ciprofloxacin (Cipro, Ciloxan)
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Introduction
Tradename: Cipro. (ciprofloxacin HCl)
Indications
- adjunctive treatment of moderate to severe bacterial infections caused by susceptible gram positive & gram negative organisms
- as a single agent in urinary tract infections for adults & children[9]
- single dose treatment of gonorrhea
- chancroid[11]
- lower respiratory tract infections
- intra-abdominal infections
- skin or soft tissue infection
- infectious arthritis, osteomyelitis[11]
- otitis externa (otic)
- eye infection due to corneal ulcer (ophthalmic)
- ciprofloxacin & ofloxacin are used in multidrug regimens for treatment of drug-resistant Mycobacterium tuberculosis
- empiric treatment of febrile neutropenia
Contraindications
- anaerobic & Streptococcal infections
- poor coverage
Dosage
200-400 mg IV every 12 hours
Tabs: 250, 500, 750 mg.
Ophthalmic agent: Tradename: Ciloxan
1 drop every 1-6 hours, 0.35%
Dosage adjustment in renal failure
Table
| Creatinine clearance | dose |
|---|---|
| > 50 mL/min | 500-750 mg every 12 hours |
| 30-49 mL/min | 500 mg every 12 hours |
| 10-29 mL/min | 500-750 mg every 24 hours |
| < 10 mL/min | 500 mg every 24 hours |
| hemodialysis | 200 mg every 12 hours |
Pharmacokinetics
- oral route achieves similar concentration to parenteral route
- highly concentrated in urine, prostate & lungs
- most of drug is eliminated in the urine
- 1/2life is 4-5 hours (6-9 hours with ESRD)
elimination via kidney
elimination via liver
1/2life = 3-5 hours
protein binding = 30 %
elimination by hemodialysis = -
elimination by peritoneal dialysis = -
Antimicrobial activity
- Streptococcus pneumonia (+/-)
- Staphylococcus aureus (MSSA)
- Staphylococcus epidermidis
- Listeria monocytogenes
- Neisseria gonorrhoeae
- Neisseria meningitidis
- Moraxella catarrhalis
- Haemophilus influenzae
- Haemophilus parainfluenzae
- Escherichia coli#
- Klebsiella species
- Enterobacter species
- Serratia species
- Salmonella species
- Shigella species
- Proteus mirabilis
- Proteus vulgaris
- Providencia species
- Morganella species
- Citrobacter species
- Aeromonas species
- Acinetobacter species
- Pseudomonas aeruginosa*
- Yersinia enterocolitica
- Legionella species
- Pasteurella multocida
- Campylobacter[11]
- Clostridium species (+/-)
- Peptostreptococcus species (+/-)
- Bacterioides[11]
*Among the quinolones, ciprofloxacin has the best activity against Pseudomonas aeruginosa.
# 20% of healthy women delivering twins are colonized with ciprofloxacin resistant E coli
- antibiotic exposure not identified as risk factor for colonization[12]
Adverse effects
- most common (1-10%)
- uncommon (< 1%)
- tremor, dizziness, confusion, seizures, anemia, increased serum transaminases, arthralgia, acute renal failure, photosensitivity, allergic reactions (rare)
- Do not use in children & pregnant women because of effects on cartilage
- dose-related neurotoxicity in elderly, especially parenteral administration
- ophthalmic agent
- white granular or crystalline precipitate superficially on corneal defect (17% of patients with bacterial keratitis) does NOT warrant discontinuation of therapy
- ocular irritation (10%)
- taste abnormality (5%)
- crystal nephropathy, especially in the elderly[9]
- QT prolongation []
Drug interactions
- absorption decreased 30-60% when administered concurrently with antacids, sucralfate, Mg+2, Ca+2, Fe+2, Zn+2 or Al+3-containing products, including enteral & vitamin/mineral formulas;
- administer ciprofloxacin 2 hours before or afterwards
- ciprofloxacin decreases metabolism of theophylline
- didanosine (ddI) reduces ciprofloxacin levels; administer ciprofloxacin 2 hours before or afterwards
- probenecid decreases renal clearance of ciprofloxacin
- ciprofloxacin may increase prothrombin time in patients receiving warfarin
- ciprofloxacin inhibits cyt P450 1A2
- may increase levels of drugs metabolized by cyt P450 1A2
- see fluoroquinolone
- drug interaction(s) anticonvulsants with anti-bacterial agents
- drug interaction(s) of antibiotics with warfarin
- drug interaction(s) of tizanidine with ciprofloxacin
- drug interaction(s) of theophylline with fluoroquinolone
- drug interaction(s) of beta-adrenergic receptor antagonists with quinolones
- drug interaction(s) of fluroquinolones with amiodarone
- drug interaction(s) of fluroquinolones with sulfonylureas
- drug interaction(s) of fluoroquinolones with hypoglycemic agents
Laboratory
- specimen:
- methods: HPLC, bioassay
- interferences:
- presence of other antimicrobial agents may interfere with bioassay
Mechanism of action
concentration-dependent, bactericidal, inhibitor of DNA gyrase
More general terms
More specific terms
Additional terms
Component of
- ciprofloxacin/fluocinolone
- ciprofloxacin/dexamethasone
- ciprofloxacin/dexamethasone otic (Ciprodex Otic)
- ciprofloxacin/cortisol (Cipro HC)
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 165
- ↑ Sanford Guide to antimicrobial therapy 1997, 2001
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, 19. American College of Physicians, Philadelphia 1998, 2021
- ↑ Clinical Guide to Laboratory Tests, 3rd ed. Teitz ed., W.B. Saunders, 1995
- ↑ Prescriber's Letter 13(3): 2006 Cytochrome P450 drug interactions Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=220233&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 9.0 9.1 9.2 9.3 Prescriber's Letter 11(5):29 2004 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=200506&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Stratta P et al, Ciprofloxcin crystal nephropathy. Am J Kidney Dis 2007, 50:330 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17660035
- ↑ 11.0 11.1 11.2 11.3 11.4 11.5 Deprecated Reference
- ↑ 12.0 12.1 Gurnee EA et al. Gut colonization of healthy children and their mothers with pathogenic ciprofloxacin-resistant Escherichia coli. J Infect Dis 2015 Dec 15; 212:1862 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25969564 <Internet> http://jid.oxfordjournals.org/content/212/12/1862
Spellberg B, Doi Y. The rise of fluoroquinolone-resistant Escherichia coli in the community: Scarier than we thought. J Infect Dis 2015 Dec 15; 212:1853 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25969562 <Internet> http://jid.oxfordjournals.org/content/212/12/1853