What is the recommended dosage of Cipro (ciprofloxacin) for treating Pseudomonas aeruginosa infections?

Ciprofloxacin Dosage for Pseudomonas aeruginosa Infections

For Pseudomonas aeruginosa infections, ciprofloxacin should be administered at 10-20 mg/kg/dose PO every 12 hours (maximum 750 mg/dose) or 10 mg/kg/dose IV every 8-12 hours (maximum 400 mg/dose). 1

Adult Dosing Recommendations

• Oral administration:

  • 500-750 mg twice daily 1
  • Maximum daily oral dose: 1500 mg 1

• Intravenous administration:

  • 400 mg every 8-12 hours 1, 2
  • Higher frequency (every 8 hours) is preferred for serious Pseudomonas infections to improve clinical outcomes 2

Pediatric Dosing Recommendations

• Oral administration:

  • 10-20 mg/kg/dose every 12 hours 1
  • Maximum dose: 750 mg per dose 1

• Intravenous administration:

  • 10 mg/kg/dose every 8-12 hours 1
  • Maximum dose: 400 mg per dose 1

Site-Specific Considerations

Urinary Tract Infections

• For uncomplicated UTIs: 500 mg PO twice daily 3, 4
• For complicated UTIs: 750 mg PO twice daily or 400 mg IV every 8-12 hours 4

Respiratory Infections

• For Pseudomonas respiratory infections: 750 mg PO twice daily or 400 mg IV every 8 hours 1, 2

Bone and Joint Infections

• Higher doses recommended: 750 mg PO twice daily or 400 mg IV every 8 hours 5, 6
• Longer duration of therapy (4-6 weeks) may be necessary 6

Treatment Duration

• Standard duration for most Pseudomonas infections: 10-14 days 7
• Complicated infections may require longer treatment courses:
  • Bone infections: 4-6 weeks or longer 6
  • Complicated UTIs: 14 days 7, 3

Important Clinical Considerations

• MIC-based dosing: Treatment efficacy significantly decreases when pathogen MICs are ≥0.5 μg/ml; use the highest recommended dose for isolates with MICs approaching this threshold 2

• Resistance development: Resistance may develop during therapy, particularly when initial MICs are >0.5 μg/ml 6

• Combination therapy: Consider combination with an aminoglycoside or beta-lactam for severe infections, immunocompromised patients, or when resistance is a concern 5

• Monitoring: Assess clinical response within 72 hours of initiating therapy 7

• Follow-up cultures: Consider follow-up cultures after completion of therapy to confirm eradication, especially in complicated or recurrent infections 7

Cautions

• Ciprofloxacin pediatric use should be reserved for infections where benefit outweighs risk; consultation with pediatric infectious disease specialists is recommended 1

• Higher doses (400 mg IV every 8 hours) should be used for serious Pseudomonas infections to improve pharmacodynamic target attainment and clinical cure rates 2