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# Ciprofloxacin
## Overview
Ciprofloxacin is a broad-spectrum fluoroquinolone antibiotic effective against many Gram-positive and Gram-negative bacteria.
## Primary Indications
* Urinary tract infections (complicated and uncomplicated)
* Lower respiratory tract infections
* Skin and skin structure infections
* Bone and joint infections
* Intra-abdominal infections (in combination with metronidazole)
* Infectious diarrhea
* Anthrax (prophylaxis and treatment)
* Plague (prophylaxis and treatment)
## Adult Dosing
* **Urinary Tract Infections (Uncomplicated):** 250 mg PO BID for 3 days.
* **Urinary Tract Infections (Complicated) & Prostatitis:** 500 mg PO BID for 7-28 days, or 400 mg IV BID for 7-28 days.
* **Other Indications:** Dosing varies by infection type and severity. Typical doses range from 250-750 mg PO BID or 200-400 mg IV BID.
* **Maximum Dose:** Generally 1500 mg PO daily or 1200 mg IV daily, but may be higher in specific severe infections like anthrax or plague as per guidelines.
## Pediatric Dosing
Dosing is weight-based and indication-specific. Consult pediatric infectious disease guidelines or specialist for specific recommendations. Examples include:
* **Urinary Tract Infections:** 10-20 mg/kg/day divided BID, not to exceed adult doses.
* **Acute Otitis Media:** 10 mg/kg/dose BID for 10 days (max 500 mg/dose).
* **Chickenpox:** 15 mg/kg/day divided BID (max 500 mg/dose).
* **Cystic Fibrosis Pulmonary Exacerbations:** Dosing is highly variable and guided by clinical response and pharmacokinetic principles.
## Dose Adjustments
* **Renal Impairment:**
* CrCl > 30 mL/min: No adjustment needed.
* CrCl 5-30 mL/min: Increase dosing interval by 50% (e.g., BID becomes every 12 hours, TID becomes every 18 hours).
* CrCl < 5 mL/min or hemodialysis/continuous ambulatory peritoneal dialysis (CAPD): Increase dosing interval by 50% or use 75% of the standard dose every 24 hours.
* **Hepatic Impairment:** No specific dose adjustment is typically required.
## Contraindications
* Hypersensitivity to ciprofloxacin, other fluoroquinolones, or any component of the formulation.
* Concurrent use with tizanidine.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, headache, dizziness, rash.
* **Serious:** Tendon rupture (especially Achilles), peripheral neuropathy, central nervous system effects (seizures, confusion, hallucinations), *Clostridioides difficile*-associated diarrhea, QT prolongation, phototoxicity, dysglycemia (hypoglycemia and hyperglycemia), aortic aneurysm and dissection, arthralgia, myalgia, mental health effects.
## Key Drug Interactions
* **Tizanidine:** Increased tizanidine levels and severe hypotension/sedation. Avoid concurrent use.
* **Theophylline:** Increased theophylline levels. Monitor theophylline levels and adjust dose if necessary.
* **Warfarin:** Enhanced anticoagulant effect. Monitor INR closely.
* **Antacids, Sucralfate, Iron, Zinc, Multivitamins (containing divalent/trivalent cations):** Reduced absorption of ciprofloxacin. Separate administration by at least 2 hours before or 6 hours after.
* **CYP1A2 substrates (e.g., clozapine, ropinirole, duloxetine):** Increased plasma concentrations. Monitor for adverse effects.
* **NSAIDs:** Increased risk of CNS stimulation and seizures.
* **Potassium-depleting agents (e.g., diuretics, corticosteroids):** May increase risk of QT prolongation.
## Monitoring
* **Renal function:** Especially in patients with pre-existing renal impairment or those at risk for kidney injury.
* **Glucose levels:** Monitor for hypoglycemia or hyperglycemia, particularly in diabetic patients.
* **Tendon pain/swelling:** Counsel patients to report any signs of tendon issues.
* **Neurological symptoms:** Monitor for dizziness, confusion, hallucinations, and peripheral neuropathy.
* **Signs of *C. difficile* infection:** Diarrhea, abdominal pain, fever.
* **INR:** If used concurrently with warfarin.
* **ECG:** Consider in patients with risk factors for QT prolongation or when used with other QT-prolonging agents.
## Clinical Pearls
* Achieve adequate hydration to prevent crystalluria.
* Avoid concurrent administration with polyvalent cation-containing products to maximize absorption.
* Tendon rupture is a serious risk; discontinue if tendon pain or inflammation occurs and advise patients to avoid exercise.
* Consider risk of CNS effects and neuropathy; use with caution in patients with seizure disorders or neurological conditions.
* Can cause phototoxicity; advise patients to avoid excessive sun exposure and use protective measures.
* Use cautiously in patients with known QT prolongation or those taking other QT-prolonging medications.
* Ciprofloxacin is not generally recommended for uncomplicated gonorrhea due to widespread resistance.
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***Disclaimer:** This information is for educational purposes and does not substitute professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines for complete and up-to-date details regarding drug use, including specific dosing, contraindications, interactions, and adverse effects. Local protocols may influence prescribing decisions.*
