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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 (UTIs)
* Prostatitis
* Gastrointestinal infections (e.g., traveler's diarrhea, Shigella, Salmonella)
* Bone and joint infections
* Lower respiratory tract infections (e.g., *Pseudomonas aeruginosa* in cystic fibrosis patients)
* Intra-abdominal infections (often in combination therapy)
* Anthrax (prophylaxis and treatment)
* Certain sexually transmitted infections (e.g., gonorrhea, chlamydia)
## Adult Dosing
* **Oral:**
* UTIs: 250-500 mg every 12 hours for 3-7 days.
* Complicated UTIs/Prostatitis: 500-750 mg every 12 hours for 7-28 days.
* Gastrointestinal infections: 500 mg every 12 hours for 5-7 days.
* Bone and joint infections: 500-750 mg every 12 hours for 4-12 weeks.
* Inhalational anthrax: 500 mg every 12 hours for 60 days.
* **Intravenous (IV):**
* 200-400 mg every 8-12 hours.
* Maximum IV dose generally 400 mg every 8 hours.
* Duration varies by indication; e.g., 7-14 days for severe UTIs, 7-21 days for intra-abdominal infections.
## Pediatric Dosing
* **Oral or IV:** Dosing is weight-based and indication-specific. Consult current guidelines or PDR.
* General UTI: 10-20 mg/kg per dose every 12 hours (max 750 mg/dose orally, 400 mg/dose IV).
* Complicated UTI: 10-20 mg/kg per dose every 12 hours (max 750 mg/dose orally, 400 mg/dose IV).
* Inhalational anthrax: 10-15 mg/kg per dose every 12 hours (max 500 mg/dose orally or 400 mg/dose IV) for 60 days.
* **Note:** Fluoroquinolones are generally reserved for specific situations in children due to concerns about arthropathy, though this risk is less well-established than previously thought.
## Dose Adjustments
* **Renal Impairment:**
* CrCl > 30 mL/min: No adjustment needed.
* CrCl 5-30 mL/min (oral): Reduce dose by 33-50% depending on indication.
* CrCl < 5 mL/min or hemodialysis/peritoneal dialysis: Reduce dose by 50% and administer after dialysis if given on dialysis days. Use oral dose intervals.
* **Hepatic Impairment:** Dose adjustment not typically required, but caution is advised.
## Contraindications
* Hypersensitivity to ciprofloxacin or other fluoroquinolones.
* Concomitant use with tizanidine.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, headache, dizziness.
* **Serious/Less Common:**
* **Tendonitis/Tendon Rupture:** Risk increases with age, corticosteroid use, and renal impairment. Discontinue immediately if tendon pain or swelling occurs.
* **QTc Prolongation:** Risk with other QTc-prolonging agents.
* **CNS Effects:** Seizures, confusion, hallucinations, depression, increased intracranial pressure.
* **Hypersensitivity Reactions:** Anaphylaxis, Stevens-Johnson syndrome.
* **Clostridium difficile-associated diarrhea (CDAD).**
* **Peripheral Neuropathy.**
* **Photosensitivity.**
* **Dysglycemia:** Both hyperglycemia and hypoglycemia, particularly in diabetic patients also receiving oral hypoglycemics or insulin.
* **Aortic Aneurysm/Dissection:** Increased risk observed in elderly patients using fluoroquinolones.
## Key Drug Interactions
* **Tizanidine:** Contraindicated due to significant additive hypotensive effect.
* **Warfarin:** May enhance anticoagulant effect. Monitor INR closely.
* **Theophylline:** May increase theophylline levels. Monitor theophylline levels.
* **Cation-containing Antacids (Al, Mg), Sucralfate, Iron Supplements, Calcium Supplements, Multivitamins:** Oral ciprofloxacin absorption significantly reduced. Separate administration by at least 2 hours before or 6 hours after these products.
* **Oral Hypoglycemics/Insulin:** Monitor glucose closely; risk of dysglycemia.
* **NSAIDs:** May increase risk of CNS stimulation and seizures.
* **Raltegravir:** May increase concentrations of both drugs.
## Monitoring
* Renal function (for dose adjustment).
* Signs and symptoms of tendonitis (pain, swelling).
* Signs and symptoms of CNS effects.
* Signs and symptoms of hypersensitivity.
* Blood glucose in diabetic patients.
* INR in patients on warfarin.
* Theophylline levels if indicated.
* Signs of *C. difficile* infection.
## Clinical Pearls
* Administer oral ciprofloxacin on an empty stomach for better absorption, if tolerated. If GI upset occurs, can take with food.
* Do not administer IV ciprofloxacin with other IV medications unless compatible; typically administered as a diluted infusion.
* Ensure adequate hydration to minimize crystalluria risk.
* Consider risks vs. benefits, especially in elderly patients and those with pre-existing risk factors for tendon rupture or aortic dissection.
* Ciprofloxacin has poor activity against anaerobes and streptococci; may not be suitable for certain infections.
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*This information is intended as a quick reference and does not replace comprehensive drug information resources. Always verify current prescribing information, guidelines, and institutional protocols before use.*
