Ciprofloxacin

C difficile risk
High
Oral Bioavailability
Excellent

Dosing

Usual doseSevere infections; infections due to Pseudomonas aeruginosa400mg IV q12h400mg IV q8h

Usual doseInfection of the bone or skin, infections due to Pseudomonas spp or severe infections500mg PO q12h750mg PO q12h

CrCl 30-49CrCl 0-29IV:

  • 400mg IV q12h

  • For severe infections; infections due to Pseudomonas aeruginosa: 400mg IV q12h

PO:

  • 500mg PO q12h

  • For infection of the bone or skin; infections due to Pseudomonas spp or severe infections: 500mg PO q12hIV: 400mg IV q24h PO: 500mg PO q24h

IV: 400mg IV q24h; administer dose after dialysis on dialysis days PO: 250-500mg PO q24h; administer dose after dialysis on dialysis days

General Information

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

NOT first line for uncomplicated UTIs

Monitor QTc in patients with increased risk

  • QTc prolongation

  • Dysglycemia

  • Tendinopathy and rupture

  • GI upset

  • Rash

  • Retinal detachment

  • CNS toxicity including confusion, psychosis

  • Weakness exacerbation in myasthenia gravis

CYP1A2 inhibitor - Multiple interactions possible.

QTc prolongation - Increased risk with other agents that prolong QTc.

Divalent & trivalent cations including Al, Ca, Fe, Mg (antacids, dairy products, iron supplements, some enteral feeds) - Decreased absorption

Cyclosporine - Increased levels of cyclosporine

Warfarin - Increased INR

Methadone - Lowered seizure threshold

  • Intravenous ciprofloxacin: only for patients unable to take oral medication. Bioavailability ~70-80% (80% of 500 mg PO = 400 mg absorbed, which is equal to IV dose)

Oral Ciprofloxacin Administration

  • Avoid dairy products, antacids, and other sources of divalent cations (Ca, Fe, Mg, Al, Zn) which can chelate ciprofloxacin and prevent absorption (administer ciprofloxacin 2 hours before or 6 hours after)

  • Must hold continuous tube feeding 2 h before and 2 h after administration

Antimicrobial class: Fluoroquinolone

Pregnancy category: C

Average serum half life: 4 hours

Urine penetration: Therapeutic

Lung penetration: Therapeutic

CSF penetration: Moderate (IV only)

Biliary penetration: Therapeutic

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