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# Ciprofloxacin (Cipro)
## Overview
Ciprofloxacin is a broad-spectrum fluoroquinolone antibiotic effective against many gram-positive and gram-negative bacteria, including *Pseudomonas aeruginosa*. It works by inhibiting bacterial DNA gyrase and topoisomerase IV.
## Primary Indications
* Urinary tract infections (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 (often in combination with other agents)
* Infectious diarrhea
* Anthrax (prophylaxis and treatment)
* Plague
## Adult Dosing
* **Urinary Tract Infections (Uncomplicated):** 250 mg orally twice daily for 3 days.
* **Urinary Tract Infections (Complicated):** 500 mg orally twice daily for 7-14 days.
* **Prostatitis:** 500 mg orally twice daily for 28 days.
* **Respiratory Tract Infections, Skin/Skin Structure Infections, Bone/Joint Infections:** 500-750 mg orally twice daily for 7-14 days (duration varies by indication and severity).
* **Intra-abdominal Infections:** 500 mg orally twice daily for 7-14 days (typically in combination therapy).
* **Anthrax (Inhalational):** 500 mg orally twice daily for 60 days.
* **Intravenous Dosing:** Typically 200-400 mg IV every 8-12 hours, depending on indication. Usual maximum IV dose is 400 mg every 8 hours.
## Pediatric Dosing
Dosing is weight-based and depends on the indication. The risks and benefits should be carefully considered due to potential for arthropathy. Consult specific guidelines or institutional protocols for precise dosing.
* **Urinary Tract Infections:** 10-20 mg/kg/day divided every 12 hours (maximum 750 mg/dose). Duration varies (e.g., 7-14 days for complicated UTI).
* **Osteomyelitis:** 10-15 mg/kg/day divided every 12 hours (maximum 750 mg/dose).
* **Anthrax (Inhalational):** 15 mg/kg/dose every 12 hours (maximum 500 mg/dose).
## Dose Adjustments
* **Renal Impairment:** Reduce dose in moderate to severe renal impairment (CrCl < 30 mL/min). Consult prescribing information for specific dosing adjustments.
* **Hepatic Impairment:** No dose adjustment typically needed, but caution is advised.
## Contraindications
* Hypersensitivity to ciprofloxacin or other fluoroquinolones.
* Use in patients with a history of tendon disorders related to fluoroquinolone administration.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, headache, dizziness.
* **Serious:** Tendon rupture/tendinitis (especially Achilles tendon), peripheral neuropathy, CNS effects (seizures, tremor, confusion), *Clostridioides difficile*-associated diarrhea, QT interval prolongation, phototoxicity, dysglycemia (hypoglycemia and hyperglycemia, particularly in diabetic patients), aortic aneurysm and dissection.
## Key Drug Interactions
* **Theophylline:** Increased theophylline levels; monitor and potentially reduce theophylline dose.
* **Caffeine:** Reduced metabolism of caffeine; limit caffeine intake.
* **Warfarin:** Increased anticoagulant effect; monitor INR closely.
* **Antacids, Sucralfate, Metal Cations (e.g., iron, calcium, magnesium, zinc):** Reduced absorption of ciprofloxacin; separate administration by at least 2 hours before or 6 hours after ciprofloxacin.
* **NSAIDs:** Increased risk of CNS stimulation and seizures.
* **P-glycoprotein inhibitors (e.g., cyclosporine):** May increase ciprofloxacin levels.
* **CYP1A2 substrates:** Ciprofloxacin can inhibit CYP1A2, potentially increasing levels of substrates like clozapine, duloxetine, ropinirole, theophylline.
## Monitoring
* **Renal and Hepatic Function:** Periodically, especially in patients with pre-existing impairment.
* **Glucose Levels:** In diabetic patients, monitor for hypoglycemia or hyperglycemia.
* **Signs of Tendon Inflammation/Rupture:** Educate patients to report pain, swelling, or tearing.
* **Mental Status Changes:** Assess for CNS side effects.
* **INR:** If co-administered with warfarin.
## Clinical Pearls
* Administer oral ciprofloxacin at least 2 hours before or 6 hours after cation-containing antacids, iron supplements, or multivalent cation-containing products.
* Maintain adequate hydration to prevent crystalluria.
* Avoid excessive exposure to sunlight or UV light due to phototoxicity risk.
* Discontinue ciprofloxacin immediately if tendon pain or swelling occurs and consider alternative antibiotic therapy.
* Due to the risk of dysglycemia, particularly in elderly and diabetic patients, monitor blood glucose closely.
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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 relevant guidelines for complete details and to ensure patient safety.*
