Ciprofloxacin information from DrugsUpdate
P - Contraindicated in pregnancy
L - Contraindicated in lactation
FI - Food *
Ciprofloxacin is a drug used to treat bacterial infections. It is a second generation fluoroquinolone antibacterial. It kills bacteria by interfering with the enzymes that cause DNA to rewind after being copied, which stops DNA and protein synthesis.
Ciprofloxacin is marketed worldwide with over three hundred different brand names. In the United States, Canada and the UK, it is marketed as Ciloxan, Cipro, Cipro XR, Cipro XL Ciproxin and, most recently, Proquin. In Mexico it is available over the counter and marketed under the names Ciproflox or Ciprofloxacino. In Ecuador it is available and marketed under the name Cidrax. In Nigeria it is sold as Ciprotab while in Bangladesh it is marketed as Tablets and Microcapsules for Suspension by numerous companies, one of which is by Edruc Limited as Cipron. Additionally, ciprofloxacin is available as a generic drug under a variety of different brand names and is also available for limited use in veterinary medicine.
Ciprofloxacin was first patented in 1983 by Bayer A.G. and subsequently approved by the United States Food and Drug Administration (FDA) in 1987.Ciprofloxacin has 12 F.D.A.-approved human uses and other veterinary uses, but it is often used for non-approved uses (off-label).
Ciprofloxacin interacts with other drugs, herbal and natural supplements, and thyroid medications.
Pharmacodynamics
Pharmacokinetics
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 hours (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 hours (elimination half-life). Removed by haemodialysis and peritoneal dialysis (small amounts).
Ciprofloxacin Indications / Ciprofloxacin Uses
Information Not Available
Ciprofloxacin Adverse Reactions / Ciprofloxacin Side Effects
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.
Precautions
Information Not Available
Special Precautions
Warnings
Tendonitis
Ciprofloxacin has been associated with an increased risk of tendonitis and tendon rupture in patients of all ages. The risk is increased in patients older than 60 years of age, in patients taking corticosteroids, and in patients with kidney, heart, or lung transplants.
Monitor
Ensure CBC (including platelets and differential), renal function, and liver enzymes are evaluated before starting therapy and periodically thereafter during prolonged therapy. Monitor patient's response to therapy. Periodically assess organ system function with prolonged therapy.
Ophthalmic
No overall differences in safety and efficacy have been observed between elderly and younger patients.
Hypersensitivity
Serious and potentially fatal reactions have occurred. Discontinue drug if allergic reaction occurs.
Renal Function
Adjust dose downward accordingly.
Superinfection
Use of antibiotics may result in bacterial or fungal overgrowth.
Photosensitivity
Moderate to severe reactions have occurred with some fluoroquinolones; avoid excessive sunlight and discontinue therapy if phototoxicity occurs.
C. difficile –associated diarrhea
Consider possibility in patients with diarrhea.
CNS disorders
Seizures, increased intracranial pressure, and toxic psychosis have been reported. May also cause nervousness, agitation, insomnia, anxiety, nightmares, paranoia, dizziness, confusion, tremors, hallucinations, depression, and rarely, suicidal thoughts or acts. Discontinue therapy and institute appropriate measures if these reactions occur. Use with caution in patients with known or suspected CNS disorders or other risk factors (eg, drug therapy, renal function impairment) that may predispose to seizures or lower the seizure threshold.
Crystalline precipitate
An ocular white crystalline precipitate in superficial portion of corneal defect may occur.
Crystalluria
Has been reported rarely. Avoid alkalinity of the urine and keep patient well hydrated.
ER tablets
Ensure that ER tablets are not used to treat infections other than UTIs.
Peripheral neuropathy
Sensory or sensorimotor axonal polyneuropathy resulting in paresthesias, hypoesthesias, dysesthesias, and weakness has been rarely reported. To prevent development of an irreversible condition, discontinue therapy if patient experiences symptoms of neuropathy.
Serious reactions
Clinical manifestations of serious and sometimes fatal reactions that have been reported with ciprofloxacin include acute hepatic necrosis or failure, acute renal insufficiency or failure, agranulocytosis, allergic pneumonitis, anemia (including hemolytic and aplastic), arthralgia, fever, hepatitis, interstitial nephritis, jaundice, leukopenia, myalgia, pancytopenia, rash, serum sickness, Stevens-Johnson syndrome, thrombocytopenia (including thrombotic thrombocytopenic purpura), toxic epidermal necrolysis, and vasculitis.
Syphilis
Not effective in treatment of syphilis. All patients with gonorrhea should have a serologic test for syphilis at time of diagnosis and 3 months after treatment with ciprofloxacin.
Tendon ruptures
Achilles and other tendon ruptures requiring surgical repair and prolonged disability have been reported. Risk increased with concomitant corticosteroid therapy, especially in elderly patients. Discontinue use if patient experiences pain, inflammation, or rupture of tendon.
Other 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.
Other Interactions
Food Interactions: Food decreases rate but not the extent of absorption.
Dosage
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 years: 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
Surgical prophylaxis
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
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
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
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
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
Pseudomonal lung infections in cystic fibrosis
Adult: 400 mg bid. Max: 400 mg tid.
Child: >5 years old: 10 mg/kg tid infused over 60 min. Max: 400 mg tid.
Renal impairment: Dosing adjustments may be needed.
Ophthalmic
Superficial ocular infections
Adult: Apply 0.3% solution every 15 minutes for 6 hours then every 30 minutes on the 1st day, then apply every hour on the 2nd day and every 4 hours 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.
Food(before/after)
May be taken with or without food. (May be taken with meals to minimise GI discomfort. Do not take with antacids, Fe or dairy products.)
List of Contraindications
Ciprofloxacin and Pregnancy
Contraindicated in pregnancy.
Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.
Ciprofloxacin and Lactation
Contraindicated in lactation
Ciprofloxacin and Children
Not drug of first choice in children because of increased incidence of adverse reactions related to joints and surrounding tissue. Do not use ciprofloxacin tablets, oral suspension, or injection in children younger than 18 years of age, except for listed indications. Do not use ophthalmic solution or otic solution in children younger than 1 year of age, ophthalmic ointment in children younger than 2 years of age, or ER tablets in children younger than 18 years of age.
Ciprofloxacin and Geriatic
Because of the risk of reduced renal function, take care in dose selection; renal function monitoring may be useful. Elderly patients may be more susceptible to effects on QT interval or tendons.
Ciprofloxacin and Other Contraindications
Hypersensitivity. Not to be used concurrently with tizanidine. Avoid exposure to strong sunlight or sun lamps during treatment.
Storage
Intravenous
Store at 5-25°C.
Ophthalmic
Store at 2-25°C.
Oral
Store at 25°C.
Lab interference
Intravenous
Store at 5-25°C.
Ophthalmic
Store at 2-25°C.
Oral
Store at 25°C.
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