Inj%20ciprofloxacin

# Inj Ciprofloxacin ## Overview Intravenous fluoroquinolone antibiotic with broad-spectrum bactericidal activity. Inhibits DNA gyrase and topoisomerase IV. ## Primary Indications - Complicated urinary tract infections (UTI) including pyelonephritis - Intra-abdominal infections (in combination with metronidazole) - Respiratory tract infections (including nosocomial pneumonia, anthrax) - Bone and joint infections - Septicemia - Skin and soft tissue infections - Empiric therapy for febrile neutropenia (in combination) ## Adult Dosing - **Usual:** 200–400 mg IV every 8–12 hours. - **Severe/complicated infections:** 400 mg IV every 8 hours. - **Anthrax (inhalation):** 400 mg IV every 12 hours (post-exposure, 60 days total). - **Acute uncomplicated pyelonephritis:** 400 mg IV every 12 hours. - Infuse over 60 minutes. Doses >400 mg single dose not recommended. ## Pediatric Dosing - **Limited approved uses** (due to arthropathy risk, but may be used when benefit outweighs risk). - **UTI/pyelonephritis:** 10–20 mg/kg IV every 8 hours (max 400 mg/dose). - **Febrile neutropenia:** 10 mg/kg IV every 8 hours (max 400 mg/dose). - **Anthrax (inhalation):** 10 mg/kg IV every 12 hours (max 400 mg/dose). - Infuse over 60 minutes. Exact dosing may vary by local protocol; consult pediatric infectious disease. ## Dose Adjustments - **Renal impairment (CrCl 30–50 mL/min):** 200–400 mg IV every 12 hours (instead of every 8 hours). - **CrCl 5–29 mL/min:** 200–400 mg IV every 18–24 hours. - **Hemodialysis:** Administer after dialysis; maintenance dose every 24 hours. - **Hepatic impairment:** No dose adjustment required. ## Contraindications - Hypersensitivity to ciprofloxacin or any fluoroquinolone. - Concomitant tizanidine (risk of severe hypotension/sedation). - Avoid in children <18 years except for specific indications (anthrax, pseudomonal infections, complicated UTI) due to tendon/joint injury risk. - Pregnant and lactating women (use only if life-threatening infection). ## Adverse Effects - Common: GI upset (nausea, diarrhea), headache, restlessness, injection site reaction (phlebitis). - Serious: Tendinitis/tendon rupture (especially Achilles), peripheral neuropathy, CNS effects (seizures, confusion), QT prolongation, C. difficile diarrhea, phototoxicity, severe hypersensitivity (anaphylaxis), hepatotoxicity. - Discontinue at first sign of tendon pain or neuropathy. ## Key Drug Interactions - **Tizanidine:** Contraindicated (profound hypotension/sedation). - **Warfarin:** Enhanced anticoagulant effect (monitor INR). - **Theophylline:** Increased theophylline levels (risk of seizure). - **Oral hypoglycemics/sulfonylureas:** Risk of hypoglycemia. - **NSAIDs:** Increased CNS stimulation/seizure risk. - **Antacids, iron, calcium, sucralfate (IV route minimizes this, but caution if IV line shared with these agents—flush line).** - **Class IA/III antiarrhythmics:** Increased QT prolongation risk. ## Monitoring - Renal function (CrCl) for dose adjustment. - Signs of tendon/neuropathy (daily assessment). - Blood glucose (especially in diabetics). - CBC, LFTs periodically during prolonged therapy. - ECG (QTc) if concurrent QT-prolonging drugs or electrolyte abnormalities. - INR if on warfarin. ## Clinical Pearls - IV to oral switch is feasible when patient is stable; oral bioavailability is ~70%. - Avoid rapid IV bolus; infuse over 60 minutes to reduce phlebitis and CNS effects. - Ciprofloxacin is a potent CYP1A2 inhibitor; review patient's full medication list. - Reserve for infections where alternatives are limited; use as directed due to resistance concerns. - Maximum single dose 400 mg IV; daily maximum rarely exceeds 1200 mg (e.g., in severe infections). --- **Disclaimer:** This information is for educational purposes and does not replace clinical judgment. Dosing may vary by local protocols, formulary restrictions, and patient-specific factors. Always verify current prescribing information from the manufacturer’s label and relevant guidelines before administration.