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# Ciprofloxacin (Cipro)
## Overview
Ciprofloxacin is a broad-spectrum fluoroquinolone antibiotic.
## Primary Indications
* Urinary tract infections (UTIs) - complicated and uncomplicated
* Prostatitis
* Lower respiratory tract infections (e.g., acute exacerbations of chronic bronchitis, community-acquired pneumonia)
* Skin and skin structure infections
* Bone and joint infections
* Intra-abdominal infections (in combination with metronidazole)
* Infectious diarrhea
* Anthrax (prophylaxis and treatment)
* Plague (treatment)
## Adult Dosing
Dosing varies significantly by indication and severity. Typical doses range from 250 mg to 750 mg administered orally or intravenously every 12 hours.
* Uncomplicated UTIs: 250 mg PO BID for 3 days or 500 mg PO BID for 7 days.
* Complicated UTIs: 500 mg PO/IV BID for 7-14 days or 750 mg PO BID for 7-14 days.
* Community-acquired pneumonia: 500 mg PO/IV BID for 7-14 days.
* Anthrax (post-exposure prophylaxis): 500 mg PO BID for 60 days.
* Anthrax (treatment): 500 mg IV BID for 14 days, followed by 500 mg PO BID for a total duration of 60 days.
Maximum daily dose typically 1500 mg PO or 1000 mg IV.
## Pediatric Dosing
Used in specific situations due to potential for arthropathy. Dosing is typically based on weight and indication.
* Urinary tract infections: 10-20 mg/kg/day IV or PO divided every 8-12 hours. Maximum 750 mg/dose or 1500 mg/day.
* Complicated urinary tract infections and pyelonephritis: 10-20 mg/kg/day IV or PO divided every 8-12 hours. Maximum 750 mg/dose or 1500 mg/day.
* Inhalational anthrax post-exposure prophylaxis: 15 mg/kg/dose IV or PO every 12 hours for 60 days. Maximum 500 mg/dose or 1000 mg/day.
## Dose Adjustments
* **Renal Impairment:** Dose reduction is required when CrCl < 30 mL/min.
* For doses usually given every 12 hours, administer every 18 hours if CrCl is 5-29 mL/min.
* For doses usually given every 12 hours, omit or administer every 24 hours if CrCl < 5 mL/min (use with caution).
* **Hepatic Impairment:** No specific dose adjustment is typically recommended, but caution is advised.
## Contraindications
* Hypersensitivity to ciprofloxacin, other quinolones, or any component of the formulation.
* Concurrent use with tizanidine.
## Adverse Effects
Common: Nausea, vomiting, diarrhea, rash, abnormal liver function tests.
Serious: Tendon rupture (especially Achilles tendon), peripheral neuropathy, CNS effects (dizziness, headache, confusion, hallucinations), QT prolongation, C. difficile-associated diarrhea, dysglycemia (hypoglycemia and hyperglycemia), aortic aneurysm and dissection, phototoxicity.
## Key Drug Interactions
* **Tizanidine:** Contraindicated; risk of severe hypotension and somnolence.
* **Theophylline:** Increased theophylline levels; monitor therapeutic drug levels.
* **Warfarin:** Increased anticoagulant effect; monitor INR closely.
* **CYP1A2 substrates:** May increase concentrations of drugs metabolized by CYP1A2 (e.g., clozapine, ropinirole, theophylline).
* **Antacids, Sucralfate, Multivitamins (containing iron or zinc), Calcium, Iron, Magnesium, Zinc:** Reduced oral absorption; separate administration by at least 2 hours before or 6 hours after.
* **Oral hypoglycemics/Insulin:** Increased risk of dysglycemia; monitor blood glucose.
* **NSAIDs:** Increased risk of CNS stimulation and seizures.
## Monitoring
* Renal and hepatic function.
* Signs and symptoms of tendon inflammation or rupture.
* Neurological status.
* Blood glucose levels, especially in diabetic patients.
* INR if co-administered with warfarin.
* ECG for QT interval, particularly in patients with risk factors.
## Clinical Pearls
* Administer oral suspensions and tablets at least 2 hours before or 6 hours after antacids or supplements containing divalent/trivalent cations.
* Intravenous infusions should be administered over at least 60 minutes.
* Monitor for tendon pain or swelling. Discontinue if suspected.
* Use with caution in patients with known QT prolongation risk factors or those taking other QT-prolonging medications.
* Avoid excessive sunlight or UV exposure due to phototoxicity risk.
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***Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and institutional protocols before making any treatment decisions. Dosing and safety information may vary based on patient-specific factors and the latest clinical evidence.*
