Ciprofloxacin

(sip-ROW-FLOX-uh-sin)

Trade Name(s):

Cipro

Tablets

250 mg

Tablets

500 mg

Tablets

750 mg

Suspension, oral

5 g/100 mL (5%)

Suspension, oral

10 g/100 mL (10%)

Cipro IV

Injection

200 mg

Injection

400 mg

Ciloxan

Solution

3.5 mg/mL (equivalent to 3 mg base)

Indicates Canadian trade names.

Class:

Antibiotic

Fluoroquinolone

Action:
Interferes with microbial DNA synthesis.

Indications:
Treatment of infections of lower respiratory tract, skin and skin structure, bone and joint, urinary tract, gonorrhea, chancroid, and infectious diarrhea caused by susceptible strains of specific organisms; typhoid fever; uncomplicated cervical and urethral gonorrhea; women with acute uncomplicated cystitis; acute sinusitis; nosocomial pneumonia; chronic bacterial prostatitis; complicated intra-abdominal infections; reduce incidence or progression of inhalational anthrax following exposure to aerosolized Bacillus anthracis.

Ophthalmic use: Treatment of corneal ulcers and conjunctivitis caused by susceptible organisms. Unlabeled use(s): Treatment of pulmonary exacerbations associated with cystic fibrosis; management of malignant external otitis, "traveler's" diarrhea, mycobacterial infections.

Contraindications:
Hypersensitivity to fluoroquinolones or quinolones; tendonitis or tendon rupture associated with quinolone use.

Ophthalmic use: Epithelial herpes simplex keratitis; vaccinia; varicella; fungal disease of ocular structure; mycobacterial infections of eye.

Route/Dosage:

Urinary Tract Infections

Adults:
PO 250 to 500 mg or
IV 200 to 400 mg q 12 hr.

Respiratory Tract; Bone and Joint; Skin and Skin Structure Infections

Adults:
PO 500 to 750 mg or
IV 400 mg q 12 hr.

Infectious Diarrhea

Adults:
PO 500 mg q 12 hr.

Inhalational Anthrax (Postexposure)

Adults:
PO 500 mg q 12 hr for 60 days or
IV 400 mg q 12 hr for 60 days.

Children:
PO 15 mg/kg/dose (max 500 mg dose) q 12 hr for 60 days or
IV 10 mg/kg/dose (max 400 mg dose) q 12 hr for 60 days.

Ocular Infections

Adults:
Topical Acute infection: 1 to 2 drops q 15 to 30 min; Moderate infection: 1 to 2 drops 4 to 6 times daily.

Typhoid Fever

Adults:
PO 500 mg q 12 hr.

Urethral/Cervical Gonococcocal Infections

Adults:
PO 250 mg as a single dose.

Acute Uncomplicated Cystitis

Adults:
PO 100 mg q 12 hr.

Acute Sinusitis; Chronic Bacterial Prostatitis; Complicated Intra-Abdominal Infections

Adults:
PO 500 mg q 12 hr.
IV 400 mg q 12 hr.

Nosocomial Pneumonia

Adults:
IV 400 mg q 8 hr.

Chancroid

Adults:
PO 500 mg bid.

Gonorrhea, Disseminated

Adults: Initial treatment
IV 500 mg q 12 hr for 24 to 48 hr, then
PO 500 mg bid for 7 days.

Gonorrhea, Uncomplicated
PO 500 mg as a single dose plus azithromycin 1 g (single dose) or doxycycline 100 mg bid for 7 days.

Interactions:

Antacids, iron salts, zinc salts, sucralfate, didanosine: May decrease oral absorption of fluoroquinolone. Stagger administration times.

Anticoagulants: May increase effect of warfarin; monitor prothrombin time.

Antineoplastic agents: Fluoroquinolone serum levels may be decreased by cyclophosphamide, cytarabine, daunorubicin, doxorubicin, mitoxantrone, and vincristine.

Azlocillin: Decreased clearance of ciprofloxacin.

Caffeine: Clearance of caffeine is reduced.

Cimetidine: May interfere with fluoroquinolone elimination and increase effect.

Cyclosporine: Nephrotoxic effects of cyclosporine may be increased; monitor renal function.

Probenecid: Decreased ciprofloxacin renal clearance.

Theophylline: Decreased clearance and increased plasma levels of theophylline may result in toxicity; monitor theophylline level.

Lab Test Interferences:
Increased ALT, AST, LDH, alkaline phosphatase, serum bilirubin; increased serum creatinine and BUN; increased triglycerides and cholesterol.

Adverse Reactions:

CNS:: Headache; restlessness.
DERM:: Rash.
EENT:: (Ophthalmic use): Lid margin crusting; foreign body sensation; itching; conjunctival hyperemia; decreased vision; sensitivity reactions (eg, transient irritation, burning, stinging, inflammation, angioneurotic edema, dermatitis). Ophthalmic use may produce same adverse effects seen with systemic use.
GI:: Diarrhea; nausea; vomiting; abdominal pain/discomfort.
OTHER:: Abnormal taste; photosensitivity.

Precautions:

Pregnancy: Category C.

Lactation: Excreted in breast milk.

Children: Do not use in children < 18 yr.

Convulsions: CNS stimulation can occur; use with caution in patients with known or suspected CNS disorders.

Renal function impairment: Reduced clearance may occur; adjust dose downward accordingly in patients with Ccr < 50 mL/min. Refer to manufacturer's package insert for dose calculations.

Hypersensitivity reactions: Serious and potentially fatal reactions have occurred. Discontinue drug if allergic reaction occurs.

Pseudomembranous colitis: Consider possibility in patients with diarrhea.

Superinfection: Use of antibiotics may result in bacterial or fungal overgrowth. Do not use topically in deep-seated ocular infections.

Photosensitivity: Moderate-to-severe reactions have occurred with some fluoroquinolones; avoid excessive sunlight and discontinue therapy if phototoxicity occurs.

Crystalline precipitate: A white crystalline precipitate in superficial portion of corneal defect may occur; reaction is generally self-limiting and does not appear to affect outcome.

Patient Care Considerations

Administration/Storage:

Oral

Give oral preparation 2 hr after meals; if necessary it may be taken with food. Avoid concurrent use of dairy products, antacids, iron- or zinc-containing products, such as multivitamins, with ciprofloxacin.

For IV infusion, dilute before administration to final concentration of 1 to 2 mg/mL.
Refrigerate or store at room temperature and use within 14 days.
Infuse over 60 min in large vein to reduce risk of venous irritation.

Ophthalmic

For ophthalmic application, have patient tilt head back, pull lower lid out to make pocket, then place medication in conjunctival sac. Then, without touching patient's eyes, close them. Apply light finger pressure on lacrimal sac for 1 min following application.

Assessment/Interventions:

Obtain patient history, including drug history and any known allergies.
Monitor I&O.
Monitor for signs of anaphylaxis (eg, pharyngeal or facial edema, dyspnea, urticaria, itching, hypotension).
Assess patency of IV site and observe for signs of phlebitis frequently during therapy.
Monitor signs of infection throughout course of treatment.
Notify health care provider if symptoms of pseudomembranous colitis occur (eg, loose or foul-smelling stools) or if symptoms of CNS stimulation occur (eg, tremor, restlessness, confusion, hallucinations).

OVERDOSAGE: SIGNS & SYMPTOMS
Acute renal failure

Patient/Family Education:

Instruct patient to drink sufficient fluids to ensure adequate urinary output.
Inform patient that tablets may be taken orally without regard to meals, although manufacturer recommends 2-hr interval after meals.
Caution patient to avoid exposure to sunlight, and to use sunscreens or protective clothing until tolerance is determined.
Instruct patient to report signs of bacterial or fungal overgrowth (eg, black, furry appearance of tongue, vaginal itching or discharge, loose or foul-smelling stools).
Caution patient that drug may cause dizziness or lightheadedness, and to use caution while driving or performing other tasks requiring mental alertness.
Caution patients against doubling a dose to "catch up" unless advised by a health care provider. Instruct patient to contact health care provider if > 1 dose is missed.
Emphasize importance of completing entire dose regimen.
Advise patient not to take any otc medications without consulting health care provider.
Instruct patient to stop treatment and inform health care provider if experiencing pain, inflammation, or rupture of tendon, and to rest or refrain from exercise until diagnosis of tendonitis or tendon rupture has been excluded.