Ciprofloxacin Dosing for Pseudomonas UTI
For Pseudomonas urinary tract infections, ciprofloxacin should be dosed at 400 mg IV every 8 hours for intravenous therapy, or 500-750 mg orally twice daily for oral therapy, with treatment duration of 7-14 days. 1
Recommended Dosing Regimens
Carbapenem-Susceptible Pseudomonas aeruginosa
- Ciprofloxacin 400 mg IV q8h (intravenous) 1
- Ciprofloxacin 500-750 mg orally twice daily (oral therapy) 1, 2
Treatment Duration
- 7-14 days is the recommended duration for Pseudomonas UTI 1, 2
- The Centers for Disease Control and Prevention recommends treating UTIs in men with 7-14 days of appropriate antibiotics 2
Special Considerations
Renal Dosing Adjustments
Adjust dosing based on creatinine clearance:
- ≥50 mL/min: standard dosing
- 26-49 mL/min: 500 mg once daily
- 10-25 mL/min: 250 mg once daily 2
Antimicrobial Stewardship
- Fluoroquinolones should be reserved for situations where other options cannot be used due to increasing resistance rates 2
- Therapy should be adjusted based on culture and susceptibility results when available 2
- For Pseudomonas UTI, fluoroquinolones remain a primary treatment option due to their excellent urinary penetration and activity against Pseudomonas 1
Clinical Pearls
- Always obtain urine culture before initiating antibiotics for suspected UTI 2
- Consider local antibiogram patterns when selecting empiric therapy 2
- For complicated UTIs, including those caused by Pseudomonas, a longer treatment duration (7-14 days) is necessary 1, 2
- Resistance to fluoroquinolones is increasing globally, so susceptibility testing is crucial 2
Cautions
- Development of resistance during therapy is possible, particularly when initial MICs are higher than 0.5 mg/L 3
- Fluoroquinolones carry FDA warnings for potential serious adverse effects including tendinitis, tendon rupture, peripheral neuropathy, and CNS effects
- Single-dose therapy is not recommended for Pseudomonas UTI or for UTIs in men 2
Alternative Treatments for Pseudomonas UTI
For patients with contraindications to fluoroquinolones or in cases of fluoroquinolone-resistant Pseudomonas:
For carbapenem-resistant Pseudomonas (CRPA) susceptible to other agents:
- Piperacillin 3-4 g IV q6h
- Piperacillin/tazobactam 3.375-4.5 g IV q6h
- Ceftazidime 2 g IV q8h
- Cefepime 2 g IV q8-12h
- Amikacin 15 mg/kg IV qd (for UTI only) 1
For difficult-to-treat Pseudomonas (DTR-PA):
- Colistin monotherapy or combination therapy
- Ceftolozane/tazobactam 1.5-3 g IV q8h
- Ceftazidime/avibactam 2.5 g IV q8h 1
Remember that aminoglycoside monotherapy (like amikacin) is only indicated for urinary tract infections, not for systemic infections 1.