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# Ciprofloxacin
## Overview
Ciprofloxacin is a broad-spectrum fluoroquinolone antibiotic effective against many Gram-positive and Gram-negative bacteria.
## Primary Indications
* Urinary tract infections (complicated and uncomplicated)
* Prostatitis
* Anthrax (prophylaxis and treatment)
* Typhoid fever
* Infectious diarrhea
* Certain respiratory tract, bone and joint, skin and soft tissue infections, and intra-abdominal infections when other agents are not suitable.
## Adult Dosing
Dosing varies significantly by indication and site of infection. Usual adult doses range from 250 mg to 750 mg twice daily. For severe infections, doses may be up to 750 mg twice daily. Intravenous doses are typically 200 mg to 400 mg every 8 to 12 hours. Specific dosing should follow institutional guidelines or current prescribing information.
## Pediatric Dosing
Recommended for specific indications such as post-exposure anthrax prophylaxis and treatment, complicated urinary tract infections, and plague when benefits outweigh risks. Dosing is typically based on weight, ranging from 7.5 mg/kg to 20 mg/kg per dose, administered every 8 to 12 hours. Maximum doses are generally 500 mg per dose or 1500 mg per day for oral and 400 mg per dose or 1200 mg per day for IV. Long-term use in children is generally avoided due to potential for arthropathy.
## Dose Adjustments
* **Renal Impairment:** Reduce dose in patients with significant renal impairment (CrCl < 30 mL/min). Specific recommendations vary by indication and should be guided by prescribing information.
* **Hepatic Impairment:** No dose adjustment typically needed, but caution advised.
## Contraindications
* Hypersensitivity to ciprofloxacin or other fluoroquinolones.
* Concomitant use with tizanidine.
## Adverse Effects
Common: Nausea, vomiting, diarrhea, abdominal pain, headache, dizziness.
Serious: Tendonitis and tendon rupture (especially Achilles), central nervous system effects (seizures, confusion, hallucinations), peripheral neuropathy, QT interval prolongation, C. difficile-associated diarrhea, phototoxicity, hypoglycemia, psychiatric disturbances.
## Key Drug Interactions
* **Cation-containing products:** Antacids, sucralfate, iron supplements, zinc supplements, calcium supplements, multivitamins can decrease ciprofloxacin absorption. Administer ciprofloxacin at least 2 hours before or 6 hours after these products.
* **Theophylline:** Ciprofloxacin can inhibit the metabolism of theophylline, increasing serum levels and risk of toxicity.
* **Warfarin:** May increase the anticoagulant effect of warfarin. Monitor INR closely.
* **CYP1A2 Substrates:** Other drugs metabolized by CYP1A2 (e.g., clozapine, ropinirole, tizanidine) may have increased concentrations. Avoid concomitant use with tizanidine.
* **NSAIDs:** Increased risk of CNS stimulation and seizures.
* **QT-prolonging agents:** Increased risk of arrhythmias.
## Monitoring
* Renal function.
* Signs of tendon inflammation or rupture.
* Central nervous system symptoms.
* For patients on warfarin, INR.
* For patients on theophylline, theophylline levels if clinically indicated.
* Blood glucose, especially in diabetic patients.
## Clinical Pearls
* Ensure adequate hydration to prevent crystalluria.
* Avoid concurrent use with dairy products and calcium-fortified juices when taken orally, as they can reduce absorption. Space administration by at least 2 hours.
* Tendon rupture is a serious risk and can occur during treatment or months after discontinuation. Discontinue if tendon pain or inflammation occurs.
* Use with caution in patients with a history of CNS disorders or prolonged QTc interval.
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**Disclaimer:** This information is intended for healthcare professionals. Please consult the current official prescribing information and relevant guidelines for complete and up-to-date product details. Patient-specific factors must always be considered.
