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

Ciprofloxacin Dosing and Treatment Regimens

Ciprofloxacin dosing varies significantly by infection type and severity, with uncomplicated UTIs requiring only 250 mg twice daily for 3 days, while complicated infections demand 500-750 mg twice daily for 7-14 days. 1

Urinary Tract Infections

Uncomplicated Cystitis (Simple Bladder Infection)

• Standard dose: 250 mg orally twice daily for 3 days 2, 1
• Alternative: 500 mg extended-release once daily for 3 days 2
• Critical caveat: Ciprofloxacin should NOT be first-line therapy for uncomplicated UTI due to concerns about promoting resistance in more serious pathogens, including MRSA 2
• Reserve for cases where nitrofurantoin or trimethoprim-sulfamethoxazole cannot be used 2

Complicated UTI and Pyelonephritis (Kidney Infection)

• Mild to moderate pyelonephritis: 500 mg orally twice daily for 7 days 3, 2, 1
• Severe pyelonephritis: 750 mg orally twice daily for 7 days 2, 1
• Alternative: 1000 mg extended-release once daily for 7 days 3
• Intravenous therapy: 400 mg IV every 12 hours for hospitalized patients, then switch to oral when clinically appropriate 2, 1
• Resistance threshold: Only use if local fluoroquinolone resistance is <10% 3, 2
• If resistance exceeds 10%, give initial dose of ceftriaxone 1g IV before starting ciprofloxacin 3, 2

Chronic Bacterial Prostatitis

• 500 mg orally twice daily for 28 days 1

Sexually Transmitted Infections

Uncomplicated Gonorrhea

• Historical dose: 500 mg orally as single dose 3
• Critical warning: Ciprofloxacin is NO LONGER recommended for gonorrhea in the United States due to widespread quinolone-resistant N. gonorrhoeae (QRNG) 3
• Should not be used in men who have sex with men, patients with recent foreign travel, or infections acquired in California, Hawaii, or other high-resistance areas 3

Respiratory Tract Infections

Lower Respiratory Tract Infections

• Mild to moderate: 500 mg orally twice daily for 7-14 days 1
• Severe or complicated: 750 mg orally twice daily for 7-14 days 1

Acute Sinusitis

• 500 mg orally twice daily for 10 days 1

Skin and Soft Tissue Infections

• Mild to moderate: 500 mg orally twice daily for 7-14 days 1
• Severe or complicated: 750 mg orally twice daily for 7-14 days 1
• Particularly useful for Pseudomonas aeruginosa skin infections from contaminated pools/hot tubs, offering oral alternative to parenteral therapy 3

Bone and Joint Infections

• Mild to moderate: 500 mg orally twice daily for ≥4-6 weeks 1
• Severe or complicated: 750 mg orally twice daily for ≥4-6 weeks 1

Gastrointestinal Infections

Infectious Diarrhea

• 500 mg orally twice daily for 5-7 days (all severity levels) 1

Typhoid Fever

• 500 mg orally twice daily for 10 days 1

Complicated Intra-Abdominal Infections

• 500 mg orally twice daily for 7-14 days (used with metronidazole) 1

Bioterrorism/Special Situations

Inhalational Anthrax (Post-Exposure Prophylaxis)

• Adults: 500 mg orally twice daily for 60 days 3, 1
• Children: 15 mg/kg orally twice daily (maximum 500 mg per dose) for 60 days 3, 1
• Alternative pediatric IV dosing: 10 mg/kg IV every 12 hours (maximum 400 mg per dose) 3, 1
• Begin therapy as soon as possible after suspected or confirmed exposure 3, 1

Meningococcal Carriage Eradication

• Single dose: 500 mg for adults, 20 mg/kg for children >1 month 3
• Preferred in nonpregnant adults as alternative to rifampin 3

Pediatric Dosing

Complicated UTI/Pyelonephritis (Ages 1-17 Years)

• Oral: 10-20 mg/kg twice daily (maximum 750 mg per dose) for 10-21 days 1
• IV: 6-10 mg/kg every 8 hours (maximum 400 mg per dose) 1
• Important caveat: Increased incidence of joint-related adverse events in children 3, 1
• Fluoroquinolones remain second-line in pediatrics; cephalosporins preferred for uncomplicated UTI 3

Multidrug-Resistant Infections in Children

• May represent only treatment option for multidrug-resistant gram-negative bacteria or tuberculosis when other agents unsuitable 3
• Long-term use (1-2 years) for multidrug-resistant tuberculosis has not shown joint toxicity in children, though systematic safety data lacking 3

Renal Impairment Adjustments

Dosing must be adjusted for creatinine clearance <50 mL/min: 1

• CrCl >50 mL/min: Use standard dosing 1
• CrCl 30-50 mL/min: 250-500 mg every 12 hours 1
• CrCl 5-29 mL/min: 250-500 mg every 18 hours 1
• Hemodialysis or peritoneal dialysis: 250-500 mg every 24 hours (after dialysis) 1
• For severe infections with severe renal impairment, 750 mg may be given at adjusted intervals with careful monitoring 1

Administration Considerations

Critical drug interactions requiring timing adjustments: 1

• Administer at least 2 hours before or 6 hours after: 1
  • Magnesium/aluminum antacids
  • Sucralfate
  • Calcium, iron, or zinc supplements
  • Highly buffered medications (including didanosine)

IV to Oral Conversion

Equivalent dosing when switching from IV to oral: 1

• 200 mg IV every 12 hours = 250 mg oral every 12 hours 1
• 400 mg IV every 12 hours = 500 mg oral every 12 hours 1
• 400 mg IV every 8 hours = 750 mg oral every 12 hours 1

Duration Principles

General rule: Continue for at least 2 days after signs and symptoms resolve (except anthrax prophylaxis) 1

Common pitfall: The 3-day regimen for uncomplicated UTI is as effective as 7-day treatment but with significantly fewer adverse events 2, 4. Longer durations increase side effects without improving outcomes for simple cystitis 2.

Resistance monitoring: Emergence of resistance during therapy occurs infrequently but has been reported with Pseudomonas aeruginosa, Staphylococcus aureus, and Serratia marcescens 5, 6. The twice-daily regimen (250 mg) shows better bacteriologic eradication than once-daily dosing (500 mg) for complicated UTIs 7.