Ciprofloxacin

Indications
 Oral
Susceptible infections
Adult: 250-750 mg bid depending on the severity and nature of infection.
Child: 5-15 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Oral
Cat scratch disease
Adult: 250-750 mg bid depending on the severity and nature of infection.
Child: 5-15 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Oral
Q fever
Adult: 250-750 mg bid depending on the severity and nature of infection.
Child: 5-15 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Oral
Spotted fever
Adult: 250-750 mg bid depending on the severity and nature of infection.
Child: 5-15 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Oral
Typhus
Adult: 250-750 mg bid depending on the severity and nature of infection.
Child: 5-15 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Oral
Urinary tract infections
Adult: 250-750 mg bid depending on the severity and nature of infection.
Child: 5-15 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Oral
Biliary tract infections
Adult: 250-750 mg bid depending on the severity and nature of infection.
Child: 5-15 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Oral
Bone and joint infections
Adult: 250-750 mg bid depending on the severity and nature of infection.
Child: 5-15 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Oral
Chanroid
Adult: 250-750 mg bid depending on the severity and nature of infection.
Child: 5-15 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Oral
Infections in immunocompromised patients
Adult: 250-750 mg bid depending on the severity and nature of infection.
Child: 5-15 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Oral
Legionnaire's disease
Adult: 250-750 mg bid depending on the severity and nature of infection.
Child: 5-15 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Oral
Lower respiratory tract infections
Adult: 250-750 mg bid depending on the severity and nature of infection.
Child: 5-15 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Oral
Peritonitis
Adult: 250-750 mg bid depending on the severity and nature of infection.
Child: 5-15 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Oral
Septicaemia
Adult: 250-750 mg bid depending on the severity and nature of infection.
Child: 5-15 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Oral
Skin infections
Adult: 250-750 mg bid depending on the severity and nature of infection.
Child: 5-15 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Oral
Brucellosis
Adult: 250-750 mg bid depending on the severity and nature of infection.
Child: 5-15 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Oral
Infected animal bites
Adult: 250-750 mg bid depending on the severity and nature of infection.
Child: 5-15 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Oral
Anthrax
Adult: 250-750 mg bid depending on the severity and nature of infection.
Child: 5-15 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Oral
Typhoid and paratyphoid fever
Adult: 250-750 mg bid depending on the severity and nature of infection.
Child: 5-15 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Oral
Gastroenteritis
Adult: 250-750 mg bid depending on the severity and nature of infection.
Child: 5-15 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Oral
Acute uncomplicated cystitis
Adult: 100 mg bid for 3 days.
Renal impairment: Dosing adjustments may be needed.
Oral
Gonorrhoea
Adult: 250-500 mg as a single dose.
Renal impairment: Dosing adjustments may be needed.
Oral
Acute exacerbations of cystic fibrosis
Adult: Associated with P. aeruginosa infection: 20 mg/kg bid. Max: 750 mg bid.
Child: Associated with P. aeruginosa infection: >5 yr: 20 mg/kg bid. Max: 750 mg bid.
Renal impairment: Dosing adjustments may be needed.
Oral
Prophylaxis of meningococcal meningitis
Adult: 500 mg as a single dose.
Renal impairment: Dosing adjustments may be needed.
Oral
Prophylaxis of surgical infections
Adult: 750 mg as a single dose 60-90 minutes before procedure.
Renal impairment: Dosing adjustments may be needed.
Intravenous
Susceptible infections
Adult: 100-400 mg bid infused over 30-60 minutes.
Child: 4-8 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Intravenous
Cat scratch disease
Adult: 100-400 mg bid infused over 30-60 minutes.
Child: 4-8 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Intravenous
Q fever
Adult: 100-400 mg bid infused over 30-60 minutes.
Child: 4-8 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Intravenous
Spotted fever
Adult: 100-400 mg bid infused over 30-60 minutes.
Child: 4-8 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Intravenous
Typhus
Adult: 100-400 mg bid infused over 30-60 minutes.
Child: 4-8 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Intravenous
Urinary tract infections
Adult: 100-400 mg bid infused over 30-60 minutes.
Child: 4-8 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Intravenous
Biliary tract infections
Adult: 100-400 mg bid infused over 30-60 minutes.
Child: 4-8 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Intravenous
Bone and joint infections
Adult: 100-400 mg bid infused over 30-60 minutes.
Child: 4-8 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Intravenous
Chanroid
Adult: 100-400 mg bid infused over 30-60 minutes.
Child: 4-8 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Intravenous
Infections in immunocompromised patients
Adult: 100-400 mg bid infused over 30-60 minutes.
Child: 4-8 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Intravenous
Legionnaire's disease
Adult: 100-400 mg bid infused over 30-60 minutes.
Child: 4-8 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Intravenous
Lower respiratory tract infections
Adult: 100-400 mg bid infused over 30-60 minutes.
Child: 4-8 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Intravenous
Peritonitis
Adult: 100-400 mg bid infused over 30-60 minutes.
Child: 4-8 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Intravenous
Septicaemia
Adult: 100-400 mg bid infused over 30-60 minutes.
Child: 4-8 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Intravenous
Skin infections
Adult: 100-400 mg bid infused over 30-60 minutes.
Child: 4-8 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Intravenous
Brucellosis
Adult: 100-400 mg bid infused over 30-60 minutes.
Child: 4-8 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Intravenous
Infected animal bites
Adult: 100-400 mg bid infused over 30-60 minutes.
Child: 4-8 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Intravenous
Anthrax
Adult: 100-400 mg bid infused over 30-60 minutes.
Child: 4-8 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Intravenous
Typhoid and paratyphoid fever
Adult: 100-400 mg bid infused over 30-60 minutes.
Child: 4-8 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Intravenous
Gastroenteritis
Adult: 100-400 mg bid infused over 30-60 minutes.
Child: 4-8 mg/kg bid.
Renal impairment: Dosing adjustments may be needed.
Intravenous
Pseudomonal lung infections in cystic fibrosis
Adult: 400 mg bid. Max: 400 mg tid.
Child: >5 yr old: 10 mg/kg tid infused over 60 min. Max: 400 mg tid.
Renal impairment: Dosing adjustments may be needed.
Ophthalmic
Superficial ophthalmic infections
Adult: Apply 0.3% solution every 15 minutes for 6 hr then every 30 minutes on the 1st day, then apply every hr on the 2nd day and every 4 hr on the 3rd-14th day of treatment. Treatment should not exceed 21 days.
Elderly:
Otic/Aural
Otitis externa
Adult: As a 0.2 or 0.3% solution: Instil 4 drops bid into the affected ear(s) for 7 days. Usually used in combination with a corticosteroid.
Otic/Aural
Otitis media
Adult: As a 0.2 or 0.3% solution: Instil 4 drops bid into the affected ear(s) for 7 days. Usually used in combination with a corticosteroid.

Special Populations: Renal impairment: Dose changes according to creatinine clearance. Duration of treatment: Generally 5-7 days. Continued for at least 3 days after symptoms have subsided.
Contraindications
 Hypersensitivity. Not to be used concurrently with tizanidine. Avoid exposure to strong sunlight or sun lamps during treatment.
Warnings / Precautions
 Epilepsy, history of CNS disorders; severe renal or hepatic dysfunction; G6PD deficiency; maintain adequate hydration; myasthaenia gravis. Caution when used in patients with QT prolongation or risk factors e.g. bradycardia, pre-existing cardiac disease or uncorrected electrolyte disturbances. Discontinue treatment if patients experience tendon pain, inflammation or rupture. Avoid usage in methicillin-resistant staphylococcus aureus (MRSA) infections due to high level of resistance. May impair ability to drive or operate machinery. Safety and efficacy have not been established in pregnant and lactating women. Not to be used in children <18 yr; except where benefit clearly exceeds risk.
Adverse Reactions
 GI disturbances; headache, tremor, confusion, convulsions; rashes; joint pain; phototoxicity. Transient increases in serum creatinine. Haematological, hepatic and renal disturbances. Vasculitis, pseudomembranous colitis and tachycardia. Phototoxicity.
Potentially Fatal: Anaphylactoid reaction; cardiopulmonary arrest.
Overdose Reactions
 Overdosage may lead to reversible renal toxicity. May empty stomach by inducing vomiting or by gastric lavage. Monitor renal function and maintain adequate hydration. Careful observation and supportive treatment, including admin of magnesium or calcium containing antacids which can reduce the absorption of ciprofloxacin are recommended.
Drug Interactions
 Decreased absorption with concurrent sucralfate, magnesium-aluminum antacids, calcium, iron, zinc and multivitamins. Increased methotrexate and caffeine levels when taken concurrently with ciprofloxacin. Probenecid reduces renal clearance of ciprofloxacin. Potentiates oral anticoagulants and glibenclamide. Concurrent use with corticosteroids may increase tendon rupture. Concurrent use with ciclosporin may cause transient increases in serum creatinine. CNS excitation may occur with concurrent admin of quinolones and NSAIDs. Serum concentrations of theophylline are markedly elevated when co-administered with ciprofloxacin; monitor serum levels of theophylline.
Potentially Fatal: Concurrent use with tizanidine can cause marked elevation in serum levels of tizanidine; avoid concurrent usage.
See Below for More ciprofloxacin Drug Interactions
Food Interactions
 Food decreases rate but not the extent of absorption.
Mechanism of Actions
 Ciprofloxacin promotes breakage of double-stranded DNA in susceptible organisms and inhibits DNA gyrase, which is essential in reproduction of bacterial DNA.
Absorption: Rapidly and well absorbed from the GI tract with peak plasma concentrations after 2 hr (oral); may be delayed by the presence of food.
Distribution: Bile (high concentrations), CSF (10% of those in plasma in the absence of meningitis); crosses the placenta and enters the breast milk. Protein-binding: 20-40%.
Metabolism: Converted to oxociprofloxacin, sulfociprofloxacin and other active metabolites.
Excretion: Mainly via the urine by active tubular secretion and glomerular filtration (as oxociprofloxacin and 15% metabolites, 40% unchanged after oral dose; 70% as unchanged, 10% as metabolites after IV dose); hepatic, biliary and transluminal secretion (non-renal excretion). Via the faeces (as sulfociprofloxacin; 35% after oral dose, 15% after IV dose); 3.5-4.5 hr (elimination half-life). Removed by haemodialysis and peritoneal dialysis (small amounts).
Administration
 May be taken with or without food. (May be taken w/ meals to minimise GI discomfort. Do not take w/ antacids, Fe or dairy products.)
Storage Conditions
 Intravenous: Store at 5-25°C. Ophthalmic: Store at 2-25°C. Oral: Store at 25°C.
ATC Classification
 J01MA02 - ciprofloxacin ; Belongs to the class of fluoroquinolones. Used in the systemic treatment of infections.
S01AX13 - ciprofloxacin ; Belongs to the class of other antiinfectives. Used in the treatment of eye infections.
S02AA15 - ciprofloxacin ; Belongs to the class of antiinfectives used in the treatment of ear infections.
S03AA07 - ciprofloxacin ; Belongs to the class of antiinfectives used in ophthalmologic and otologic preparations.
Storage
 Intravenous: Store at 5-25°C. Ophthalmic: Store at 2-25°C. Oral: Store at 25°C.
Available As
  • Ciprofloxacin 0.05% w/w
  • Ciprofloxacin 0.3 % w/v
  • Ciprofloxacin 0.3%
  • Ciprofloxacin 0.3% w/v
  • Ciprofloxacin 0.3% w/w
  • Ciprofloxacin 0.3%w/v
  • Ciprofloxacin 0.30% w/v
  • Ciprofloxacin 0.5%
  • Ciprofloxacin 0.5% w/w
  • Ciprofloxacin 100 mg
  • Ciprofloxacin 1000 mg
  • Ciprofloxacin 125 mg
  • Ciprofloxacin 2 mg
  • Ciprofloxacin 20 mg
  • Ciprofloxacin 200 mg
  • Ciprofloxacin 250 mg
  • Ciprofloxacin 3 mg
  • Ciprofloxacin 3% w/v
  • Ciprofloxacin 300 mg
  • Ciprofloxacin 400 mg
  • Ciprofloxacin 50 mg
  • Ciprofloxacin 500 mg
  • Ciprofloxacin 600 mg
  • Ciprofloxacin 750 mg

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