II. Indications
- See Second Generation Fluoroquinolone
- Complicated Urinary Tract Infections
- Specific types of Bacterial Gastroenteritis
- Prostatitis
- Sexually Transmitted Disease
- Avoid in Community Acquired Pneumonia
- Risk of pneumococcal bacteremia and Meningitis
- Additional Indications specific to Ciprofloxacin (not with Ofloxacin)
- Pseudomonas aeruginosa
- Bacillus anthracis or Anthrax (first line agent)
- Vibrio Cholerae (Norfloxacin also covers)
- Yersinia pestis or Plague (first line agent)
- Tularemia (alternative medication)
III. Contraindications
- See Fluoroquinolone
- Myasthenia Gravis (exacerbates motor weakness)
- Tizanidine use
- Children
- Relative contraindication due to risk of Arthropathy in animals
- Studies have not demonstrated Arthropathy (other than transient large joint Arthralgias)
- Ciprofloxacin is commonly used off label in children with Cystic Fibrosis (due to Pseudomonas coverage)
IV. Mechanism
- See Fluoroquinolone
V. Medications
- Tablets: 250, 500 and 750 mg
- Oral Suspension 250 and 500 mg per 5 ml
- Shake container well for 15 seconds before administering dose
- Do not give via nasogastric or Feeding Tube
- Extended release tablets: 500 and 1000 mg
- Not interchangeable with regular, non-extended release formulations
VI. Dosing: Adult
- See Anthrax
-
Urinary Tract Infection
- Use higher dose of range for Pyelonephritis for 7 to 14 days
- Give 200 to 400 mg IV every 12 hours OR
- Take 250 to 500 mg orally twice daily OR
- Extended Release Ciprofloxacin 1000 mg orally daily
-
Chronic Bacterial Prostatitis
- Take 500 mg orally twice daily for up to 28 days
-
Diverticulitis or Complicated intraabdominal infections (with Metronidazole)
- Give 400 mg IV every 12 hours OR
- Take 500 mg orally twice daily
-
Infectious Diarrhea
- Take 500 mg orally twice daily for 5 to 7 days
- Use 1 to 3 days (or 750 mg for one dose) for Traveler's Diarrhea
- Use 10 days for Typhoid Fever
-
Malignant Otitis Externa (not FDA approved)
- Give 400 mg IV every 12 hours, or
- Take 750 mg orally every 12 hours
- Foot Osteomyelitis due to Pseudomonas Osteochondritis (Sweaty Tennis Shoe Syndrome)
- Take 750 mg orally twice daily for up to 6 to 8 weeks
- Bone and joint infections (based on sensitivity testing, treated for 4 to 8 weeks)
- Give 400 mg IV every 8 to 12 hours initially, then
- Take 500 to 750 mg orally twice daily
-
Plague (treated for 14 days)
- Give 400 mg IV every 8 to 12 hours OR
- Take 500 mg orally twice daily
-
Chancroid (not FDA approved)
- Take 500 mg orally twice daily for 3 days
-
Renal Dosing (immediate release)
- eGFR 30 to 50 ml/min: 250 to 500 mg orally every 12 hours
- eGFR 5 to 29 ml/min: 200 to 400 mg IV every 18 to 24 hours OR 250 to 500 mg every 18 hours
- Hemodialysis: 250 to 500 mg orally every 24 hours after Dialysis
VII. Dosing: Child
- See Anthrax
- See Precautions above under contraindications
- Complicated Urinary Tract Infection or Pyelonephritis (age 1 to 17 years)
- Give 6 to 10 mg/kg IV (up to 400 mg/dose) every 8 hours, then
- Give 10 to 20 mg/kg (up to 750 mg/dose) orally every 12 hours
-
Plague (age birth to 17 years, treated for 10 to 21 days)
- Give 10 mg/kg IV (up to 400 mg/dose) every 8 to 12 hours, then
- Give 15 mg/kg (up to 500 mg/dose) orally every 8 to 12 hours
- Acute respiratory exacerbation of Cystic Fibrosis
- Give 10 mg/kg IV (up to 400 mg/dose) every 8 to 12 hours for 7 days, then
- Give 20 mg/kg (up to 750 mg/dose) orally every 12 hours for a total course of 10 to 21 days
VIII. Adverse Effects
- See Fluoroquinolone
- Fluoroquinolones have several serious warnings (e.g. tendon rupture, Neuropathy, Aortic Dissection)
- QTc Prolongation
- Hypersensitivity
- Urine Crystal formation (in alkaline urine)
- Photosensitivity (Sunburn risk)
- Gastrointestinal (Nausea, Vomiting, Diarrhea, Abdominal Pain)
- Neurologic (Headache, Dizziness, confusion)
- Rash
- Serum transaminase increase
- Serum Creatinine increase
- White cell changes (Eosinophilia, Neutropenia)
- Seizure risk (class effect due to GABA inhibition)
IX. Safety
- Avoided in pregnancy (despite pregnancy Category C)
- Cartilage damage risk
- Considered safe in Lactation
- However, risk of pediatric Arthropathy
X. Pharmacokinetics
- Rapid but variable absorption, reaching peak levels within 1 to 2 hours of ingestion
- Half-Life: 4 hours
- Partial hepatic metabolism and renal excretion
- Urine concentrations remain high for many hours after dose
- Distributes widely (except CSF), with high concentrations in urine, stool, bile, Prostate, bone and Sputum
XI. Drug Interactions
-
Sulfonylureas
- Hypoglycemia risk
-
Warfarin
- May potentiate Anticoagulant effects
-
Tizanidine
- Do not use with Ciprofloxacin
- Ciprofloxacin is a strong CYP1A2 Inhibitor and increases drug levels of its substrates
- Drugs that interfere with absorption (give at least 2 hours before or after dose)
XII. Resources
- Ciprofloxacin Tablet (DailyMed)
- Ciprofloxacin Injection Solution (DailyMed)
XIII. References
Images: Related links to external sites (from Bing)
Related Studies
ciprofloxacin (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
CIPROFLOXACIN 0.2% OTIC SOLN | Generic | $6.34 each |
CIPROFLOXACIN 0.3% EYE DROP | Generic | $1.74 per ml |
CIPROFLOXACIN HCL 250 MG TAB | Generic | $0.10 each |
CIPROFLOXACIN HCL 500 MG TAB | Generic | $0.15 each |
CIPROFLOXACIN HCL 750 MG TAB | Generic | $0.21 each |
cipro (on 11/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
CIPRO 10% SUSPENSION | $1.46 per ml | |
CIPRO 5% SUSPENSION | $1.26 per ml | |
CIPRO HC OTIC SUSPENSION | $31.77 per ml | |
CIPRODEX OTIC SUSPENSION | Generic | $17.53 per ml |
CIPROFLOX-DEXAMETH OTIC SUSP | Generic | $17.53 per ml |
Ontology: Ciprofloxacin (C0008809)
Definition (CHV) | a drug used to treat a cancer as well as an infection |
Definition (NCI) | A synthetic broad spectrum fluoroquinolone antibiotic. Ciprofloxacin binds to and inhibits bacterial DNA gyrase, an enzyme essential for DNA replication. This agent is more active against Gram-negative bacteria than Gram-positive bacteria. (NCI04) |
Definition (NCI_NCI-GLOSS) | A drug that is used to treat infections caused by bacteria and is being studied in the treatment of bladder cancer. Cipro is a type of fluoroquinolone. |
Definition (CSP) | broad spectrum antimicrobial carboxyfluoroquinoline. |
Definition (MSH) | A broad-spectrum antimicrobial carboxyfluoroquinoline. |
Definition (PDQ) | A synthetic broad spectrum fluoroquinolone antibiotic. Ciprofloxacin binds to and inhibits bacterial DNA gyrase, an enzyme essential for DNA replication. This agent is more active against Gram-negative bacteria than Gram-positive bacteria. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=40784&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=40784&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C375" NCI Thesaurus) |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D002939 |
SnomedCT | 392412000, 330416009, 372840008, 7577004 |
LNC | LP15380-6, MTHU004599 |
English | Ciprofloxacin, 3-Quinolinecarboxylic acid, 1-cyclopropyl-6-fluoro-1,4-dihydro-4-oxo-7-(1-piperazinyl)-, Ciprofloxacin [eye], 1-Cyclopropyl-6-fluoro-1,4-dihydro-4-oxo-7-(1-piperazinyl)-3-quinolinecarboxylic Acid, Ciprofloxacin ophthalmic preparation, Ciprofloxacin ophthalmic preparation (product), ciprofloxacin, Ciprofloxacin opthalmic preparation (product), Ciprofloxacin opthalmic preparation, CIPROFLOXACIN, ciprofloxacin (medication), Ciprofloxacin [Chemical/Ingredient], Ciprofloxacin [eye] (product), Ciprofloxacin product, Ciprofloxacin (product), Ciprofloxacin (substance), CPFX, Ciprofloxacin [eye] (substance) |
Swedish | Ciprofloxacin |
Czech | ciprofloxacin |
Finnish | Siprofloksasiini |
Russian | TSIPROFLOKSATSIN, ЦИПРОФЛОКСАЦИН |
Croatian | CIPROFLOKSACIN |
Spanish | ciprofloxacina, ciprofloxacina (producto), ciprofloxacino, ciprofloxacino (producto), ciprofloxacino (sustancia), ciprofloxacina [uso oftálmico], ciprofloxacina [uso oftálmico] (producto), ciprofloxacina (sustancia), ciprofloxacina [oftálmica] (producto), ciprofloxacina [oftálmica], ciprofloxacina, preparado oftálmico (producto), ciprofloxacina, preparado oftálmico, preparado oftálmico con ciprofloxacina (producto), preparado oftálmico con ciprofloxacina, Ciprofloxacino |
Polish | Cyprofloksacyna, Ciprofloksacyna |
Japanese | シプロフロキサシン, シプロキサン, 塩酸シプロフロキサシン, シプロフロキサシン塩酸塩 |
Portuguese | Ciprofloxacina, Ciprofloxacino |
French | Ciprofloxacine |
German | Ciprofloxacin |
Italian | Ciproflossacina |