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## Ciprofloxacin (Cipro)
### Overview
Ciprofloxacin is a broad-spectrum fluoroquinolone antibiotic effective against many Gram-positive and Gram-negative bacteria, including many that are resistant to other antibiotics.
### Primary Indications
* Urinary tract infections (complicated and uncomplicated)
* Lower respiratory tract infections (e.g., community-acquired pneumonia)
* Skin and soft tissue infections
* Bone and joint infections
* Intra-abdominal infections
* Infectious diarrhea
* Anthrax (prophylaxis and treatment)
* Plague
* Prostatitis
### Adult Dosing
Dosing varies significantly based on indication, severity, and renal function. Typical doses:
* **Urinary Tract Infection (Uncomplicated):** 250 mg PO q12h for 3 days OR 500 mg PO q12h for 3 days.
* **Urinary Tract Infection (Complicated):** 500 mg PO q12h for 7-14 days OR 250 mg IV q12h for 7-14 days.
* **Community-Acquired Pneumonia:** 500-750 mg PO q12h for 7-14 days OR 400 mg IV q12h for 7-14 days.
* **Severe or Complicated Infections:** 750 mg PO q12h for 7-14 days OR 400 mg IV q8-12h.
* **Anthrax (Inhalational):** 500 mg PO q12h for 60 days OR 400 mg IV q12h for 60 days.
* **Maximum dose:** Generally 1500 mg PO daily or 1200 mg IV daily, but may be higher for specific severe indications.
### Pediatric Dosing
Established for specific indications, often based on weight. Local protocols and specialist guidance are crucial.
* **Urinary Tract Infection:** 10-20 mg/kg/day divided q12h PO or IV. Maximum 750 mg/dose.
* **Osteomyelitis or Anthrax:** 10-15 mg/kg/dose q8-12h PO or IV. Maximum 750 mg/dose. Duration varies by indication.
* **Note:** Fluoroquinolones are generally reserved for situations where benefits outweigh risks due to potential for arthropathy.
### Dose Adjustments
* **Renal Impairment:**
* CrCl > 30 mL/min: No adjustment needed.
* CrCl 5-30 mL/min: Decrease dose by 50% if frequency is q12h, or by 33% if frequency is q8h.
* CrCl < 5 mL/min (including hemodialysis/peritoneal dialysis): Administer usual dose, then give 50% of the usual dose after dialysis or every 24 hours if not on dialysis.
* **Hepatic Impairment:** No specific dose adjustment is generally recommended.
### Contraindications
* Hypersensitivity to ciprofloxacin, other fluoroquinolones, or any component of the formulation.
* Concurrent use with tizanidine.
### Adverse Effects
Common: Nausea, vomiting, diarrhea, abdominal pain, headache, dizziness.
Serious: Tendon rupture (especially Achilles tendon), peripheral neuropathy, central nervous system effects (seizures, psychosis), QTc prolongation, C. difficile-associated diarrhea, phototoxicity, dysglycemia (hypoglycemia and hyperglycemia), aortic aneurysm and dissection, mental health adverse events.
### Key Drug Interactions
* **Theophylline:** Monitor theophylline levels closely; ciprofloxacin can significantly increase theophylline serum concentrations.
* **Warfarin:** Enhanced anticoagulant effect; monitor INR closely.
* **Antacids (containing aluminum, magnesium, calcium), Sucralfate, iron supplements, and multivalent cations (e.g., zinc):** Oral absorption of ciprofloxacin is reduced. Separate administration by at least 2 hours before or 6 hours after.
* **Oral Hypoglycemics/Insulin:** Risk of dysglycemia; monitor blood glucose closely.
* **QTc-prolonging agents:** Increased risk of torsades de pointes.
* **Tizanidine:** Contraindicated due to significant increase in tizanidine plasma concentrations.
### Monitoring
* Renal function (for dose adjustments).
* Signs and symptoms of C. difficile infection.
* Signs and symptoms of tendon inflammation or rupture.
* Neurological status.
* Blood glucose levels, especially in diabetic patients.
* ECG if risk factors for QTc prolongation exist.
### Clinical Pearls
* Administer oral ciprofloxacin at least 2 hours before or 6 hours after products containing multivalent cations.
* Adequate hydration is important to prevent crystalluria.
* Discontinue immediately if tendon pain or swelling occurs.
* Black box warnings highlight the risks of serious adverse reactions including tendinopathy, peripheral neuropathy, CNS effects, myasthenia gravis exacerbation, and aortic aneurysm/dissection. Use should be reserved for situations where alternative options are not suitable.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider regarding any medical condition or before making any decisions related to your health or treatment. Always verify current prescribing information with the latest FDA-approved product labeling or other reliable drug references.
