What is the recommended oral dosage of Ciprofloxacin (ciprofloxacin) for an adult patient with normal renal function?

Ciprofloxacin Oral Dosage for Adults with Normal Renal Function

For adults with normal renal function, ciprofloxacin oral dosing ranges from 250 mg to 750 mg every 12 hours, with the specific dose and duration determined by infection type and severity. 1

Standard Dosing by Infection Type

Urinary Tract Infections

• Uncomplicated UTI: Not recommended as first-line due to fluoroquinolone stewardship concerns; reserve for cases where other agents cannot be used 2
• Complicated UTI/Pyelonephritis: 500 mg every 12 hours for 7 days (or 1000 mg extended-release daily for 7 days) in areas where fluoroquinolone resistance is <10% 2
• Chronic bacterial prostatitis: 500 mg every 12 hours for 28 days 1

Respiratory Tract Infections

• Mild/moderate lower respiratory tract infections: 500 mg every 12 hours for 7-14 days 1
• Severe/complicated lower respiratory tract infections: 750 mg every 12 hours for 7-14 days 1
• Acute sinusitis: 500 mg every 12 hours for 10 days 1

Skin, Bone, and Intra-abdominal Infections

• Mild/moderate skin and skin structure infections: 500 mg every 12 hours for 7-14 days 1
• Severe/complicated skin infections: 750 mg every 12 hours for 7-14 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
• Complicated intra-abdominal infections (with metronidazole): 500 mg every 12 hours for 7-14 days 1

Gastrointestinal and Other Infections

• Infectious diarrhea: 500 mg every 12 hours for 5-7 days 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

Critical Administration Considerations

Drug Interactions

• Administer ciprofloxacin at least 2 hours before or 6 hours after products containing divalent/trivalent cations (magnesium/aluminum antacids, calcium, iron, zinc supplements, sucralfate, or buffered didanosine), as these dramatically reduce absorption 1, 3

Duration Principles

• Continue therapy for at least 2 days after signs and symptoms of infection have disappeared (except for inhalational anthrax, which requires the full 60-day course) 1

Important Clinical Caveats

Fluoroquinolone Stewardship

• Reserve fluoroquinolones as alternative agents for acute cystitis when other UTI antimicrobials cannot be used, due to collateral damage concerns and the need to preserve these agents for more serious infections 2
• For pyelonephritis, avoid empirical fluoroquinolone use if local resistance exceeds 10%; consider initial parenteral therapy with ceftriaxone or aminoglycoside 2

Monitoring Requirements

• Perform ECG monitoring at baseline and at 2 weeks due to QTc prolongation risk 4
• Monitor blood glucose regularly in diabetic patients due to hypoglycemia risk 4
• Check CBC, renal function, and liver function tests intermittently throughout treatment 4
• Monitor for CNS adverse effects (dizziness, headache, insomnia), which may indicate drug accumulation 3

Special Populations Requiring Dose Adjustment

• Renal impairment: Major dosage adjustments are not required until creatinine clearance falls below 30 mL/min 5, 6
• Critically ill patients with augmented renal clearance: May require doses up to 600 mg four times daily for pathogens with MIC ≥0.5 mg/L to achieve adequate target attainment 7