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# Ciproxin (Ciprofloxacin)
## Overview
Ciprofloxacin is a broad-spectrum second-generation fluoroquinolone antibiotic. It functions by inhibiting bacterial DNA gyrase and topoisomerase IV, preventing DNA replication.
## Primary Indications
* Urinary tract infections (UTIs)
* Respiratory tract infections (chronic bronchitis, pneumonia)
* Bone and joint infections
* Intra-abdominal infections
* Typhoid fever
* Post-exposure prophylaxis/treatment of inhalational anthrax
## Adult Dosing
* **Uncomplicated UTI:** 250 mg every 12 hours (oral) for 3 days.
* **Complicated UTI/Pyelonephritis:** 500 mg every 12 hours (oral) or 400 mg IV every 12 hours for 7–14 days.
* **Respiratory/Bone/Joint Infections:** 500–750 mg every 12 hours (oral) or 400 mg IV every 8–12 hours.
* **Max dosage:** 1.5 g/day (oral) or 1.2 g/day (IV).
## Pediatric Dosing
*Usage is generally restricted due to potential for cartilage damage; reserved for cases where benefits outweigh risks (e.g., anthrax, multidrug-resistant infections).*
* **Systemic infections:** 10–20 mg/kg/dose every 12 hours.
* **Max:** 750 mg/dose.
* **Cystic Fibrosis (FDA approved):** 20 mg/kg/dose twice daily (max 750 mg/dose).
## Dose Adjustments
* **Renal Impairment:** Requires adjustment when CrCl ≤ 50 mL/min.
* CrCl 30–50 mL/min: 250–500 mg every 12 hours.
* CrCl < 30 mL/min: 250–500 mg every 18–24 hours.
* **Hepatic Impairment:** No specific adjustment required, but use with caution.
## Contraindications
* Hypersensitivity to fluoroquinolones.
* Concomitant administration with tizanidine.
* History of myasthenia gravis (may exacerbate muscle weakness).
## Adverse Effects
* **Common:** Nausea, diarrhea, vomiting, rash.
* **Serious (Black Box Warnings):** Tendonitis and tendon rupture (risk increases with age >60 and corticosteroid use), peripheral neuropathy, and CNS effects (seizures, hallucinations).
* **Others:** QT interval prolongation, *C. difficile*-associated diarrhea, glucose disturbances.
## Key Drug Interactions
* **Cations:** Aluminum, magnesium, calcium, iron, or zinc supplements/antacids significantly decrease absorption. Take ciprofloxacin 2 hours before or 6 hours after these agents.
* **CYP450 Inhibitors:** Increases levels of theophylline, caffeine, and warfarin (monitor INR).
* **QT Prolonging Agents:** Increased risk of arrhythmias.
## Monitoring
* Renal function (BUN/Cr) at baseline and periodically.
* Blood glucose in diabetic patients.
* Signs of tendon rupture, psychiatric changes, or peripheral neuropathy.
* ECG in patients with risk factors for QT prolongation.
## Clinical Pearls
* **Hydration:** Instruct patients to drink plenty of fluids to prevent crystalluria.
* **Phototoxicity:** Advise patients to avoid excessive sunlight or UV light.
* **Administration:** May take with or without food, but avoid dairy products (high calcium) as the sole vehicle for intake, as they may reduce bioavailability.
* **Local Protocols:** Always check local antibiograms; resistance to ciprofloxacin is increasing in common pathogens like *E. coli*.
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**Disclaimer:** This information is for educational purposes only. Clinical practice guidelines and local resistance patterns vary. Always verify specific dosing, safety profiles, and contraindications using institutional protocols or official prescribing information (e.g., package inserts or clinical databases like Lexicomp/UpToDate) before prescribing or administering medication.
