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### Ciproxin (ciprofloxacin)
## Overview
Ciprofloxacin is a synthetic fluoroquinolone antibiotic with broad-spectrum activity against gram-positive and gram-negative bacteria, including many aerobic organisms.
## Primary Indications
* Urinary tract infections (complicated and uncomplicated)
* Prostatitis
* Lower respiratory tract infections (e.g., acute exacerbations of chronic bronchitis, community-acquired pneumonia)
* Skin and skin structure infections
* Bone and joint infections
* Intra-abdominal infections (in combination with other agents)
* Infectious diarrhea
* Anthrax (prophylaxis and treatment)
* Plague
## Adult Dosing
* **Uncomplicated Urinary Tract Infections:** 250 mg PO every 12 hours for 3 days.
* **Complicated Urinary Tract Infections:** 500 mg PO every 12 hours for 7-14 days.
* **Prostatitis:** 500 mg PO every 12 hours for 28 days.
* **Community-Acquired Pneumonia:** 500-750 mg PO every 12 hours for 7-14 days.
* **Acute Sinusitis:** 500 mg PO every 12 hours for 10 days.
* **Anthrax (inhalation, post-exposure):** 500 mg PO every 12 hours for 60 days.
* **Other indications:** Dosing varies based on severity and site of infection, typically 250-750 mg PO or IV every 12 hours.
Oral doses are generally given every 12 hours. Intravenous (IV) doses are also typically given every 12 hours. Higher doses (e.g., 750 mg PO, 400 mg IV) may be used for more severe infections.
## Pediatric Dosing
Ciprofloxacin is generally not recommended for children younger than 1 year of age due to potential risks to developing cartilage, though it may be used in specific circumstances (e.g., complicated UTIs, anthrax) where benefits outweigh risks, and alternative agents are not suitable.
* **Dosage is highly individualized based on indication, severity, weight, and renal function.** Specific dosing charts and guidelines should be consulted.
* **Commonly used for UTIs and Kawasaki disease.**
* **Maximum dose typically 20 mg/kg/day divided every 12 hours, not to exceed adult maximums.**
## Dose Adjustments
* **Renal Impairment:**
* CrCl > 30 mL/min: No dose adjustment needed.
* CrCl 5-30 mL/min: Reduce dose by 50%; administer every 12 hours.
* CrCl < 5 mL/min (or hemodialysis/peritoneal dialysis): Reduce dose by 50-75%; administer every 12-24 hours. A supplemental dose is not usually required after hemodialysis.
## Contraindications
* Known hypersensitivity to ciprofloxacin, other fluoroquinolones, or any component of the formulation.
* Concomitant administration with tizanidine.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, rash, headache, dizziness.
* **Serious:**
* Tendonitis and tendon rupture (especially Achilles tendon), potentially irreversible. Risk increased in elderly, those on corticosteroids, and transplant recipients. Discontinue immediately if tendon pain or swelling occurs.
* Peripheral neuropathy (can be permanent).
* Central nervous system effects (e.g., seizures, confusion, hallucinations, suicidal thoughts).
* QT interval prolongation, torsades de pointes.
* Clostridioides difficile-associated diarrhea (CDAD).
* Hepatotoxicity.
* Photosensitivity.
* Hypoglycemia and hyperglycemia.
* Aortic aneurysm and dissection.
## Key Drug Interactions
* **Antacids, iron salts, sucralfate, multivalent cations (e.g., calcium, magnesium, aluminum, zinc):** Can significantly decrease oral absorption of ciprofloxacin. Separate administration by at least 2 hours before or 6 hours after ciprofloxacin.
* **Warfarin:** May potentiate the anticoagulant effect. Monitor INR closely.
* **Theophylline:** May increase serum theophylline levels, potentially leading to toxicity. Monitor theophylline levels.
* **Caffeine:** May decrease the metabolism of caffeine, leading to increased side effects. Limit caffeine intake.
* **Tizanidine:** Contraindicated due to potential for significant and prolonged hypotension and CNS effects.
* **Duloxetine, Rivaroxaban, Sildenafil:** Ciprofloxacin can inhibit CYP1A2, leading to increased concentrations of these drugs.
* **QTc-prolonging agents:** Use with caution due to additive risk of QT prolongation.
## Monitoring
* **Renal function:** Essential for dose adjustment.
* **Signs and symptoms of tendonitis/tendon rupture:** Counsel patients to report pain or swelling.
* **Neurological status:** Monitor for CNS effects.
* **Blood glucose:** Especially in diabetic patients.
* **Signs/symptoms of C. difficile infection.**
* **INR:** If patient is on warfarin concurrently.
## Clinical Pearls
* Administer oral ciprofloxacin at least 2 hours before or 6 hours after products containing polyvalent cations (e.g., antacids, iron, calcium, zinc, sucralfate).
* Fluoroquinolones carry a "black box warning" regarding increased risk of tendonitis and tendon rupture.
* Use cautiously in patients with known QT prolongation, uncorrected electrolyte imbalances, or concurrent use of other QTc-prolonging drugs.
* Ciprofloxacin is a potent inhibitor of CYP1A2.
* Extended-release formulations should not be crushed or chewed.
***
**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and hospital protocols for complete details and to ensure adherence to local guidelines. This information is not a substitute for professional medical advice.
