From the Guidelines
Ciprofloxacin is a broad-spectrum fluoroquinolone antibiotic that covers a wide range of bacterial infections, including those caused by gram-negative bacteria such as Escherichia coli, Pseudomonas aeruginosa, and Salmonella species, as well as some gram-positive organisms like Staphylococcus aureus and Streptococcus pneumoniae.
Infections Covered by Ciprofloxacin
- Urinary tract infections (UTIs) caused by Escherichia coli, Pseudomonas aeruginosa, and other gram-negative bacteria 1
- Gastrointestinal infections caused by Salmonella and Shigella species 1
- Respiratory tract infections, particularly those caused by gram-negative organisms like Pseudomonas aeruginosa 1
- Skin and soft tissue infections, including those caused by Staphylococcus aureus and Streptococcus pneumoniae 1
- Bone and joint infections, including those caused by gram-negative bacteria like Pseudomonas aeruginosa 1
- Sexually transmitted infections like gonorrhea, caused by Neisseria gonorrhoeae 1
Dosage and Administration
The typical adult dose of ciprofloxacin ranges from 250-750 mg orally twice daily or 200-400 mg IV twice daily, with duration depending on the infection type and severity 1.
Mechanism of Action
Ciprofloxacin works by inhibiting bacterial DNA gyrase and topoisomerase IV, enzymes essential for bacterial DNA replication, transcription, and repair 1.
Precautions and Side Effects
However, due to increasing resistance and potential side effects including tendon rupture, peripheral neuropathy, and C. difficile infection, ciprofloxacin should be used judiciously and according to local resistance patterns 1.
Recent Guidelines
Recent guidelines recommend ciprofloxacin as a first-choice option for empiric treatment of mild-to-moderate pyelonephritis and prostatitis if local/national data on antimicrobial resistance patterns allow its use 1.
From the FDA Drug Label
Ciprofloxacin has been shown to be active against most strains of the following microorganisms, both in vitro and in clinical infections as described in the INDICATIONS AND USAGE section of the package insert for Ciprofloxacin Hydrochloride Tablets USP, 250mg, 500mg and 750mg. Aerobic gram-positive microorganisms Enterococcus faecalis (Many strains are only moderately susceptible.) Staphylococcus saprophyticus Streptococcus pneumoniae (penicillin-susceptible strains only) Streptococcus pyogenes Aerobic gram-negative microorganisms Campylobacter jejuni Proteus mirabilis Citrobacter diversus Proteus vulgaris Citrobacter freundii Providencia rettgeri Enterobacter cloacae Providencia stuartii Escherichia coli Pseudomonas aeruginosa Haemophilus influenzae Salmonella typhi Haemophilus parainfluenzae Serratia marcescens Klebsiella pneumoniae Shigella boydii Moraxella catarrhalis Shigella dysenteriae Morganella morganii Shigella flexneri Neisseria gonorrhoeae Shigella sonnei Ciprofloxacin has been shown to be active against Bacillus anthracis both in vitro and by use of serum levels as a surrogate marker
Ciprofloxacin covers a wide range of gram-negative and gram-positive microorganisms, including:
- Aerobic gram-positive microorganisms:
- Enterococcus faecalis
- Staphylococcus saprophyticus
- Streptococcus pneumoniae (penicillin-susceptible strains only)
- Streptococcus pyogenes
- Aerobic gram-negative microorganisms:
- Campylobacter jejuni
- Proteus mirabilis
- Citrobacter diversus
- Proteus vulgaris
- Citrobacter freundii
- Providencia rettgeri
- Enterobacter cloacae
- Providencia stuartii
- Escherichia coli
- Pseudomonas aeruginosa
- Haemophilus influenzae
- Salmonella typhi
- Haemophilus parainfluenzae
- Serratia marcescens
- Klebsiella pneumoniae
- Shigella boydii
- Moraxella catarrhalis
- Shigella dysenteriae
- Morganella morganii
- Shigella flexneri
- Neisseria gonorrhoeae
- Shigella sonnei
- Bacillus anthracis 2 2
From the Research
Infections Covered by Ciprofloxacin
Ciprofloxacin is a broad-spectrum fluoroquinolone antibacterial agent that is effective against a wide range of infections, including:
- Complicated urinary tract infections (UTIs) 3, 4, 5
- Sexually transmitted diseases such as gonorrhoea and chancroid 4
- Skin and bone infections 4, 6, 7
- Gastrointestinal infections caused by multiresistant organisms 4, 6
- Lower respiratory tract infections, including those in patients with cystic fibrosis 4, 6, 7
- Febrile neutropenia (combined with an agent that possesses good activity against Gram-positive bacteria) 4
- Intra-abdominal infections (combined with an antianaerobic agent) 4
- Malignant external otitis 4, 7
- Bacterial prostatitis 7
- Acute uncomplicated pyelonephritis 5
Bacterial Coverage
Ciprofloxacin is effective against a wide range of bacterial pathogens, including:
- Gram-negative bacteria such as Escherichia coli, Proteus spp., Klebsiella pneumoniae, and Pseudomonas aeruginosa 3, 4, 6, 7
- Gram-positive bacteria such as Streptococcus pneumoniae, although it is not considered a first-line empirical therapy for respiratory tract infections if penicillin-susceptible S. pneumoniae is the primary pathogen 4
Dosage and Administration
The recommended dosage of ciprofloxacin varies depending on the severity of the infection and the susceptibility of the pathogen, ranging from 100 to 500 mg twice daily orally 3, or 1,000 mg once daily for extended-release formulations 5.