What is the recommended oral dosing for ciprofloxacin (Cipro)

Ciprofloxacin Oral Dosing

For adults, ciprofloxacin oral dosing ranges from 250 mg to 750 mg every 12 hours depending on infection severity and type, with most common infections treated with 500 mg every 12 hours. 1

Adult Dosing by Infection Type

Common Infections

• Urinary tract infections (uncomplicated): 250 mg every 12 hours for 3 days 1
• Complicated UTI/pyelonephritis: 500 mg every 12 hours for 7-14 days 1
• Respiratory tract infections (mild/moderate): 500 mg every 12 hours for 7-14 days 1
• Respiratory tract infections (severe/complicated): 750 mg every 12 hours for 7-14 days 1
• Skin and soft tissue (mild/moderate): 500 mg every 12 hours for 7-14 days 1
• Skin and soft tissue (severe/complicated): 750 mg every 12 hours for 7-14 days 1
• Infectious diarrhea: 500 mg every 12 hours for 5-7 days 1
• Acute sinusitis: 500 mg every 12 hours for 10 days 1

Specialized Infections

• Chronic bacterial prostatitis: 500 mg every 12 hours for 28 days 1
• Bone and joint infections (mild/moderate): 500 mg every 12 hours for ≥4-6 weeks 1
• Bone and joint infections (severe/complicated): 750 mg every 12 hours for ≥4-6 weeks 1
• Intra-abdominal infections (complicated): 500 mg every 12 hours for 7-14 days, used with metronidazole 1
• Typhoid fever: 500 mg every 12 hours for 10 days 1
• Uncomplicated gonorrhea: 250 mg single dose 1
• Inhalational anthrax (post-exposure): 500 mg every 12 hours for 60 days 1

Pediatric Dosing

For children, use 10-15 mg/kg orally every 12 hours with a maximum daily dose of 1 g regardless of weight. 2, 3, 4

Specific Pediatric Indications

• Complicated UTI/pyelonephritis: 10-20 mg/kg every 12 hours (maximum 750 mg per dose) for 10-21 days 1
• Inhalational anthrax (post-exposure): 15 mg/kg every 12 hours (maximum 500 mg per dose) for 60 days 1
• Neonates: 15 mg/kg twice daily 3, 4

Critical Pediatric Considerations

• Ciprofloxacin should only be used in children for FDA-approved indications (complicated UTI, pyelonephritis, inhalational anthrax) or when no alternative exists due to risk of permanent cartilage damage in weight-bearing joints 3, 4
• Pediatric infectious disease consultation is strongly recommended before initiating therapy in children 3

Renal Impairment Dosing

Dose adjustments are required for patients with 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 administered at the adjusted intervals with careful monitoring 1

Administration Considerations

Timing and Drug Interactions

Ciprofloxacin must be administered at least 2 hours before or 6 hours after products containing divalent cations (magnesium, aluminum, calcium, iron, zinc) to avoid reduced absorption. 3, 1

• This includes antacids, sucralfate, didanosine buffered tablets, and multivitamins with minerals 3, 1

Pharmacokinetics

• Oral ciprofloxacin is rapidly and well absorbed with 70% bioavailability and no substantial first-pass metabolism 4
• Maximum serum concentrations are attained 1-2 hours after oral dosing 4
• Peak serum levels after 500 mg oral dose range from 1.5-2.9 mcg/mL 5

Monitoring Requirements

Essential Monitoring

• ECG monitoring: At baseline, 2 weeks, and after addition of any QT-prolonging medication 3, 4
• Blood glucose: In diabetic patients due to hypoglycemia risk 3, 4
• Hepatic and renal function: Regular monitoring throughout treatment 3, 4

Therapeutic Drug Monitoring

For severe infections with poor clinical response, consider therapeutic drug monitoring with target levels: 3, 4

• 500 mg twice daily: Trough 1 mg/L, peak 3 mg/L
• 750 mg twice daily: Trough 1.5 mg/L, peak 4.5 mg/L

Special Populations

Pregnancy

• Use only for life-threatening infections where benefits outweigh risks (e.g., inhalational anthrax) 4
• For anthrax exposure, standard adult dosing of 500 mg every 12 hours for 60 days is recommended despite teratogenic concerns 3
• Avoid for routine infections; use alternatives like ampicillin, cefotaxime, or ceftriaxone 4

Common Pitfalls

• Do not exceed 1 g/day in children regardless of weight-based calculations 2, 3, 4
• Continue therapy for at least 2 days after signs and symptoms resolve (except for anthrax post-exposure, which requires full 60-day course) 1
• Avoid single-dose therapy for most infections as it is statistically less effective than 3-7 day courses 6
• Monitor for CNS effects including seizures, particularly in patients with renal impairment or CNS disorders 7