Ciprofloxacin

C difficile risk
High
Oral Bioavailability
Excellent

Dosing

PO: 500 mg po q12h

IV: 400 mg IV q12h

PO: 750 mg po q12h

IV: 400 mg IV q8h

<10 eGFR10 - 30 eGFR30+ eGFR250 - 500 mg PO daily500 - 750 mg PO daily500 - 750mg PO BID

0 - 30 eGFR30+ eGFR400 mg IV q24h400 mg IV q8 - 12h

General Information

Pseudomonas and other gram negative infections of urinary tract, bone/joint, abdomen, lung, and other sites

Pregnancy:

  • Ciprofloxacin crosses the placenta.

  • Ciprofloxacin use during pregnancy has not been associated with congenital malformations or evidence of cartilage damage or tendon rupture in newborns.

  • Ciprofloxacin and its effect on joint development are still being studied.

  • Fluoroquinolones should only be used during pregnancy in the absence of other alternatives to treat the infection.

Breastfeeding:

  • The amount of ciprofloxacin transfer into breast milk is reported as low.

  • There has been one case report of pseudomembranous colitis in an infant of a mother who self medicated with ciprofloxacin for 6 days while breastfeeding.

  • Use of ciprofloxacin is acceptable in breastfeeding with monitoring of the infant for possible effects on the gastrointestinal flora, such as diarrhea.

  • Maternal use of an ear drop or eye drop that contains ciprofloxacin presents negligible risk for the nursing infant.

  • Monitor QTc in patients with increased risk.

  • Multiple drug interactions, consult pharmacy.

  • QTc prolongation

  • Dysglycemia

  • CNS toxicity including confusion, psychosis

  • Tendinopathy and rupture

  • GI upset

  • Weakness exacerbation in myasthenia gravis

  • Rash

  • Retinal detachment

  • CYP1A2 inhibitor - multiple interactions possible, consult pharmacy.

  • QTc prolongation - increased risk with other agents that prolong QTc.

  • Di - & Trivalent cations including Al, Ca, Fe, Mg (antacids, dairy products, iron supplements, some enteral feeds) - decreased absorption of ciprofloxacin.

  • Concurrent use of steroids may increase the risk of tendon rupture for patients at risk.

FDA Black Box warning against use in uncomplicated UTI, acute bacterial sinusitis, and acute exacerbation of chronic bronchitis where alternatives exist due to serious adverse side effects.

May exacerbate muscle weakness in persons with myasthenia gravis. Avoid Use.

Antimicrobial class: Fluoroquinolone