Ciprofloxacin: Difference between revisions
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*Type: [[Fluoroquinolones]]
*Type: [[Fluoroquinolones]]
*Dosage Forms: IV; PO (Standard: 100, 250, 500; ER 500, 1000)
*Dosage Forms: IV; PO (Standard: 100, 250, 500; ER 500, 1000)
*Common Trade Names: Cipro
*Common Trade Names: Cipro, Ciloxan (ophthalmic)
 
'''Given the multiple adverse effects listed below, there has been a recent move away from prescribing this and other fluoroquinolones as first line antibiotics for many indications (such as UTI or pneumonia).'''


==Adult Dosing==
==Adult Dosing==
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===[[Anthrax]]===
===[[Anthrax]]===
*'''Inhalational, Gi, oropharyngeal'''
*'''Inhalational, GI, Oropharyngeal'''
**400mg IV q12h OR 500mg PO q12 x 60 days
**400mg IV q12h OR 500mg PO q12 x 60 days
**First dose: 400mg IV + 1-2 additional antibiotics
**First dose: 400mg IV + 1-2 additional antibiotics
*'''Cutaneous'''
*'''Cutaneous'''
**400mg IV q12h OR 500mg PO q12 x 7-10 days
**400mg IV q12h OR 500mg PO q12 x 7-10 days
***Info: Give x 60 days if [[bioterrorism]] suspected
**Info: Give x 60 days if [[bioterrorism]] suspected
*'''Post-Exposure Prophylaxis'''
*'''Post-Exposure Prophylaxis'''
**500mg PO q12h x 60 days (or exposure excluded)
**500mg PO q12h x 60 days (or exposure excluded)
===[[Traveler's Diarrhea]]<ref>Sanford 2014</ref>===
*750mg PO BID x 1-3 days


===[[Typhoid Fever]]===
===[[Typhoid Fever]]===
*500mg PO q12h x 2 weeks
*500mg PO q12h x 2 weeks


===[[Chancorid]]===
===[[Chancroid]]===
*500mg PO q12h x 3 days
*500mg PO q12h x 3 days


===[[Salmonella]]===
===[[Salmonella]]===
*''Acute'''
*'''Acute'''
**500-750mg PO q12h x 3-7 days
**500-750mg PO q12h x 3-7 days
***Extend treatment x 1 week if immunocompromised
**Extend treatment x 1 week if immunocompromised
*'''Chronic Carrier'''
*'''Chronic Carrier'''
**750mg PO q12h x 1 month
**750mg PO q12h x 1 month
===[[Otitis externa]]===
*Cipro HC otic: 3 drops in affected ear BID x 7 days
**Contains hydrocortisone
**Not safe with perforation
*Ciprodex: 4 drops in affected ear BID x 7 days
**Similar to cipro HC but contains [[dexamethasone]]
**Not covered by many insurance companies


==Pediatric Dosing==
==Pediatric Dosing==
===General===
*'''PO'''
**20-30mg/kg/day PO divided q12h
**First Dose: 10-15mg/kg PO x 1
**Max: 750mg/dose PO
*'''IV'''
**15-30mg/kg/day IV divided q8-12h
**First Dose: 5-15mg/kg IV x 1
**Max: 400mg/dose IV
===[[Anthrax]]===
''Max (All): 400mg/dose IV or 500mg/dose PO''
*'''Inhalational, GI, Oropharyngeal'''
**20-30mg/kg/day IV/PO divided q12h x 60 days
**First Dose: 10-15mg/kg IV x 1 (give with 1-2 additional antibiotics)
*'''Cutaneous'''
**20-30mg/kg/day IV/PO divided q12h x 7-10 days
**First Dose: 10-15mg/kg IV/PO x 1
**Info: Give x 60 days if [[bioterrorism]] suspected
*'''Post-Exposure Prophylaxis'''
**20-30mg/kg/day PO divided q12h x 60 days (or exposure excluded)
**First Dose: 10-15mg/kg PO x 1
===[[UTI]], Complicated (1-17 Years Old)===
''Not first line given adverse effects''
*'''IV'''
**6-10mg/kg IV q8h
**First Dose:
**Max: 400mg/dose IV
*'''PO'''
**10-20mg/kg PO q12h
**First Dose:
**Max: 750mg/dose PO


==Special Populations==
==Special Populations==
*Pregnancy: C (but indicated for [[anthrax]])
*[[Drug ratings in pregnancy]]: C (but indicated for [[anthrax]])
*Lactation: Probably safe
*[[Lactation risk categories]]: Probably safe
*Renal Dosing
*Renal Dosing
**Adult
**Adult: renal impairment less than creatinine clearance 30 mL/min, q24hrs instead of q12hrs
**Pediatric
*Hepatic Dosing
**Adult
**Pediatric
**Pediatric
*Hepatic Dosing - no dose adjustments needed


==Contraindications==
==Contraindications==
*Allergy to class/drug
*Allergy to class/drug
*Administration with Tizanidine


==Adverse Reactions==
==Adverse Reactions==
===Serious===
===Serious===
*Prolonged QT interval and Syncope/Torsades de pointes
*Photosensitivity
*Stevens-Johnson syndrome/Toxic epidermal necrolysis
*Clostridium difficile diarrhea, Pseudomembranous enterocolitis
*Tendonitis or tendon rupture (black box warning) - increased risk in age >60, immunosuppressed, corticosteroid use
*peripheral neuropathy
*severe hypoglycemia <ref>FDA updates warnings for fluoroquinolone antibiotics on risks of mental health and low blood sugar adverse reactions. US Food and Drug Administration. https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm612995.htm. Updated July 10, 2018. Accessed Oct 22, 2018.</ref>
*mental health effects


===Common===
===Common===
*Rash
*[[Diarrhea]]/Nausea/Vomiting


==Pharmacology==
==Pharmacology==
*Half-life:  
*Half-life: 4 hours
*Metabolism:  
*Metabolism: Liver
*Excretion:  
*Excretion: Urine, Feces
*Mechanism of Action:
*Mechanism of Action: Bactericidal. Inhibits DNA gyrase
 
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''Group'''
| align="center" style="background:#f0f0f0;"|'''Organism'''
| align="center" style="background:#f0f0f0;"|'''Sensitivity'''
|-
| Gram Positive||[[Strep. Group A, B, C, G]]||I
|-
| ||[[Strep. Pneumoniae]]||I
|-
| ||[[Viridans strep]]||R
|-
| ||Strep. anginosus gp||R
|-
| ||[[Enterococcus faecalis]]||U
|-
| ||[[Enterococcus faecium]]||R
|-
| ||[[MSSA]]||'''S'''
|-
| ||[[MRSA]]||R
|-
| ||[[CA-MRSA]]||I
|-
| ||[[Staph. Epidermidis]]||'''S'''
|-
| ||[[C. jeikeium]]||R
|-
| ||[[L. monocytogenes]]||'''S'''
|-
| Gram Negatives||[[N. gonorrhoeae]]||I
|-
| ||[[N. meningitidis]]||'''S'''
|-
| ||[[Moraxella catarrhalis]]||'''S'''
|-
| ||[[H. influenzae]]||'''S'''
|-
| ||[[E. coli]]||'''S'''
|-
| ||[[Klebsiella]] sp||'''S'''
|-
| ||E. coli/Klebsiella ESBL+||'''S'''
|-
| ||E coli/Klebsiella KPC+||R
|-
| ||[[Enterobacter]] sp, AmpC neg||'''S'''
|-
| ||[[Enterobacter]] sp, AmpC pos||'''S'''
|-
| ||[[Serratia]] sp||'''S'''
|-
| ||Serratia marcescens||X1
|-
| ||[[Salmonella]] sp||'''S'''
|-
| ||[[Shigella]] sp||'''S'''
|-
| ||[[Proteus mirabilis]]||'''S'''
|-
| ||[[Proteus vulgaris]]||'''S'''
|-
| ||[[Providencia sp.]]||'''S'''
|-
| ||[[Morganella sp.]]||'''S'''
|-
| ||[[Citrobacter freundii]]||'''S'''
|-
| ||[[Citrobacter diversus]]||'''S'''
|-
| ||[[Citrobacter sp.]]||'''S'''
|-
| ||[[Aeromonas sp]]||'''S'''
|-
| ||[[Acinetobacter sp.]]||I
|-
| ||[[Pseudomonas aeruginosa]]||'''S'''
|-
| ||[[Burkholderia cepacia]]||R
|-
| ||[[Stenotrophomonas maltophilia]]||R
|-
| ||[[Yersinia enterocolitica]]||'''S'''
|-
| ||[[Francisella tularensis]]||X1
|-
| ||[[Brucella sp.]]||X1
|-
| ||[[Legionella sp.]]||'''S'''
|-
| ||[[Pasteurella multocida]]||'''S'''
|-
| ||[[Haemophilus ducreyi]]||X1
|-
| ||[[Vibrio vulnificus]]||X1
|-
| Misc||[[Chlamydophila sp]]||'''S'''
|-
| ||[[Mycoplasm pneumoniae]]||'''S'''
|-
| ||[[Rickettsia sp]]||X1
|-
| ||[[Mycobacterium avium]]||X1
|-
| Anaerobes||[[Actinomyces]]||R
|-
| ||[[Bacteroides fragilis]]||R
|-
| ||[[Prevotella melaninogenica]]||R
|-
| ||[[Clostridium difficile]]||R
|-
| ||[[Clostridium (not difficile)]]||I
|-
| ||[[Fusobacterium necrophorum]]||X1
|-
| ||[[Peptostreptococcus sp.]]||I
|}
 
===Key===
{{Template:Antibacterial Spectra Key}}


==See Also==
==See Also==
*[[Antibiotics (Main)]]
*[[Antibiotics (Main)]]


==Source==
==References==
<references/>


<references/>
[[Category:Pharmacology]]
[[Category:Drugs]]
[[Category:ID]]

Revision as of 15:12, 15 February 2020

General

  • Type: Fluoroquinolones
  • Dosage Forms: IV; PO (Standard: 100, 250, 500; ER 500, 1000)
  • Common Trade Names: Cipro, Ciloxan (ophthalmic)

Given the multiple adverse effects listed below, there has been a recent move away from prescribing this and other fluoroquinolones as first line antibiotics for many indications (such as UTI or pneumonia).

Adult Dosing

General

  • PO
    • 250-750mg PO q12h
    • First Dose: 250-750mg PO x1
  • IV
    • 200-400mg IV q12
    • First Dose: 400mg IV x 1
    • Alt: 400mg IV q8h

UTI

  • Uncomplicated
    • 500mg ER PO q24h x 3 days
    • Alt: 250mg PO q12h x 3 days
  • Complicated
    • IV: 400mg IV q12h x 7-14 days
    • PO: 1000mg ER PO q24h x 7-14 days
      • Alt: 500mg PO q12h x 7-14 days

Anthrax

  • Inhalational, GI, Oropharyngeal
    • 400mg IV q12h OR 500mg PO q12 x 60 days
    • First dose: 400mg IV + 1-2 additional antibiotics
  • Cutaneous
    • 400mg IV q12h OR 500mg PO q12 x 7-10 days
    • Info: Give x 60 days if bioterrorism suspected
  • Post-Exposure Prophylaxis
    • 500mg PO q12h x 60 days (or exposure excluded)

Traveler's Diarrhea[1]

  • 750mg PO BID x 1-3 days

Typhoid Fever

  • 500mg PO q12h x 2 weeks

Chancroid

  • 500mg PO q12h x 3 days

Salmonella

  • Acute
    • 500-750mg PO q12h x 3-7 days
    • Extend treatment x 1 week if immunocompromised
  • Chronic Carrier
    • 750mg PO q12h x 1 month

Otitis externa

  • Cipro HC otic: 3 drops in affected ear BID x 7 days
    • Contains hydrocortisone
    • Not safe with perforation
  • Ciprodex: 4 drops in affected ear BID x 7 days
    • Similar to cipro HC but contains dexamethasone
    • Not covered by many insurance companies

Pediatric Dosing

General

  • PO
    • 20-30mg/kg/day PO divided q12h
    • First Dose: 10-15mg/kg PO x 1
    • Max: 750mg/dose PO
  • IV
    • 15-30mg/kg/day IV divided q8-12h
    • First Dose: 5-15mg/kg IV x 1
    • Max: 400mg/dose IV

Anthrax

Max (All): 400mg/dose IV or 500mg/dose PO

  • Inhalational, GI, Oropharyngeal
    • 20-30mg/kg/day IV/PO divided q12h x 60 days
    • First Dose: 10-15mg/kg IV x 1 (give with 1-2 additional antibiotics)
  • Cutaneous
    • 20-30mg/kg/day IV/PO divided q12h x 7-10 days
    • First Dose: 10-15mg/kg IV/PO x 1
    • Info: Give x 60 days if bioterrorism suspected
  • Post-Exposure Prophylaxis
    • 20-30mg/kg/day PO divided q12h x 60 days (or exposure excluded)
    • First Dose: 10-15mg/kg PO x 1

UTI, Complicated (1-17 Years Old)

Not first line given adverse effects

  • IV
    • 6-10mg/kg IV q8h
    • First Dose:
    • Max: 400mg/dose IV
  • PO
    • 10-20mg/kg PO q12h
    • First Dose:
    • Max: 750mg/dose PO

Special Populations

Contraindications

  • Allergy to class/drug
  • Administration with Tizanidine

Adverse Reactions

Serious

  • Prolonged QT interval and Syncope/Torsades de pointes
  • Photosensitivity
  • Stevens-Johnson syndrome/Toxic epidermal necrolysis
  • Clostridium difficile diarrhea, Pseudomembranous enterocolitis
  • Tendonitis or tendon rupture (black box warning) - increased risk in age >60, immunosuppressed, corticosteroid use
  • peripheral neuropathy
  • severe hypoglycemia [2]
  • mental health effects

Common

Pharmacology

  • Half-life: 4 hours
  • Metabolism: Liver
  • Excretion: Urine, Feces
  • Mechanism of Action: Bactericidal. Inhibits DNA gyrase

Antibiotic Sensitivities[3]

Group Organism Sensitivity
Gram Positive Strep. Group A, B, C, G I
Strep. Pneumoniae I
Viridans strep R
Strep. anginosus gp R
Enterococcus faecalis U
Enterococcus faecium R
MSSA S
MRSA R
CA-MRSA I
Staph. Epidermidis S
C. jeikeium R
L. monocytogenes S
Gram Negatives N. gonorrhoeae I
N. meningitidis S
Moraxella catarrhalis S
H. influenzae S
E. coli S
Klebsiella sp S
E. coli/Klebsiella ESBL+ S
E coli/Klebsiella KPC+ R
Enterobacter sp, AmpC neg S
Enterobacter sp, AmpC pos S
Serratia sp S
Serratia marcescens X1
Salmonella sp S
Shigella sp S
Proteus mirabilis S
Proteus vulgaris S
Providencia sp. S
Morganella sp. S
Citrobacter freundii S
Citrobacter diversus S
Citrobacter sp. S
Aeromonas sp S
Acinetobacter sp. I
Pseudomonas aeruginosa S
Burkholderia cepacia R
Stenotrophomonas maltophilia R
Yersinia enterocolitica S
Francisella tularensis X1
Brucella sp. X1
Legionella sp. S
Pasteurella multocida S
Haemophilus ducreyi X1
Vibrio vulnificus X1
Misc Chlamydophila sp S
Mycoplasm pneumoniae S
Rickettsia sp X1
Mycobacterium avium X1
Anaerobes Actinomyces R
Bacteroides fragilis R
Prevotella melaninogenica R
Clostridium difficile R
Clostridium (not difficile) I
Fusobacterium necrophorum X1
Peptostreptococcus sp. I

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

References

  1. ↑ Sanford 2014
  2. ↑ FDA updates warnings for fluoroquinolone antibiotics on risks of mental health and low blood sugar adverse reactions. US Food and Drug Administration. https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm612995.htm. Updated July 10, 2018. Accessed Oct 22, 2018.
  3. ↑ Sanford Guide to Antimicrobial Therapy 2014
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