From the Guidelines
Ciprofloxacin can be taken with stage 4 chronic kidney disease (CKD4), but the dose must be adjusted based on your kidney function, with a recommended dose of 250-500 mg every 18-24 hours for patients with CrCl <30 mL/min, as indicated in the most recent and highest quality study 1. When taking ciprofloxacin with CKD4, it is crucial to adjust the dose to prevent potential side effects and ensure the medication's efficacy.
- The adjustment is necessary because ciprofloxacin is primarily eliminated by the kidneys, and reduced kidney function in CKD4 leads to slower drug clearance and potential accumulation of the medication in your body.
- Taking the full dose could increase the risk of side effects such as tendon damage, nerve problems, or worsening kidney function.
- According to the study 1, for patients with CrCl <30 mL/min, the recommended dose is 250-500 mg every 18-24 hours, which is a reduction from the usual dose of 500-750 mg every 12 hours.
- Another study 1 also supports this recommendation, suggesting a dose of 250-500 mg every 18 hours for patients with CrCl <30 mL/min.
- It's essential that your doctor prescribe the appropriate adjusted dose based on your specific kidney function tests (eGFR or creatinine clearance).
- Never adjust the dose yourself, and make sure all healthcare providers know about your kidney disease when prescribing any medication.
From the FDA Drug Label
Adults with Impaired Renal Function: Ciprofloxacin is eliminated primarily by renal excretion; however, the drug is also metabolized and partially cleared through the biliary system of the liver and through the intestine. These alternative pathways of drug elimination appear to compensate for the reduced renal excretion in patients with renal impairment Nonetheless, some modification of dosage is recommended, particularly for patients with severe renal dysfunction.
The following table provides dosage guidelines for use in patients with renal impairment: RECOMMENDED STARTING AND MAINTENANCE DOSES FOR PATIENTS WITH IMPAIRED RENAL FUNCTION Creatinine Clearance (mL/min)Dose
50 See Usual Dosage 30-50 250-500 mg q 12 h 5-29 250-500 mg q 18 h Patients on hemodialysis or Peritoneal dialysis 250-500 mg q 24 h (after dialysis)
Ciprofloxacin dosage for CKD4 patients:
- CKD4 is defined as a creatinine clearance of 15-29 mL/min.
- The recommended dose for patients with creatinine clearance of 5-29 mL/min is 250-500 mg every 18 hours.
- Patients with severe infections and severe renal impairment may receive a unit dose of 750 mg at the intervals noted above, but should be carefully monitored. 2
From the Research
Antibiotic Use in CKD Patients
- Patients with chronic kidney disease (CKD) may require antibiotic dose adjustments to prevent toxicity, as their kidney function can affect the pharmacokinetics of antibiotics 3.
- The choice of antibiotic and dosage regimen should be guided by the patient's individual pharmacokinetic alterations and the pharmacodynamic properties of the drug 3.
Ciprofloxacin Use in CKD Patients
- There is no direct evidence in the provided studies regarding the use of ciprofloxacin in patients with CKD4.
- However, it is mentioned that high rates of resistance to ciprofloxacin preclude its use as empiric treatment of urinary tract infections (UTIs) in several communities 4.
- Patients with CKD may require monitoring for potential nephrotoxins, including certain antibiotics, and adjustments to drug dosing may be necessary 5.
Dose Adjustment Considerations
- Antibiotic dose adjustments are crucial in patients with CKD to prevent adverse effects and ensure efficacy 6.
- The dosage regimen should be tailored to the individual patient's renal function and pharmacodynamic goals 3.
- Patients receiving hemodialysis have unique prescribing considerations, and antibiotics that can be administered intravenously toward the end of a dialysis session may be preferred 3.