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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
* Gastroenteritis (bacterial)
* Bone and joint infections
* Certain respiratory tract infections (e.g., acute exacerbations of chronic bronchitis)
* Intra-abdominal infections
* Anthrax (prophylaxis and treatment)
* Plague
## Adult Dosing
* **Oral:** 250 mg to 750 mg every 12 hours. Duration varies by indication (e.g., 3 days for uncomplicated UTIs, 7-14 days for more complicated infections).
* **Intravenous (IV):** 200 mg to 400 mg every 8 to 12 hours.
* **Maximum oral daily dose:** Generally 1500 mg.
* **Maximum IV daily dose:** Generally 1200 mg.
* Specific dosing for indications like anthrax may differ and is often guided by public health recommendations.
## Pediatric Dosing
* **Oral/IV:** 10 mg/kg/dose every 8 to 12 hours.
* **Maximum dose:** 1500 mg/day for oral therapy, 1200 mg/day for IV therapy, or 400 mg per dose (IV).
* Considered second-line for many common pediatric infections due to potential for arthropathy; reserve for situations where benefits outweigh risks (e.g., specific resistant organisms, anthrax, complicated UTIs).
## Dose Adjustments
* **Renal Impairment:**
* **CrCl > 30 mL/min:** No dose adjustment needed.
* **CrCl 5-30 mL/min:** Reduce usual maintenance dose by 1/3 to 1/2 and maintain dosing interval, or administer 1/2 usual dose every 12 hours (oral) or 24 hours (IV).
* **Hemodialysis/Peritoneal Dialysis:** Administer usual dose every 24 hours. Supplemental dose is generally not needed after dialysis.
* **Hepatic Impairment:** No specific dose adjustment is typically required, but caution is advised.
## Contraindications
* Hypersensitivity to ciprofloxacin, other quinolones, or any component of the formulation.
* Concomitant use with tizanidine.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, headache, dizziness.
* **Serious:**
* **Tendinopathy and tendon rupture:** Risk increased in elderly, those taking corticosteroids, and organ transplant recipients. Discontinue at the first sign of tendon pain or inflammation.
* **Central Nervous System (CNS) effects:** Tremors, restlessness, agitation, confusion, hallucinations, depression, paranoia, insomnia. Seizures have been reported.
* **QT interval prolongation:** Risk of arrhythmias. Use with caution in patients with known QT prolongation risk factors or taking other QT-prolonging drugs.
* **Peripheral neuropathy:** Can be irreversible.
* **Aortic aneurysm and dissection:** Increased risk, particularly in elderly patients with pre-existing risk factors.
* **Hypoglycemia/Hyperglycemia:** Monitor blood glucose closely, especially in diabetic patients.
* **Clostridioides difficile-associated diarrhea (CDAD).**
* **Photosensitivity.**
* **Hepatotoxicity.**
## Key Drug Interactions
* **Tizanidine:** Contraindicated; can cause profound hypotension and hyperreflexia.
* **Warfarin:** May increase anticoagulant effect. Monitor INR closely.
* **Theophylline:** May increase theophylline levels. Monitor theophylline levels and consider dose reduction.
* **Antacids, Sucralfate, Iron, Zinc, Multivitamins:** Reduce absorption of oral ciprofloxacin. Administer ciprofloxacin at least 2 hours before or 6 hours after these agents.
* **NSAIDs:** May increase risk of CNS stimulation and seizures.
* **CYP1A2 substrates (e.g., clozapine, ropinirole, duloxetine):** Ciprofloxacin inhibits CYP1A2, potentially increasing the levels of these drugs. Monitor for adverse effects and consider dose adjustments of the co-administered drug.
* **Calcium, Magnesium, Antacids, Iron, Zinc:** Can chelate with ciprofloxacin, reducing oral absorption. Separate administration by at least 2-4 hours.
* **Probenecid:** May decrease renal excretion of ciprofloxacin.
## Monitoring
* Renal function (for dose adjustment).
* Signs and symptoms of tendonitis/tendon rupture.
* CNS effects (mood changes, confusion, seizures).
* Blood glucose levels in diabetic patients.
* INR in patients taking warfarin.
* Signs of hypersensitivity.
* Diarrhea for signs of CDAD.
## Clinical Pearls
* Ensure adequate hydration to prevent crystalluria.
* Administer oral ciprofloxacin at least 2 hours before or 6 hours after products containing polyvalent cations (e.g., antacids, iron supplements, zinc supplements, multivitamins).
* For IV administration, infuse over at least 60 minutes.
* Use with caution in patients with myasthenia gravis; can exacerbate muscle weakness.
* Ciprofloxacin is a potent inhibitor of CYP1A2. Be aware of potential interactions with other CYP1A2 substrates.
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***Disclaimer:** This information is intended for healthcare professionals and is not a substitute for clinical judgment. Always verify current prescribing information and consult relevant guidelines before making treatment decisions.*
