Ciprofloxacin hydrochloride
Ciprofloxacin hydrochloride (Cipro)
Ciprofloxacin hydrochloride
(sip-row- FLOX-ah-sin)
Pregnancy Category: C Ciloxan Ophthalmic Cipro Cipro Cystitis Pack Cipro I.V. (Rx)

Classification: Fluoroquinolone anti-infective

See Also: See also Fluoroquinolones .

Action/Kinetics: Effective against both gram-positive and gram-negative organisms. Rapidly and well absorbed following PO administration. Food delays absorption of the drug. Maximum serum levels: 2-4 mcg/mL 1-2 hr after dosing. t 1/2: 4 hr for PO use and 5-6 hr for IV use. Avoid peak serum levels above 5 mcg/mL. About 40%-50% of a PO dose and 50%-70% of an IV dose is excreted unchanged in the urine.

Uses: Systemic. (1) UTIs caused by Escherichia coli, Enterobacter cloacae, Citrobacter diversus, Citrobacter freundii, Klebsiella pneumoniae, Proteus mirabilis, Providencia rettgeri, Pseudomonas aeruginosa, Morganella morganii, Serratia marcescens, Serratia epidermidis and Streptococcus faecalis. (2) Uncomplicated cervical and urethral gonorrhea due to Neisseria gonorrhoeae. (3) Chancroid due to Haemophilus ducreyi; uncomplicated or disseminated gonococcal infections. (4) Mild to moderate chronic bacterial prostatitis due to E. coli or P. mirabilis. (5) Mild to moderate sinusitis due to S. pneumoniae, H. influenzae, or M. catarrhalis. (6) Lower respiratory tract infections caused by E. coli, E. cloacae, K. pneumoniae, P. mirabilis, P. aeruginosa, Haemophilus influenzae, H. parainfluenzae and Streptococcus pneumoniae. (7) Bone and joint infections due to E. cloacae, P. aeruginosa and S. marcescens. (8) Skin and skin structure infections caused by E. coli, E. cloacae, Citrobacter freundii, M. morganii, K. pneumoniae, P. aeruginosa, P. mirabilis, Proteus vulgaris, Providencia stuartii, Staphylococcus pyogenes, Staphylococcus epidermidis and penicillinase- and non-penicillinase-producing strains of Staphylococcus aureus. (9) Infectious diarrhea caused by enterotoxigenic strains of E. coli. Also, Campylobacter jejuni, Shigella flexneri and Shigella sonnei. (10) Typhoid fever (enteric fever) due to Salmonella typhi. Efficacy in eradicating the chronic typhoid carrier state has not been shown. (11) IV as empirical therapy in febrile neutropenia.
Investigational: Clients, over 14 years of age, with cystic fibrosis who have pulmonary exacerbations due to susceptible microorganisms. Malignant external otitis. In combination with rifampin and other tuberculostatics for tuberculosis.

Contraindications: Hypersensitivity to quinolones. Use in children. Lactation. Ophthalmic use in the presence of dendritic keratitis, varicella, vaccinia, and mycobacterial and fungal eye infections and after removal of foreign bodies from the cornea.

Special Concerns: Safety and effectiveness of ophthalmic, PO, or IV use have not been determined in children. Possible antibiotic resistence when used to treat Pseudomonas aeruginosa infections.

Additional Side Effects: See also Side Effects for Fluoroquinolones .  GI: N&V;, abdominal pain/discomfort, diarrhea, dry/painful mouth, dyspepsia, heartburn, constipation, flatulence, pseudomembranous colitis, oral candidiasis, intestinal perforation anorexia, GI bleeding, bad taste in mouth. CNS: Headache, dizziness, fatigue, lethargy, malaise, drowsiness, restlessness, insomnia, nightmares, hallucinations, tremor, lightheadedness, irritability, confusion, ataxia, mania, weakness, psychotic reactions, depression, depersonalization, seizures. GU: Nephritis, hematuria, cylindruria, renal failure, urinary retention, polyuria, vaginitis, urethral bleeding, acidosis, renal calculi, interstitial nephritis, vaginal candidiasis. Skin: Urticaria, photosensitivity, hypersensitivity, flushing, erythema nodosum, cutaneous candidiasis, hyperpigmentation, rash, paresthesia, edema (of lips, neck, face, conjunctivae, hands), angioedema, toxic epidermal necrolysis, exfoliative dermatitis, Stevens-Johnson syndrome. Ophthalmic: Blurred or disturbed vision, double vision, eye pain, nystagmus. CV: Hypertension, syncope, angina pectoris, palpitations, atrial flutter, MI, cerebral thrombosis ventricular ectopy, cardiopulmonary arrest postural hypotension. Respiratory: Dyspnea, bronchospasm, pulmonary embolism, edema of larynx or lungs hemoptysis, hiccoughs, epistaxis. Hematologic: Eosinophilia, pancytopenia, leukopenia, anemia, leukocytosis, agranulocytosis bleeding diathesis. Miscellaneous: Superinfections; fever; chills; tinnitus; joint pain or stiffness; back, neck, or chest pain; flare-up of gout; flushing; worsening of myasthenia gravis; hepatic necrosis; cholestatic jaundice; hearing loss, dysphasia.
After ophthalmic use: Irritation, burning, itching, angioneurotic edema, urticaria, maculopapular and vesicular dermatitis, crusting of lid margins, conjunctival hyperemia, bad taste in mouth, corneal staining, keratitis, keratopathy, allergic reactions, photophobia, decreased vision, tearing, lid edema. Also, a white, crystalline precipitate in the superficial part of corneal defect (onset within 1-7 days after initiating therapy; lasts about 2 weeks and does not affect continued use of the medication).

Laboratory Test Alterations: ALT, AST, alkaline phosphatase, serum bilirubin, LDH, serum creatinine, BUN, serum gamma-glutamyltransferase, serum amylase, uric acid, blood monocytes, potassium, PT, triglycerides, cholesterol. H&H.; Either or blood glucose, platelets.

Additional Drug Interactions: Azlocillin / Excretion of ciprofloxacin possible effect Caffeine / Excretion of caffeine pharmacologic effects Cyclosporine / Nephrotoxic effects Hydantoins / Phenytoin serum levels Theophylline / Do not take with ciprofloxacin

How Supplied: Injection: 10 mg/mL, 200 mg/100 mL, 400 mg/200 mL; Injection in 0.9% NaCl, Injection in Dextrose 5%; Ophthalmic solution: 0.3%; Ophthalmic ointment: 0.3%; Powder for Reconstitution: 250 mg/5 mL, 500 mg/5 mL; Tablet: 100 mg, 250 mg, 500 mg, 750 mg

Dosage
?Tablets UTIs.
250 mg (mild to moderate) to 500 mg (severe/complicated) q 12 hr for 7-14 days.
Mild to moderate chronic bacterial prostatitis.
Adults: 500 mg b.i.d. for 28 days.
Mild to moderate sinusitis.
Adults: 500 mg b.i.d. for 10 days.
Urethral or cervical gonococcal infections, uncomplicated.
250 mg in a single dose.
Infectious diarrhea.
500 mg q 12 hr for 5-7 days.
Skin, skin structures, lower respiratory tract, bone and joint infections.
500 mg (mild to moderate) to 750 mg (severe or complicated) q 12 hr for 7-14 days. Treatment may be required for 4-6 weeks in bone and joint infections.
Typhoid fever.
500 mg (mild to moderate) q 12 hr for 10 days.
Chancroid ( H. ducreyi infection).
500 mg b.i.d. for 3 days.
Disseminated gonococcal infections.
500 mg b.i.d. to complete a full week of therapy after initial treatment with ceftriaxone, 1 g IM or IV q 24 hr for 24-48 hr after improvement begins.
Uncomplicated gonococcal infections.
500 mg in a single dose plus doxycycline.
NOTE: Dose must be reduced with a C _CR less than 50 mL/min. The PO dose should be 250-500 mg q 12 hr if the C _CR is 30-50 mL/min and 250-500 mg q 18 hr (IV: 200-400 mg q 18-24 hr) if the C _CR is 5-29 mL/min. If the client is on hemodialysis or peritoneal dialysis, the PO dose should be 250-500 mg q 24 hr after dialysis.
?Cipro Cystitis Pack Uncomplicated UTI infections.
100 mg b.i.d. for 3 days. The pack contains six 100-mg tablets of ciprofloxacin and is intended to increase compliance.
?IV Infusion UTIs.
200 mg (mild to moderate) to 400 mg (severe or complicated) q 12 hr for 7-14 days.
Skin, skin structures, respiratory tract, bone and joint infections.
400 mg (for mild to moderate infections) q 12 hr for 7-14 days.
?Ophthalmic Solution Acute infections.
Initial, 1-2 gtt q 15-30 min; then, reduce dosage as infection improves.
Moderate infections.
1-2 gtt 4-6 (or more) times/day.