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# Ciprofloxacin (Cipro)
## Overview
Ciprofloxacin is a broad-spectrum fluoroquinolone antibiotic.
## Primary Indications
* Urinary tract infections (complicated and uncomplicated)
* Lower respiratory tract infections (e.g., pneumonia)
* Skin and skin structure infections
* Bone and joint infections
* Intra-abdominal infections
* Infectious diarrhea
* Prostatitis
* Anthrax (prophylaxis and treatment)
* Plague
## Adult Dosing
* **Urinary Tract Infections (Uncomplicated):** 250 mg orally every 12 hours for 3 days.
* **Urinary Tract Infections (Complicated):** 500 mg orally every 12 hours for 7-14 days.
* **Pneumonia, Bone/Joint Infections, Skin Infections:** 500-750 mg orally every 12 hours for 7-14 days (longer for bone/joint infections).
* **Prostatitis:** 500 mg orally every 12 hours for 28 days.
* **Anthrax (Inhalational):** 500 mg orally every 12 hours for 60 days.
* **IV Dosing:** Typically 200-400 mg IV every 8-12 hours, converted from oral dose based on severity.
Maximum oral dose: 1500 mg/day.
## Pediatric Dosing
* **Urinary Tract Infections:** 10-20 mg/kg/day divided into two doses, not to exceed 750 mg/day. Duration varies based on indication.
* **Anthrax (Inhalational):** 15 mg/kg/dose orally every 12 hours. Maximum 500 mg/dose, 1000 mg/day.
* **Cystic Fibrosis Exacerbations:** Dosing varies significantly; consult specialist literature.
**Note:** Use in pediatrics should be reserved for situations where benefits outweigh risks, particularly due to potential for arthropathy.
## Dose Adjustments
* **Renal Impairment:**
* CrCl > 30 mL/min: No adjustment needed.
* CrCl 5-30 mL/min: Oral: 250-500 mg every 12 hours. IV: 200-400 mg every 12 hours.
* CrCl < 5 mL/min: Oral: 250 mg every 12 hours. IV: 200 mg every 12 hours.
* **Hepatic Impairment:** Dose adjustment is generally not required.
## Contraindications
* Hypersensitivity to ciprofloxacin, other fluoroquinolones, or any component of the formulation.
* Concurrent use with tizanidine.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, headache, dizziness.
* **Serious:** Tendonitis and tendon rupture (especially Achilles), peripheral neuropathy, central nervous system effects (seizures, confusion, hallucinations), *Clostridioides difficile*-associated diarrhea, QT prolongation, phototoxicity, dysglycemia (hypoglycemia and hyperglycemia), mental health effects, aortic aneurysm and dissection.
## Key Drug Interactions
* **Theophylline:** Increased theophylline levels, risk of toxicity.
* **Caffeine:** Reduced caffeine clearance, increased risk of adverse effects.
* **Warfarin:** Increased anticoagulant effect.
* **Antacids (aluminum/magnesium), sucralfate, calcium, iron, zinc:** Reduced absorption of ciprofloxacin. Separate administration by at least 2 hours.
* **QTc-prolonging agents:** Increased risk of ventricular arrhythmias.
* **Tizanidine:** Contraindicated; profound hypotension and somnolence.
* **NSAIDs:** Increased risk of CNS stimulation and seizures.
* **Diabetes medications:** Potential for dysglycemia.
## Monitoring
* Renal function.
* Signs and symptoms of tendonitis/tendon rupture.
* Neurologic status.
* Glucose levels in patients with diabetes.
* Signs of *C. difficile* infection.
* ECG if concurrent QTc-prolonging agents are used or risk factors exist.
## Clinical Pearls
* Administer oral ciprofloxacin at least 2 hours before or 6 hours after antacids, iron, zinc, calcium, or sucralfate.
* Avoid excessive sun exposure due to phototoxicity risk.
* Educate patients on the risk of tendon rupture and to report any pain or swelling.
* Use with caution in patients with a history of CNS disorders, myasthenia gravis, or peripheral neuropathy.
* Risk of dysglycemia is significant; monitor blood glucose closely, especially in diabetic patients.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the current official prescribing information and relevant literature for complete details, including patient-specific considerations and local protocols.
