What is Ciprofloxacin (ciprofloxacin) used for?

Ciprofloxacin: Clinical Indications

Ciprofloxacin is a broad-spectrum fluoroquinolone antibiotic primarily indicated for complicated urinary tract infections, gastrointestinal infections caused by resistant organisms, and specific serious infections when first-line agents are unsuitable. 1

Primary Indications

Urinary Tract Infections

• Ciprofloxacin is recommended as first-choice therapy for mild-to-moderate pyelonephritis and prostatitis when local antimicrobial resistance patterns permit its use 2
• For complicated UTIs and pyelonephritis, ciprofloxacin serves as an appropriate option when standard agents are contraindicated due to resistance, allergy, or adverse event history 2
• It should not be used for uncomplicated lower UTIs, where amoxicillin-clavulanic acid, nitrofurantoin, or trimethoprim-sulfamethoxazole are preferred 2
• The extended-release formulation provides once-daily dosing with maintained therapeutic levels over 24 hours 3

Gastrointestinal Infections

• Ciprofloxacin demonstrates clinical and microbiological success for typhoid fever (including multidrug-resistant strains), invasive nontyphoid salmonellosis, and shigellosis 2
• However, caution is warranted for travelers returning from India due to emerging fluoroquinolone-resistant Salmonella typhi strains 2
• Resistance rates in Campylobacter species are problematic in Taiwan (57%), Thailand (84%), and Sweden (up to 88%), limiting its utility for traveler's diarrhea in these regions 2

Respiratory Tract Infections

• Ciprofloxacin is NOT appropriate for community-acquired pneumonia due to inadequate activity against Streptococcus pneumoniae and increasing resistance 2
• It remains effective for complicated lower respiratory tract infections in cystic fibrosis patients and pseudomonal infections 4

Skin and Soft Tissue Infections

• For Pseudomonas aeruginosa skin infections (including folliculitis from inadequately chlorinated pools/hot tubs), ciprofloxacin offers an oral treatment option preferred over parenteral therapy 2

Mycobacterial Infections

• Ciprofloxacin has activity against Mycobacterium tuberculosis and nontuberculous mycobacteria, though levofloxacin and moxifloxacin demonstrate superior bactericidal activity 2
• For multidrug-resistant and extensively drug-resistant tuberculosis, fluoroquinolones are incorporated into individualized regimens when other active alternatives are unavailable 2

Other Specific Indications

• Single-dose ciprofloxacin (500 mg adults, 20 mg/kg children >1 month) effectively eradicates nasal carriage of Neisseria meningitidis and is preferred in nonpregnant adult women as an alternative to rifampin 2
• For multidrug-resistant Gram-negative meningitis when no other suitable agents exist, fluoroquinolones may represent the only treatment option due to good cerebrospinal fluid penetration 2
• Effective for bone and joint infections, febrile neutropenia (combined with agents active against Gram-positive bacteria), and intra-abdominal infections (combined with antianaerobic agents) 5, 4

Critical Safety Considerations

FDA Black Box Warnings

• Serious side effects include tendon rupture/tendinitis, particularly in patients >60 years, those taking corticosteroids, or transplant recipients 1
• Risk of central nervous system effects and seizures, especially when combined with NSAIDs 1
• Since 2016, the FDA has warned of serious safety issues affecting tendons, muscles, joints, nerves, and the central nervous system, recommending use only for serious infections where benefits outweigh risks 2

Pediatric Use

• Children <18 years have higher risk of musculoskeletal problems (bone, joint, tendon pain/swelling) and ciprofloxacin should not be first-choice therapy 1
• Acceptable pediatric indications are limited to complicated UTIs and inhalational anthrax prophylaxis 1
• Pediatric infectious diseases consultation is suggested prior to use in children 2

Resistance Considerations

Fluoroquinolones, including ciprofloxacin, are NOT recommended as first-line empirical therapy for community-acquired intra-abdominal infections in regions where fluoroquinolone resistance among E. coli exceeds 20% 2. This particularly applies to China, India, Thailand, and Vietnam 2.

For urinary tract infections, ciprofloxacin remains appropriate when local resistance patterns support its use, as E. coli susceptibility to ciprofloxacin generally remains higher than to trimethoprim-sulfamethoxazole in many regions 3.