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# Ciprofloxacin (Cipro)
## 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
* Infectious diarrhea
* Bone and joint infections
* Intra-abdominal infections
* Lower respiratory tract infections
* Skin and skin structure infections
* Anthrax (prophylaxis and treatment)
* Plague
## Adult Dosing
Dosing varies significantly by indication. Typical doses include:
* **Uncomplicated UTI:** 250 mg orally twice daily for 3 days.
* **Complicated UTI:** 500 mg orally twice daily for 7-14 days.
* **Prostatitis:** 500 mg orally twice daily for 28 days.
* **Infectious Diarrhea:** 500 mg orally twice daily for 5 days.
* **Bone and Joint Infections:** 500-750 mg orally twice daily for 4 weeks or longer.
* **Anthrax:** 500 mg orally twice daily for 60 days.
* **Pneumonia (community-acquired):** 500-750 mg orally twice daily for 7-14 days.
* **Intravenous:** Doses range from 200 mg every 12 hours to 400 mg every 8 hours, depending on the indication.
Maximum oral dose generally 750 mg twice daily, IV 400 mg every 8 hours. Specific dosing for certain complex infections may require specialist consultation or adherence to local guidelines.
## Pediatric Dosing
Recommended for specific indications (e.g., complicated UTI, post-exposure anthrax prophylaxis) when benefits outweigh risks. Dosing is typically weight-based:
* **Complicated UTI:** 10-20 mg/kg/day divided into two doses for 10-21 days.
* **Anthrax prophylaxis:** 10-15 mg/kg/dose orally twice daily for 60 days.
Maximum pediatric dose: 750 mg twice daily or 30 mg/kg/day, whichever is less.
## Dose Adjustments
* **Renal Impairment:** Dosage reduction is necessary for CrCl < 30 mL/min. Consult specific drug information for exact reduction ratios.
* **Hepatic Impairment:** No dose adjustment generally required.
## Contraindications
* Hypersensitivity to ciprofloxacin or other quinolones.
* Concomitant use with tizanidine.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, headache, dizziness.
* **Serious:** Tendinopathy/tendon rupture (especially Achilles), peripheral neuropathy, CNS effects (seizures, hallucinations), QT prolongation, *Clostridioides difficile*-associated diarrhea, photosensitivity, dysglycemia (hypo- and hyperglycemia, especially in diabetics), arthropathies in pediatric patients.
## Key Drug Interactions
* **Cations (Aluminum, Calcium, Iron, Magnesium, Zinc):** Reduces absorption. Separate administration by at least 2 hours before or 6 hours after chelating agents.
* **Warfarin:** May enhance anticoagulant effect. Monitor INR closely.
* **Theophylline:** May increase theophylline levels; monitor plasma concentrations.
* **Tizanidine:** Contraindicated due to significant increase in tizanidine levels and adverse effects.
* **Probenecid:** May increase ciprofloxacin levels.
* **CYP1A2 Substrates:** Potential for increased levels of substrates like clozapine, olanzapine, ropinirole.
## Monitoring
* Renal function (for dose adjustments).
* Signs and symptoms of tendon inflammation or rupture.
* Neurologic status for CNS effects.
* Blood glucose in diabetic patients.
* INR if co-administered with warfarin.
* For *C. difficile* associated diarrhea.
## Clinical Pearls
* Encourage adequate hydration to minimize crystalluria.
* Counsel patients to avoid sun exposure and use sun protection due to photosensitivity.
* Advise patients to report any signs of tendon pain or swelling immediately.
* Avoid concomitant use with dairy products or calcium-fortified juices when taken orally to avoid decreased absorption.
* Duration of therapy is crucial for effectiveness and resistance prevention.
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*Disclaimer: This information is intended for healthcare professionals. Always verify current prescribing information, dosage guidelines, and contraindications with official drug labeling or a trusted clinical resource before prescribing or administering any medication.*
