What is the recommended dose of ciprofloxacin (fluoroquinolone antibiotic) for adults with uncomplicated and complicated infections?

From the Guidelines

For adults with uncomplicated and complicated infections, the recommended dose of ciprofloxacin is 400 mg every 12 hours, as indicated in the most recent and highest quality study 1.

Key Considerations

• The dose may need to be adjusted for patients with renal impairment, with a recommended dose of 250-500 mg every 12 hours for patients with a creatinine clearance of 30-50 mL/min, and 250-500 mg every 18 hours for patients with a creatinine clearance of less than 30 mL/min 1.
• Intravenous administration at 400 mg every 8-12 hours may be necessary for patients unable to take oral medication or with severe infections.
• Ciprofloxacin works by inhibiting bacterial DNA gyrase and topoisomerase IV, preventing DNA replication and ultimately killing the bacteria.

Important Precautions

• Patients should take the full course of antibiotics even if symptoms improve.
• Patients should drink plenty of fluids and avoid antacids, dairy products, and multivitamins within 2 hours of taking ciprofloxacin.
• Patients should be aware of potential side effects, including tendon damage, central nervous system effects, and photosensitivity.

Additional Guidance

• For uncomplicated urinary tract infections, a 5-7 day course of fluoroquinolones, including ciprofloxacin, may be prescribed 1.
• For complicated urinary tract infections, a 7-14 day course of fluoroquinolones, including ciprofloxacin, may be prescribed 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION - ADULTS Ciprofloxacin Injection, USP should be administered to adults by intravenous infusion over a period of 60 minutes at dosages described in the Dosage Guidelines table.

Days Lower Respiratory Tract Mild/Moderate Severe/Complicated 400 mg 400 mg q12h q8h 7 to 14 Days 7 to 14 Days

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) Dosage >30 See usual dosage 5 to 29 200 to 400 mg q 18 to 24 hr

The recommended dose of ciprofloxacin for adults with uncomplicated and complicated infections is:

• Mild/Moderate: 400 mg every 12 hours (q12h) for 7 to 14 days
• Severe/Complicated: 400 mg every 8 hours (q8h) for 7 to 14 days For patients with impaired renal function, the dosage is adjusted based on creatinine clearance:
• Creatinine Clearance >30 mL/min: usual dosage
• Creatinine Clearance 5-29 mL/min: 200-400 mg every 18-24 hours 2

For oral administration:

ADULT DOSAGE GUIDELINES InfectionSeverityDoseFrequencyUsual Durations† Lower Respiratory Tract Mild/Moderate 500 mg q 12 h 7 to 14 days Severe/Complicated 750 mg q 12 h 7 to 14 days

The recommended oral dose of ciprofloxacin for adults with uncomplicated and complicated infections is:

• Mild/Moderate: 500 mg every 12 hours (q12h) for 7 to 14 days
• Severe/Complicated: 750 mg every 12 hours (q12h) for 7 to 14 days 3

From the Research

Dose of Ciprofloxacin for Uncomplicated and Complicated Infections

• The recommended dose of ciprofloxacin for adults with uncomplicated infections is 100 mg twice daily for 3 days 4.
• For complicated infections, the dose is 250 mg twice daily for 7-20 days 5.
• A study also found that a 500-mg daily dose of ciprofloxacin was effective for treating urinary tract infections, but the incidence of superinfections was higher compared to the 250-mg twice-daily regimen 5.
• Another study used a dose of 400 mg every 12 hours or a loading dose of 600 mg every 12 hours on Day 1, followed by 400 mg every 12 hours on successive treatment days, for severe hospital-acquired infections 6.
• Extended-release ciprofloxacin 500 mg once daily for 3 days has also been shown to be effective in treating uncomplicated urinary tract infections, with symptom improvement reported by 50% of patients within 6 hours of the first dose 7.

Dosage Forms and Administration

• Ciprofloxacin can be administered orally or intravenously 8, 6.
• The oral dose can be given in one or two divided doses per day 4, 5.
• The intravenous dose can be given every 12 hours, with or without a loading dose 6.

Safety and Tolerability

• Ciprofloxacin is generally well tolerated, with mild to moderate side effects reported in 8-9% of patients 8, 5.
• The most common side effects include gastrointestinal reactions, such as nausea and diarrhea 8, 5.
• Serious side effects are rare, but can include convulsions, exanthem, and transient elevation of liver enzymes 8, 6.