Ciprofloxacin

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General

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

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
  • 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

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
  • 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
  • Rupture of tendon or Tendinitis

Common

Common

Pharmacology

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

Antibiotic Sensitivities[2]

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. Sanford Guide to Antimicrobial Therapy 2014