (lower)
* Gastrointestinal infections (e.g., infectious diarrhea)
* Bone and joint infections
* Skin and soft tissue infections
* Post-exposure prophylaxis/treatment of inhalation anthrax
## Adult Dosing
* **Uncomplicated UTI:** 250 mg orally every 12 hours for 3 days.
* **Complicated UTI/Pyelonephritis:** 500 mg orally every 12 hours for 7–14 days.
* **Respiratory/Skin/Bone infections:** 500–750 mg orally every 12 hours.
* **Inhalation Anthrax:** 500 mg orally every 12 hours for 60 days.
* *Note: Max oral dose is typically 750 mg twice daily.*
## Pediatric Dosing
*Use is generally avoided due to concerns regarding cartilage toxicity unless benefits outweigh risks (e.g., anthrax exposure, complicated UTI with resistant organisms).*
* **Standard infections:** 10–20 mg/kg/dose (max 750 mg) orally every 12 hours.
* **Inhalation Anthrax:** 15 mg/kg/dose (max 500 mg) orally every 12 hours for 60 days.
## Dose Adjustments
* **Renal Impairment:** Requires dose adjustment if CrCl < 50 mL/min. Consultation with renal dosing guidelines (e.g., Sanford Guide or local protocols) is mandatory.
* **Hepatic Impairment:** No specific adjustment required, but use with caution.
## Contraindications
* Hypersensitivity to fluoroquinolones.
* Concurrent administration with tizanidine.
* History of myasthenia gravis (may exacerbate muscle weakness).
## Adverse Effects
* **Common:** Nausea, diarrhea, vomiting, abdominal pain, rash.
* **Serious (Black Box Warnings):** Tendon rupture (Achilles tendon most common), peripheral neuropathy, CNS effects (seizures, hallucinations), QT prolongation, and exacerbation of myasthenia gravis.
* **C. difficile infection:** Risk of diarrhea secondary to microbiome disruption.
## Key Drug Interactions
* **Cations:** Aluminium, magnesium, calcium, iron, or zinc supplements reduce absorption significantly. Separate doses by at least 2 hours before or 6 hours after.
* **Warfarin:** May increase INR/bleeding risk; monitor closely.
* **QT Prolonging Agents:** Increased risk of Torsades de Pointes.
* **Theophylline:** Ciprofloxacin inhibits CYP1A2, significantly increasing theophylline levels.
## Monitoring
* Renal function (BUN/SCr).
* Signs of tendon pain or rupture.
* Blood glucose (hypoglycemia/hyperglycemia risk, especially in elderly).
* ECG if risk factors for QT prolongation are present.
## Clinical Pearls
* **Hydration:** Maintain adequate fluid intake to prevent crystalluria.
* **Tendon Risk:** Counsel patients to discontinue activity and report tendon pain immediately. Risk is higher in patients >60 years, those taking corticosteroids, or organ transplant recipients.
* **Absorption:** Bioavailability is high (70–80%) and oral/IV conversion is usually 1:1.
* **Uncertainty:** Dosing for specific pediatric sub-populations or multi-drug resistant organisms must follow verified institutional antibiograms and infectious disease consultation.
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*Disclaimer: This information is for educational purposes only. Clinical practice guidelines vary by institution and region. Always verify dosages, contraindications, and drug interactions against current local prescribing information, institutional protocols, and official product monographs before administering medication.*
