Known brand names include Cipro.
A fluoroquinolone antibiotic taken by mouth for urinary, skin, bone and joint, abdominal, lung, and some intestinal infections, and after anthrax or plague exposure. Because it can cause disabling tendon, nerve, and brain side effects, it is reserved for cases with no other option in uncomplicated cystitis, sinusitis, and bronchitis flares.
Labeled use. Adult UTI; pediatric complicated UTI and pyelonephritis. Reserve for uncomplicated cystitis only when there is no alternative.
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Labeled use. Complicated infections, combined with metronidazole.
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Labeled use. Acute sinusitis, only when there is no alternative.
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Labeled use. Uncomplicated cervical and urethral gonorrhea; test for syphilis at diagnosis.
Labeled use. Not a first choice for pneumococcal pneumonia; reserve for bronchitis flares when there is no alternative.
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Labeled use. Skin and skin structure infections from susceptible organisms.
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Useful for pyelonephritis and complicated UTI when local resistance is low, for Pseudomonas coverage in an oral drug, and for anthrax or plague exposure. Avoid for uncomplicated cystitis, sinusitis, and bronchitis when alternatives such as nitrofurantoin, amoxicillin, or doxycycline will work. Poor pneumococcal activity makes levofloxacin or moxifloxacin better respiratory fluoroquinolones. CDC no longer recommends it for gonorrhea because of resistance.
The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.
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Doses come from the FDA label. Study tool, not for clinical decisions.
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CrCl 30 to 50 mL/min: 250 to 500 mg every 12 hours. CrCl 5 to 29: 250 to 500 mg every 18 hours. Hemodialysis or peritoneal dialysis: 250 to 500 mg every 24 hours, after dialysis.
No adjustment given. Pharmacokinetics did not change significantly in stable cirrhosis; acute hepatic insufficiency has not been studied.
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Fluoroquinolones can cause disabling, possibly permanent reactions that may occur together: tendinitis and tendon rupture, peripheral neuropathy, and CNS effects. Stop ciprofloxacin at once and avoid all fluoroquinolones after any of these. It can worsen myasthenia gravis; avoid it in patients with that history. Reserve it for patients without other options in bronchitis flares, uncomplicated cystitis, and acute sinusitis.
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No antidote. Give supportive care with good hydration, and monitor kidney function and urine pH, acidifying if needed to prevent crystalluria. Magnesium, aluminum, or calcium antacids reduce further absorption. Dialysis removes less than 10%.
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Decades of published data have not linked ciprofloxacin to major birth defects, miscarriage, or other adverse outcomes, though the studies are small. Animal studies showed no malformations.
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Present in breast milk. Breastfeeding is not recommended during treatment and for 2 days after the last dose; the mother may pump and discard instead. For anthrax exposure, weigh the risks and benefits.
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Not a first choice in children because joint-related adverse reactions are more common. Complicated UTI or pyelonephritis, ages 1 to 17: 10 to 20 mg/kg every 12 hours, at most 750 mg per dose, for 10 to 21 days. Anthrax after exposure: 15 mg/kg every 12 hours, at most 500 mg per dose, for 60 days. Plague: 15 mg/kg every 8 to 12 hours, at most 500 mg per dose, for 14 days.
Higher risk of tendon rupture, especially with corticosteroids, and of aortic aneurysm and QT effects. No dose change with normal renal function, but choose doses carefully and consider monitoring renal function.
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