Ciprofloxacin Dosing and Usage for Bacterial Infections
Ciprofloxacin is a broad-spectrum fluoroquinolone antibiotic with specific FDA-approved indications and dosing regimens that vary by infection type, with oral doses typically ranging from 250-750 mg twice daily for 3-60 days depending on the clinical scenario. 1
FDA-Approved Indications in Adults
Urinary Tract Infections
Complicated UTI/Pyelonephritis: 500 mg orally twice daily for 7 days 2
Acute Uncomplicated Cystitis: 100-250 mg twice daily for 3 days 3
- However, fluoroquinolones should be reserved for important uses and are NOT first-line for simple cystitis 2
Chronic Bacterial Prostatitis: Caused by E. coli or Proteus mirabilis 1
Respiratory Tract Infections
- Acute Exacerbations of Chronic Bronchitis: Standard dosing 1
- Pneumonia: 500-750 mg twice daily, though NOT a first-choice agent for Streptococcus pneumoniae 1
- Acute Sinusitis: Caused by H. influenzae, penicillin-susceptible S. pneumoniae, or M. catarrhalis 1
Skin and Soft Tissue Infections
- Dosing: 500-750 mg twice daily 1
- Effective against E. coli, Klebsiella, Enterobacter, Proteus, Pseudomonas aeruginosa, methicillin-susceptible Staphylococcus, and Streptococcus pyogenes 1
Bone and Joint Infections
- Caused by Enterobacter cloacae, Serratia marcescens, or Pseudomonas aeruginosa 1
Gastrointestinal Infections
- Infectious Diarrhea: 500 mg twice daily when antibacterial therapy indicated 1
- Typhoid Fever: Caused by Salmonella typhi (does not eradicate chronic carrier state) 1
Sexually Transmitted Infections
- Uncomplicated Gonorrhea: 500 mg orally as single dose 2
Intra-Abdominal Infections
- Must be combined with metronidazole for anaerobic coverage 1
Bioterrorism-Related Infections
- Cutaneous Anthrax: 500 mg twice daily for 60 days (post-exposure prophylaxis) 2
- Inhalational Anthrax: Part of multi-drug regimen 2
Pediatric Dosing (Ages 1-17 Years)
Ciprofloxacin is NOT a first-line agent in children due to increased risk of arthropathy and joint-related adverse events 2, 1
Limited Approved Indications
- Complicated UTI/Pyelonephritis: 10-20 mg/kg/dose orally every 12 hours (maximum 750 mg/dose) 2, 1
- IV dosing: 10 mg/kg/dose every 8-12 hours (maximum 400 mg/dose) 2
Special Pediatric Considerations Where Fluoroquinolones May Be Justified
- Cystic fibrosis with Pseudomonas infections 2
- Multidrug-resistant tuberculosis (as part of combination therapy for 1-2 years) 2
- Multidrug-resistant Gram-negative meningitis when no alternatives exist 2
- Neisseria meningitidis carriage eradication: 20 mg/kg single dose (alternative to rifampin) 2
Intravenous Dosing
- Pyelonephritis: 400 mg IV twice daily 2
- Complicated infections: 400 mg IV every 8-12 hours 2
- Can switch to oral when clinically appropriate as ciprofloxacin has excellent oral bioavailability 2
Critical Safety Warnings
Musculoskeletal Toxicity
- Arthropathy risk in children: Histopathological changes in weight-bearing joints documented in juvenile animals 1
- Tendon rupture risk in all age groups 1
Resistance Considerations
- Reserve for situations where other agents are unsuitable based on susceptibility, allergy, or adverse event history 2
- Fluoroquinolone resistance is increasing globally; local resistance patterns must guide therapy 2
Drug Interactions
- Avoid concurrent use with drugs that prolong QT interval 1
Duration of Therapy by Indication
- Uncomplicated cystitis: 3 days 3
- Pyelonephritis: 5-7 days (ciprofloxacin) or 14 days (if using trimethoprim-sulfamethoxazole) 2
- Complicated UTI: 7-14 days 4
- Skin/soft tissue: 7-14 days 1
- Bone/joint: Extended therapy required 1
- Anthrax prophylaxis: 60 days 2
Efficacy Data
- UTI eradication rates: 89-98% depending on regimen 5, 4, 6, 3
- Twice-daily dosing superior to once-daily for complicated UTI (90.9% vs 84.0% eradication) 4
- Adverse event rate: 9.3% overall, with only 1.5% requiring discontinuation 7
- Most adverse effects are gastrointestinal and mild-to-moderate in severity 7