Ciprofloxacin Dosing for Pseudomonas UTI in an 82-Year-Old with Stage 2 CKD
For an 82-year-old gentleman with stage 2 CKD and a pseudomonas urinary tract infection, the recommended dose is 500 mg of ciprofloxacin orally twice daily for 7 days. 1
Dosing Considerations for Pseudomonas UTI with Stage 2 CKD
Ciprofloxacin is an appropriate first-line choice for pseudomonas urinary tract infections due to its excellent activity against Pseudomonas aeruginosa and good oral bioavailability 2, 3
The standard dosing for complicated UTIs caused by Pseudomonas is 500 mg orally twice daily 1
For stage 2 CKD (GFR 60-89 ml/min), no dose adjustment is required as significant renal impairment begins at stage 3 CKD 1
Duration of therapy should be 7 days for complicated UTIs, which is sufficient for clinical and microbiological cure while minimizing the risk of resistance development 1
Special Considerations for Elderly Patients
Despite advanced age (82 years), the primary determinant for dosing is kidney function rather than age alone 2
Ciprofloxacin has demonstrated safety and efficacy in elderly patients with complicated UTIs, including those caused by Pseudomonas aeruginosa 2, 4
Monitor for potential side effects which may be more common in elderly patients, including:
- Central nervous system effects (confusion, dizziness)
- QT interval prolongation
- Tendon inflammation or rupture 1
Treatment Efficacy and Monitoring
Ciprofloxacin has shown 84-94% cure rates for complicated UTIs caused by Pseudomonas aeruginosa in elderly patients 2, 4
Obtain urine culture before starting therapy and follow-up cultures after completion of treatment to confirm eradication 1
If local fluoroquinolone resistance rates exceed 10%, consider initial IV dose of a long-acting parenteral antimicrobial (such as ceftriaxone) before switching to oral ciprofloxacin 1
Important Cautions
Avoid concurrent administration with antacids, calcium, iron, or magnesium supplements as they can significantly reduce ciprofloxacin absorption 2
Ensure adequate hydration during treatment to prevent crystalluria, especially important in elderly patients 1
If the patient fails to respond clinically within 48-72 hours, reassess and consider alternative therapy based on culture and sensitivity results 1
For recurrent or persistent infections, evaluate for underlying urological abnormalities or foreign bodies that may require additional intervention 1