What is the dosage and treatment regimen for Ciprofloxacin (Cipro)

Ciprofloxacin Dosage and Treatment Regimens

The appropriate dosage and treatment regimen for ciprofloxacin (Cipro) varies by indication, with standard adult dosing typically being 250-750 mg orally twice daily for 3-60 days depending on the infection type and severity.

Standard Adult Dosing Guidelines

• For uncomplicated urinary tract infections (UTIs):

  • 250 mg twice daily for 3 days, or 500 mg extended-release once daily for 3 days 1
  • Fluoroquinolones should be reserved as alternative agents when other UTI antimicrobials cannot be used 1

• For complicated UTIs:

  • 500 mg twice daily for 7-14 days 2
  • Alternative regimen: 250 mg twice daily for 7-14 days (shown to be more effective than once-daily dosing in complicated UTIs) 3

• For acute pyelonephritis:

  • 500 mg twice daily for 7 days 4, 1
  • Alternative: 1000 mg extended-release once daily for 7 days 1

• For lower respiratory tract infections:

  • Mild/Moderate: 500 mg twice daily for 7-14 days 2
  • Severe/Complicated: 750 mg twice daily for 7-14 days 2

• For skin and skin structure infections:

  • Mild/Moderate: 500 mg twice daily for 7-14 days 2
  • Severe/Complicated: 750 mg twice daily for 7-14 days 2

• For bone and joint infections:

  • Mild/Moderate: 500 mg twice daily for ≥4-6 weeks 2
  • Severe/Complicated: 750 mg twice daily for ≥4-6 weeks 2

• For uncomplicated gonococcal infections:

  • 500 mg orally in a single dose 4
  • Note: Due to increasing resistance, ciprofloxacin is no longer recommended as first-line therapy for gonorrhea in many regions 4

• For inhalational anthrax (post-exposure):

  • 500 mg twice daily for 60 days 4, 2

• For cutaneous anthrax:

  • 500 mg twice daily for 60 days 4

Pediatric Dosing

• For children, ciprofloxacin dosage is 10-15 mg/kg every 12 hours (not to exceed 1 g per day) 4, 2
• Ciprofloxacin should be used in children only when benefits outweigh risks, particularly for serious infections where other agents are not suitable 4

Dosing in Renal Impairment

• For creatinine clearance 30-50 mL/min: 250-500 mg every 12 hours 2
• For creatinine clearance 5-29 mL/min: 250-500 mg every 18 hours 2
• For patients on hemodialysis or peritoneal dialysis: 250-500 mg every 24 hours (after dialysis) 2

Administration Guidelines

• Ciprofloxacin should be administered at least 2 hours before or 6 hours after magnesium/aluminum antacids, sucralfate, didanosine, or products containing calcium, iron, or zinc 2
• For most infections, treatment should continue for at least 2 days after signs and symptoms have disappeared 2

Important Considerations

• Due to concerns about antimicrobial resistance, fluoroquinolones including ciprofloxacin should be reserved for situations where other recommended antimicrobials cannot be used 1
• For uncomplicated UTIs, first-line agents include nitrofurantoin, trimethoprim-sulfamethoxazole (if local resistance <20%), and fosfomycin 1
• For pyelonephritis, ciprofloxacin should only be used empirically where fluoroquinolone resistance is <10% 1
• Short-course therapy (3-5 days) with ciprofloxacin has been shown to be as effective as conventional 7-day therapy for uncomplicated UTIs 5

Common Pitfalls and Caveats

• Overuse of fluoroquinolones contributes to antimicrobial resistance; reserve for appropriate indications 1
• Adverse effects include gastrointestinal complaints, headache, and dizziness; most are mild to moderate and resolve after therapy completion 6, 7
• Resistance to ciprofloxacin can develop during treatment, particularly with Pseudomonas aeruginosa, Staphylococcus aureus, and Serratia marcescens 7
• For gonococcal infections, local resistance patterns should guide therapy choice 4