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# Ciproxin (ciprofloxacin)
## Overview
Ciprofloxacin is a fluoroquinolone antibiotic with broad-spectrum activity against many Gram-positive and Gram-negative bacteria, including some anaerobes.
## Primary Indications
* Urinary tract infections (complicated and uncomplicated)
* Prostatitis
* Gastroenteritis (bacterial)
* Bone and joint infections
* Intra-abdominal infections (often in combination)
* Lower respiratory tract infections (e.g., community-acquired pneumonia)
* Skin and soft tissue infections
* Inhalational anthrax prophylaxis and treatment
* Plague treatment
## Adult Dosing
* **Urinary Tract Infections (Uncomplicated):** 250 mg orally twice daily for 3 days.
* **Urinary Tract Infections (Complicated):** 500 mg orally or intravenously twice daily for 7-10 days.
* **Prostatitis (Chronic Bacterial):** 500 mg orally twice daily for 28 days.
* **Gastroenteritis (Bacterial):** 500 mg orally twice daily for 5 days.
* **Bone and Joint Infections:** 500-750 mg orally or intravenously twice daily for 4-12 weeks or longer, depending on site and severity.
* **Intra-abdominal Infections:** 500 mg orally or intravenously twice daily (often in combination with metronidazole) for 5-14 days.
* **Community-Acquired Pneumonia:** 500-750 mg orally or intravenously twice daily for 7-14 days.
* **Other Infections:** Doses typically range from 500-750 mg orally or intravenously every 12 hours. IV infusion should be over 60 minutes. Maximum daily dose generally 1500 mg orally or 1200 mg IV (though higher doses may be used for severe infections under specialist guidance).
## Pediatric Dosing
* Dosing is weight-based and indication-specific. Consult pediatric infectious disease guidelines or specialist resources for precise dosing.
* **Urinary Tract Infections:** 10 mg/kg orally or intravenously every 12 hours. Maximum 400 mg per dose.
* **Inhalational Anthrax:** 15 mg/kg orally or intravenously every 12 hours. Maximum 500 mg per dose.
* **Complicated UTI and Pyelonephritis:** 10-15 mg/kg orally or intravenously every 12 hours. Maximum 750 mg per dose.
* Duration of therapy varies by indication. Potential for arthropathy and tendon issues in pediatric patients necessitates careful consideration of risks versus benefits, especially for non-severe infections.
## Dose Adjustments
* **Renal Impairment:**
* CrCl > 30 mL/min: No adjustment needed.
* CrCl 5-30 mL/min: Reduce maintenance dose by 1/3 to 1/2, administer every 12 hours.
* CrCl < 5 mL/min (hemodialysis/peritoneal dialysis): Reduce maintenance dose by 1/2, administer every 12 hours. Administer after dialysis.
* **Hepatic Impairment:** Generally no dose adjustment is required unless severe hepatic dysfunction is present and associated with renal impairment.
## 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 tendon), peripheral neuropathy, central nervous system effects (seizures, confusion, hallucinations), QT interval prolongation, C. difficile-associated diarrhea, phototoxicity, hypersensitivity reactions (including anaphylaxis), glucose dysregulation (hypoglycemia or hyperglycemia), dysgeusia, arthralgia.
## Key Drug Interactions
* **Theophylline:** Increased theophylline levels; monitor therapeutic levels closely and consider dose reduction.
* **Warfarin:** Increased anticoagulant effect; monitor INR closely.
* **Antacids (Aluminum, Magnesium), Sucralfate, Iron, Zinc, Calcium:** Reduced oral absorption; separate administration by at least 2 hours before or 6 hours after ciprofloxacin.
* **Cyclosporine:** Increased cyclosporine levels.
* **DBI inhibitors (e.g., Omeprazole):** May increase ciprofloxacin levels.
* **NSAIDs:** Increased risk of CNS stimulation and seizures.
* **Tizanidine:** Contraindicated; risk of severe hypotension and CNS adverse effects.
* **SGLT2 inhibitors:** Increased risk of hypoglycemia.
## Monitoring
* Renal function (especially with dose adjustments).
* Signs and symptoms of tendonitis/tendon rupture.
* Neurological status for CNS effects.
* Glucose levels in diabetic patients.
* INR if used with warfarin.
* Signs and symptoms of C. difficile infection.
* Hearing (if auditory toxicity is suspected).
## Clinical Pearls
* Administer oral ciprofloxacin at least 2 hours before or 6 hours after antacids, iron, calcium, zinc, or sucralfate.
* Ensure adequate hydration to prevent crystalluria.
* Discontinue immediately if tendon pain or inflammation occurs.
* Use with caution in patients with known QT prolongation issues or those taking other QTc-prolonging medications.
* Consider risk-benefit in pediatric patients due to potential for arthropathy.
* IV infusion should be administered over at least 60 minutes to minimize infusion-related reactions.
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*This information is intended for healthcare professionals. Always consult the current official prescribing information and your institution's guidelines for complete details and to ensure accuracy before making clinical decisions.*
