From the Guidelines
Ciprofloxacin is a broad-spectrum antibiotic that should be used with caution due to its potential side effects and resistance patterns, and its use should be guided by local resistance rates and patient-specific factors 1.
Overview of Ciprofloxacin
Ciprofloxacin belongs to the fluoroquinolone class of antibiotics, which work by inhibiting bacterial DNA gyrase and topoisomerase IV, preventing DNA replication and ultimately killing bacteria. It is commonly prescribed for various infections, including urinary tract infections, respiratory infections, skin infections, and gastrointestinal infections.
Dosage and Administration
The dosage of ciprofloxacin varies depending on the type and severity of the infection. For urinary tract infections, the typical dose is 250-500mg twice daily for 3-7 days. For respiratory infections, the dose is 500-750mg twice daily for 7-14 days. Ciprofloxacin is available in oral tablets, extended-release tablets, oral suspension, and intravenous formulations.
Side Effects and Contraindications
Common side effects of ciprofloxacin include nausea, diarrhea, headache, and dizziness. Serious adverse effects, though rare, include tendon rupture, peripheral neuropathy, and QT interval prolongation. Ciprofloxacin is contraindicated in patients with known hypersensitivity to fluoroquinolones, those under 18 years (except in specific circumstances), pregnant women, and should be used cautiously in elderly patients and those with kidney disease, seizure disorders, or myasthenia gravis.
Resistance Patterns and Guideline Recommendations
The use of ciprofloxacin is guided by local resistance rates and patient-specific factors. According to the European Association of Urology guidelines, ciprofloxacin should only be used if the local resistance rate is <10% when the entire treatment is given orally, the patient does not require hospitalization, and the patient has anaphylaxis to beta-lactam antimicrobials 1. The WHO's Essential Medicines and AWaRe recommendations also emphasize the importance of considering local resistance patterns when selecting antibiotics for empiric treatment 1.
Patient Education and Monitoring
Patients should be educated on the proper use of ciprofloxacin, including taking the medication with plenty of water and avoiding antacids, dairy products, and calcium-fortified foods within 2 hours of taking the medication. Patients should also be monitored for unusual side effects, particularly tendon pain, weakness, or neurological symptoms, and report them to their healthcare provider immediately.
- Key points to consider when prescribing ciprofloxacin:
- Local resistance rates and patient-specific factors should guide the use of ciprofloxacin
- Ciprofloxacin should be used with caution due to its potential side effects and resistance patterns
- Patients should be educated on the proper use of ciprofloxacin and monitored for unusual side effects
- Alternative antibiotics, such as sulfamethoxazole-trimethoprim and nitrofurantoin, may be considered based on local resistance patterns and patient-specific factors 1
From the FDA Drug Label
Ciprofloxacin Tablets USP is a fluoroquinolone antibiotic medicine used to treat certain infections caused by certain germs called bacteria. Ciprofloxacin Tablets USP can cause side effects that may be serious or even cause death. The most common side effects of Ciprofloxacin Tablets USP include: nausea, headache, diarrhea, vomiting, vaginal yeast infection, changes in liver function tests, pain or discomfort in the abdomen Ciprofloxacin Tablets USP should not be used as the first choice of antibiotic medicine in children under 18 years of age. Ciprofloxacin Tablets USP should not be used in children under 18 years old, except to treat specific serious infections, such as complicated urinary tract infections and to prevent anthrax disease after breathing the anthrax bacteria germ (inhalational exposure)
The complete drug information for Ciprofloxacin includes:
- Indications: Ciprofloxacin is used to treat certain infections caused by bacteria.
- Contraindications: It should not be used in children under 18 years old, except for specific serious infections.
- Side effects: May include nausea, headache, diarrhea, vomiting, and changes in liver function tests.
- Warnings: May cause serious side effects, such as tendon rupture or swelling, and peripheral neuropathy.
- Precautions: Should not be used as the first choice of antibiotic in children under 18 years old.
- Ingredients: Active ingredient is ciprofloxacin, and inactive ingredients include pregelatinized starch, microcrystalline cellulose, and others.
- Storage: Should be stored below 86°F (30°C) and kept out of reach of children.
- Dosage forms: Available in 250 mg, 500 mg, and 750 mg strengths. 2, 2, 2
From the Research
Ciprofloxacin Overview
- Ciprofloxacin is a broad-spectrum fluoroquinolone antibacterial agent 3
- It is effective against a wide variety of infections, particularly those caused by Gram-negative pathogens 3
- Ciprofloxacin attains therapeutic concentrations in most tissues and body fluids 3
Indications and Usage
- Ciprofloxacin is used to treat complicated urinary tract infections, sexually transmitted diseases, skin and bone infections, gastrointestinal infections, lower respiratory tract infections, and febrile neutropenia 3
- It is also used to treat intra-abdominal infections and malignant external otitis 3
- Ciprofloxacin is effective in the treatment of urinary tract infections, including uncomplicated and complicated UTIs 4, 5, 6
Dosage and Administration
- Recommended dosage adjustments in patients with impaired renal function vary between countries 3
- Major adjustments are not required until the estimated creatinine clearance is < 30 ml/min/1.73m2 (or when the serum creatinine level is > or = 2 mg/dl) 3
- An extended-release formulation of ciprofloxacin is available, allowing once-daily dosing 6
Safety and Tolerability
- Ciprofloxacin is generally well tolerated, with a low potential for adverse effects 3
- Common adverse effects include reactions of the gastrointestinal tract, such as nausea, dyspepsia, vomiting, or diarrhea 7
- Ciprofloxacin can cause CNS excitatory effects, and elderly patients should be monitored carefully for such symptoms 7
- Quinolones, including ciprofloxacin, can cause QT interval prolongation and should be avoided in patients with known prolongation of the QT interval 7
Resistance and Special Considerations
- Emerging resistance to ciprofloxacin and other fluoroquinolones is a concern, particularly in certain geographical areas 6
- Risk factors for resistance are currently poorly defined 6
- Ciprofloxacin should be used with caution in patients with known or suspected CNS disorders that predispose to seizures 7
- Chronic renal diseases, concomitant use of corticosteroids, and age >60 years are known risk factors for quinolone-induced tendopathies 7