ciprofloxacin

(si proe flox' a sin)

Ciloxan (CAN), Cipro, Cipro HC Otic, Cipro I.V., Cipro XR

Pregnancy Category C

Drug classes
Antibacterial
Fluoroquinolones

Therapeutic actions
Bactericidal; interferes with DNA replication in susceptible gram-negative bacteria
preventing cell reproduction.

Indications
• For the treatment of infections caused by susceptible gram-negative bacteria,
including E. coli, P. mirabilis, K. pneumoniae, Enterobacter cloacae, P. vulgaris,
P. rettgeri, M. morganii, P. aeruginosa, Citrobacter freundii, S. aureus, S.
epidermidis, group D streptococci
• Otic: Treatment of acute otitis externa
• Treatment of chronic bacterial prostatitis
• IV: Treatment of nosocomial pneumonia caused by Haemophilus influenzae, K.
pneumoniae
• Oral: Typhoid fever
• Oral: Sexually transmitted diseases caused by N. gonorrheae
• Prevention of anthrax following exposure to anthrax bacilla (prophylactic use in
regions suspected of using germ warfare)
• Unlabeled use: Effective in patients with cystic fibrosis who have pulmonary
exacerbations

Contraindications and cautions

• Contraindicated with allergy to ciprofloxacin, norfloxacin, pregnancy, lactation.
• Use cautiously with renal dysfunction, seizures, tendinitis or tendon rupture
associated with fluoroquinolone use.

Available forms
Tablets—100, 250, 500, 750 mg; ER tablets—500 mg; oral suspension—5, 10 g/100 ml;
injection—200, 400 mg; ophthalmic solution—3.5 mg/mL; otic suspension—2 mg/mL

Dosages
ADULTS
• Uncomplicated urinary tract infections: 100–250 mg PO q 12 hr for 3 days or
500 mg PO daily (ER tablets) for 3 days.
• Mild to moderate UTI: 250 mg q 12 hr PO for 7–14 days or 200 mg IV q 12 hr for
7–14 days.
 • Complicated urinary tract infections: 500 mg bid PO for 10–21 days or 400 mg
IV or 1,000 mg (ER tablets) PO daily q 7–14 days.
• Infectious diarrhea: 500 mg q 12 hr PO for 5–7 days.
• Anthrax postexposure: 500 mg PO q 12 hr for 60 days or 400 mg IV q 12 hr for
60 days.
• Respiratory infections 500–750 mg PO or 400 mg IV q 12 hr for 7–14 days.
• Bone, joint, skin infections: 500–750 mg PO or 400 mg IV q 12 hr for 4–6 wk.
• Nosocomial pneumonia: 400 mg IV q 8 hr.
• Ophthalmic infections caused by susceptible organisms not responsive to other
therapy: 1 or 2 drops per eye daily or bid.
• Acute otitis externa: 4 drops in infected ear, tid–qid.
PEDIATRIC PATIENTS
Not recommended; produced lesions of joint cartilage in immature experimental animals.
• Inhalational anthrax: 15 mg/kg/dose PO q 12 hr for 60 days or 10 mg/kg/dose IV
q 12 hr for 60 days; do not exceed 500 mg/dose PO or 400 mg/dose IV.
PATIENTS WITH IMPAIRED RENAL FUNCTION
For creatinine clearance of 30–50 mL/min, give 250–500 mg PO q 12 hr. For creatinine
clearance of 5–29 mL/min, give 250–500 mg PO q 18 hr or 200–400 mg IV q 18–24 hr.
For patients on hemodialysis, give 250–500 mg q 24 hr, after dialysis.

Pharmacokinetics
Route Onset Peak Duration
Oral Varies 60–90 min 4–5 hr
IV 10 min 30 min 4–5 hr

Metabolism: Hepatic; T1/2: 3.5–4 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Urine and bile

IV facts
Preparation: Dilute to a final concentration of 1–2 mg/mL with 0.9% NaCl injection
or 5% dextrose injection. Stable up to 14 days refrigerated or at room temperature.
Infusion: Administer slowly over 60 min.
Incompatibilities: Discontinue the administration of any other solutions during
ciprofloxacin infusion. Incompatible with aminophylline, amoxicillin, clindamycin,
floxacillin, heparin in solution.

Adverse effects
• CNS: Headache, dizziness, insomnia, fatigue, somnolence, depression, blurred
vision
• CV: Arrhythmias, hypotension, angina
• GI: Nausea, vomiting, dry mouth, diarrhea, abdominal pain
• Hematologic: Elevated BUN, AST, ALT, serum creatinine and alkaline
phosphatase; decreased WBC, neutrophil count, Hct
• Other: Fever, rash
Interactions
Drug-drug
• Decreased therapetic effect with iron salts, sucralfate
• Decreased absorption with antacids, didanosine
• Increased serum levels and toxic effects of theophyllines if taken concurrently
with ciprofloxacin
Drug-alternative therapy
• Increased risk of severe photosensitivity reactions if combined with St. John's
wort therapy.

Nursing considerations
Assessment
• History: Allergy to ciprofloxacin, norfloxacin or other quinolones; renal
dysfunction; seizures; lactation
• Physical: Skin color, lesions; T; orientation, reflexes, affect; mucous membranes,
bowel sounds; renal and liver function tests

Interventions
• Arrange for culture and sensitivity tests before beginning therapy.
• Continue therapy for 2 days after signs and symptoms of infection are gone.
• Ensure that patient is well hydrated.
• Give antacids at least 2 hr after dosing.
• Monitor clinical response; if no improvement is seen or a relapse occurs, repeat
culture and sensitivity.
• Encourage patient to complete full course of therapy.

Teaching points
• If an antacid is needed take it at least 2 hr before or after dose.
• Drink plenty of fluids while you are on this drug.
• These side effects may occur: Nausea, vomiting, abdominal pain (eat small,
frequent meals); diarrhea or constipation; drowsiness, blurring of vision, dizziness
(observe caution if driving or using dangerous equipment).
• Report rash, visual changes, severe GI problems, weakness, tremors.

Adverse effects in Italic are most common; those in Bold are life-threatening.