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# Ciprofloxacin (Cipro)
## Overview
Ciprofloxacin is a broad-spectrum fluoroquinolone antibiotic.
## Primary Indications
* Urinary tract infections (UTIs)
* Prostatitis
* Gastroenteritis (bacterial)
* Anthrax (prophylaxis and treatment)
* Certain respiratory tract infections, skin/soft tissue infections, bone/joint infections, and intra-abdominal infections (often in combination regimens).
## Adult Dosing
Dosing varies significantly based on indication and severity. Common examples:
* **Uncomplicated UTI:** 250 mg oral every 12 hours for 3 days.
* **Complicated UTI/Prostatitis:** 500 mg oral or IV every 12 hours for 7-28 days.
* **Bacterial Gastroenteritis:** 500 mg oral every 12 hours for 3-5 days.
* **Anthrax (post-exposure prophylaxis):** 500 mg oral every 12 hours for 60 days.
Maximum oral dose typically 1500 mg daily; maximum IV dose typically 1200 mg daily. Specific dose guidance for complex infections should follow institutional protocols or specialized guidelines.
## Pediatric Dosing
Used in pediatric patients for specific indications like complicated UTIs (cystitis or pyelonephritis) and anthrax.
* **Complicated UTI/Pyelonephritis:** 10 to 20 mg/kg/day orally or IV divided every 8-12 hours. Maximum dose 1500 mg/day. Duration typically 10-14 days.
* **Anthrax (post-exposure prophylaxis):** 15 mg/kg per dose orally every 12 hours for 60 days. Maximum dose 1000 mg/day.
Consult specific pediatric infectious disease guidelines for precise dosing.
## Dose Adjustments
* **Renal Impairment:** Oral dosing may require reduction if CrCl < 30 mL/min. IV dosing with significant renal impairment (CrCl < 30 mL/min) typically requires a 33-50% dose reduction or extending the dosing interval. Use guidelines for specific recommendations.
* **Hepatic Impairment:** Dose adjustment generally not required unless severe hepatic dysfunction is accompanied by renal impairment.
## Contraindications
* Hypersensitivity to ciprofloxacin, other fluoroquinolones, or any component of the formulation.
* Concurrent use with tizanidine.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, headache, dizziness.
* **Serious:** Tendon rupture/tendinitis (especially Achilles tendon), peripheral neuropathy, central nervous system effects (seizures, hallucinations, confusion), *Clostridioides difficile*-associated diarrhea, QT prolongation, dysglycemia (hypo- and hyperglycemia), C. diff infection, aortic aneurysm/dissection. Photosensitivity.
## Key Drug Interactions
* **Tizanidine:** Contraindicated due to significant increase in tizanidine levels and risk of severe hypotension and somnolence.
* **Theophylline:** Monitor theophylline levels; ciprofloxacin can inhibit metabolism.
* **Warfarin:** May potentiate the effect of warfarin; monitor INR closely.
* **Antacids, Sucralfate, Iron, Zinc, Calcium, Multivitamins:** Oral absorption can be decreased; separate administration by at least 2 hours before or 6 hours after. Calcium in dietary sources (e.g., milk, yogurt) generally does not require separation.
* **CYP1A2 inhibitors (e.g., fluvoxamine):** May increase ciprofloxacin levels.
* **Dolutegravir, raltegravir:** May decrease absorption of these antivirals.
* **PR interval prolonging agents:** Increased risk of QT prolongation.
## Monitoring
* Assess for signs/symptoms of tendon inflammation or rupture.
* Monitor for adverse CNS effects.
* Monitor blood glucose, especially in diabetic patients.
* Assess for signs of *C. difficile* infection.
* Monitor INR if co-administered with warfarin.
* Monitor renal function for dose adjustments.
## Clinical Pearls
* Ensure adequate hydration to prevent crystalluria.
* Avoid administration with dairy products or mineral supplements to optimize absorption, except for calcium-containing foods.
* Tendon rupture is a risk across all age groups but is higher in elderly patients, those on corticosteroids, and transplant recipients. Discontinue immediately if tendon pain or inflammation occurs.
* Peripheral neuropathy can be irreversible. Assess patients for symptoms.
* Use with caution in patients with known QT prolongation or taking other QT-prolonging agents.
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*This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines before making clinical decisions.*
