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# Ciprofloxacin (Cipro)
## Overview
Ciprofloxacin is a broad-spectrum fluoroquinolone antibiotic with bactericidal activity.
## Primary Indications
* Urinary tract infections (UTIs), including complicated UTIs and prostatitis
* Respiratory tract infections (e.g., sinusitis, community-acquired pneumonia)
* Skin and skin structure infections
* Bone and joint infections
* Intra-abdominal infections
* Infectious diarrhea
* Anthrax (prophylaxis and treatment)
* Plague
## Adult Dosing
Dosing varies significantly based on indication, severity, and pathogen. Typical oral doses range from 250 mg to 750 mg BID. IV doses range from 200 mg to 400 mg q8-12h. Maximum daily oral dose is generally 1500 mg. Maximum daily IV dose is generally 1200 mg. Specific dosing for indications like anthrax or complicated infections should follow guidelines.
## Pediatric Dosing
Established indications include complicated UTIs and post-exposure pneumonic plague.
* **Complicated UTIs:** 10-15 mg/kg PO/IV every 8-12 hours. Maximum 400 mg/dose.
* **Plague (post-exposure):** 15 mg/kg PO/IV every 12 hours for 14 days. Maximum 500 mg/dose.
Use in children should be reserved for situations where benefits outweigh risks, especially given potential for arthropathy.
## Dose Adjustments
* **Renal Impairment:** Reduce dose for CrCl < 30 mL/min. Consult specific guidelines for oral and IV adjustments.
* **Hepatic Impairment:** No dose adjustment typically required.
## Contraindications
* Hypersensitivity to ciprofloxacin or other fluoroquinolones.
* Concurrent use with tizanidine.
## Adverse Effects
Common: Nausea, vomiting, diarrhea, abdominal pain, headache, dizziness.
Serious: Tendon rupture/tendinitis (especially Achilles tendon), peripheral neuropathy, CNS effects (seizures, psychosis), QT prolongation, C. difficile-associated diarrhea, dysglycemia (hypo- and hyperglycemia), aortic aneurysm/dissection.
## Key Drug Interactions
* **Cation-containing antacids, sucralfate, iron, calcium, magnesium, zinc:** Concurrent administration decreases absorption; separate by at least 2 hours before or 6 hours after ciprofloxacin.
* **Warfarin:** May increase INR. Monitor INR closely.
* **Theophylline:** May increase theophylline levels. Monitor theophylline levels.
* **Tizanidine:** Contraindicated; ciprofloxacin inhibits its metabolism leading to significant hypotension and somnolence.
* **CYP1A2 substrates:** Potential for increased concentrations of other substrates (e.g., clozapine, duloxetine, ropinirole).
## Monitoring
* Renal function for dose adjustments.
* Signs of tendon pain or rupture.
* Neurological symptoms.
* Blood glucose levels, particularly in diabetic patients.
* INR if on warfarin.
* Signs and symptoms of C. difficile infection.
## Clinical Pearls
* Administer oral ciprofloxacin on an empty stomach for optimal absorption, but can be taken with food if GI upset occurs.
* IV fluid administration should be adequate to prevent crystalluria.
* Avoid concurrent use with dairy products or calcium-fortified juices if taken orally, unless taken with a meal.
* Discontinue immediately if tendon pain or rupture occurs.
* Use with caution in patients with known QT prolongation risk factors.
_Please verify current prescribing information for the most up-to-date details._
