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# Ciprofloxacin (Cipro)
## Overview
Ciprofloxacin is a fluoroquinolone antibiotic with broad-spectrum activity against many Gram-positive and Gram-negative bacteria, including some that are resistant to other antibiotics.
## Primary Indications
* Urinary tract infections (complicated and uncomplicated)
* Respiratory tract infections (e.g., community-acquired pneumonia, acute bacterial exacerbations of chronic bronchitis)
* Skin and soft tissue infections
* Bone and joint infections
* Intra-abdominal infections
* Infectious diarrhea
* Anthrax (prophylaxis and treatment)
* Gonococcal infections (certain types)
* Typhoid fever
## Adult Dosing
Dosing varies significantly by indication and severity. Typical adult doses:
* **Uncomplicated Urinary Tract Infection:** 250 mg PO BID for 3 days.
* **Complicated Urinary Tract Infection:** 500 mg PO/IV BID for 7-14 days.
* **Community-Acquired Pneumonia:** 500-750 mg PO/IV BID for 7-14 days.
* **Bone and Joint Infections:** 500-750 mg PO/IV BID for 4-12 weeks.
* **Anthrax (Inhalational):** 500 mg PO/IV BID for 60 days.
* **Maximum daily dose:** Generally 1500 mg PO or 1200 mg IV. Specific indications may have lower maximums.
## Pediatric Dosing
Established for specific indications. Dosing is typically based on weight.
* **Urinary Tract Infection:** 10-15 mg/kg/dose IV/PO BID, maximum 500 mg/dose, for 7-14 days.
* **Inhalational Anthrax:** 10-15 mg/kg/dose IV/PO BID, maximum 500 mg/dose, for 60 days.
* **Maximum pediatric dose:** Generally 500 mg per dose; higher doses (up to 750 mg/dose) may be used in specific situations based on clinical judgment and local protocols.
## Dose Adjustments
* **Renal Impairment:** Adjust dose based on CrCl. For CrCl < 30 mL/min, reduce dose by 50% (e.g., if standard dose is 500 mg BID, administer 250 mg BID). hemodialysis patients may require additional dosing post-dialysis. GFR-based dosing is preferred.
## Contraindications
* Hypersensitivity to ciprofloxacin, other fluoroquinolones, or any component of the formulation.
* Concomitant use with tizanidine.
## Adverse Effects
Common: Nausea, vomiting, diarrhea, abdominal pain, headache, dizziness.
Serious: Tendon rupture (especially Achilles), peripheral neuropathy, central nervous system effects (seizures, hallucinations), QT interval prolongation, C. difficile-associated diarrhea, dysglycemia (hypoglycemia and hyperglycemia), aortic dissection/aneurysm, phototoxicity, arthralgia/myalgia.
## Key Drug Interactions
* **Cations (Antacids, Sucralfate, Iron, Zinc, Calcium, Magnesium):** Reduce absorption. Separate administration by at least 2 hours before or 6 hours after ciprofloxacin.
* **Theophylline:** Ciprofloxacin can inhibit theophylline metabolism, increasing serum levels and risk of toxicity. Monitor theophylline levels.
* **Warfarin:** May enhance anticoagulant effect. Monitor INR closely.
* **Tizanidine:** Contraindicated due to increased risk of severe hypotension and somnolence.
* **CYP1A2 substrates:** Potential for increased concentrations (e.g., clozapine, duloxetine, caffeine).
* **QTc prolonging agents:** Increased risk of torsades de pointes.
## Monitoring
* Renal function (for dose adjustment).
* Signs and symptoms of tendonitis or tendon rupture.
* Neurological status.
* Blood glucose (especially in diabetics).
* INR if on warfarin.
* Stool for C. difficile if diarrhea develops.
## Clinical Pearls
* Ensure adequate hydration to minimize crystalluria risk.
* Administer oral ciprofloxacin at least 2 hours before or 6 hours after cation-containing products.
* Tendon rupture risk is increased in elderly patients, those on corticosteroids, and renal transplant recipients. Discontinue at the first sign of tendon pain or inflammation.
* Use with caution in patients with CNS disorders (e.g., epilepsy) due to potential for CNS stimulation.
* Consider potential for secondary fungal infections.
This information is intended as a concise overview and does not replace the full prescribing information. Always consult the most current drug monograph or PDR for complete details, including all warnings, precautions, and contraindications.
