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# Ciproxin (Ciprofloxacin)
## Overview
Ciprofloxacin is a broad-spectrum second-generation fluoroquinolone antibiotic. It primarily inhibits bacterial DNA gyrase and topoisomerase IV, preventing DNA replication. Note: Poor activity against *Streptococcus pneumoniae* and anaerobic pathogens.
## Primary Indications
* Urinary tract infections (UTIs), including pyelonephritis.
* Complicated intra-abdominal infections (in combination with metronidazole).
* Infectious diarrhea (shigellosis, traveler's diarrhea).
* Bone and joint infections.
* Post-exposure prophylaxis for inhalation anthrax.
## Adult Dosing
* **Uncomplicated cystitis:** 250 mg PO BID for 3 days.
* **Complicated UTI/Pyelonephritis:** 500 mg PO BID or 400 mg IV Q12H for 7–14 days.
* **Infectious diarrhea:** 500 mg PO BID for 1–3 days.
* **Severe systemic infections:** 400 mg IV Q8H–Q12H.
* **Max dose:** Generally 1.5 g/day; consult institutional protocols for severe infections.
## Pediatric Dosing
* **General use:** 10–20 mg/kg/dose PO Q12H (Max 750 mg/dose) or 10 mg/kg/dose IV Q8H–Q12H (Max 400 mg/dose).
* **Note:** Generally avoided in pediatrics due to potential arthropathy (cartilage damage), unless benefit outweighs risk (e.g., *Pseudomonas* infections, anthrax, or multidrug-resistant organisms).
## Dose Adjustments
* **Renal Impairment:** Requires adjustment if CrCl < 50 mL/min.
* Example: 250–500 mg Q12H–Q24H depending on severity.
* **Hepatic Impairment:** No standard adjustment required, but use with caution.
## Contraindications
* Hypersensitivity to fluoroquinolones.
* Concomitant use of tizanidine.
* History of myasthenia gravis (may exacerbate muscle weakness).
## Adverse Effects
* **Black Box Warnings:** Tendonitis/tendon rupture (risk increased in >60 years, corticosteroid use, transplant patients), peripheral neuropathy, and CNS effects (seizures, psychosis).
* **Common:** GI distress (nausea, diarrhea), photosensitivity, headache.
* **Cardiac:** QTc prolongation.
* **Metabolic:** Dysglycemia (hypo- and hyperglycemia).
## Key Drug Interactions
* **Cations:** Antacids, iron, calcium, magnesium, and sucralfate significantly decrease absorption; separate doses by at least 2 hours before or 6 hours after.
* **Theophylline/Tizanidine:** Increased serum levels leading to toxicity.
* **Warfarin:** Increased anticoagulant effect (monitor INR).
* **QTc-prolonging drugs:** Risk of additive cardiac arrhythmias.
## Monitoring
* Renal function (BUN/SCr).
* Blood glucose in patients with diabetes.
* Signs of tendon pain or neurologic changes.
* ECG if risk factors for QTc prolongation are present.
## Clinical Pearls
* Ciprofloxacin has excellent oral bioavailability; IV-to-PO conversion is typically 1:1.
* Advise patients to maintain adequate hydration to prevent crystalluria.
* Avoid sun exposure due to high risk of phototoxicity.
* Use as a "drug of last resort" for uncomplicated infections (sinusitis, bronchitis) due to the Black Box safety profile.
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**Disclaimer:** This information is for educational purposes only. Clinical guidelines and local antibiograms vary; always verify current prescribing information, institutional protocols, and patient-specific factors before administration.
