Ciprofloxacin
CIPRO
Pronunciation: sip-roe-FLOX-a-sin (SIP-roe)
“Sipping flocks”
What it isFluoroquinolone DNA-gyrase inhibitor with GABA-A antagonism; urinary, GI and selected Gram-negative infections.
Why this oneIt is one of the few oral antipseudomonal options, but weak pneumococcal activity limits routine respiratory use.
What limits itTendon injury, neuropathy and CNS effects can be permanent. It strongly inhibits CYP1A2, and calcium, iron or antacids block absorption.
FDA-approved for
- bacterial infections (1987)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Skin and skin structure | Adult | 500-750 mg q12h (BID) | ||
| Bone and joint | Adult | 500-750 mg q12h (BID) | ||
| Complicated intra-abdominal (with metronidazole) | Adult | 500 mg q12h (BID) | ||
| Infectious diarrhea | Adult | 500 mg q12h (BID) | ||
| Typhoid fever | Adult | 500 mg q12h (BID) | ||
| Uncomplicated urethral/cervical gonorrhea | Adult | 250 mg single dose | ||
| Inhalational anthrax (post-exposure) | Adult | 500 mg q12h (BID) x60d | ||
| Plague | Adult | 500-750 mg q12h (BID) | ||
| Chronic bacterial prostatitis | Adult | 500 mg q12h (BID) | ||
| Lower respiratory tract | Adult | 500-750 mg q12h (BID) | ||
| Urinary tract | Adult | 250-500 mg q12h (BID) | ||
| Acute uncomplicated cystitis | Adult | 250 mg q12h (BID) x3d | ||
| Acute sinusitis | Adult | 500 mg q12h (BID) | ||
| Complicated UTI / pyelonephritis | 1-17 y | 10-20 mg/kg (max 750 mg/dose) q12h (BID) | 750 mg/dose | |
| Inhalational anthrax (post-exposure) | Birth-17 y | 15 mg/kg (max 500 mg/dose) q12h (BID) x60d | 500 mg/dose | |
| Plague | Birth-17 y | 15 mg/kg (max 500 mg/dose) q8-12h | 500 mg/dose |
Renal CrCl 30-50 mL/min: 250-500 mg q12h; CrCl 5-29 mL/min: 250-500 mg q18h; hemodialysis or peritoneal dialysis: 250-500 mg q24h (after dialysis)
Hepatic Undefined
Instructions
- Take at least 2 h before or 6 h after multivalent cations (mg/al antacids, sucralfate, phosphate binders, didanosine, products with calcium/iron/zinc)
- Avoid dairy or calcium-fortified juice alone; may take with a meal containing them
- Maintain adequate hydration to prevent crystalluria
- Missed dose: take up to 6 h before next dose; do not double
Available strengths
- tab 250, 500, 750 mg
- susp 250, 500 mg/5 mL
- inj 2 mg/mL
- drops 0.2, 0.3 %
- sol 3 mg/mL
- ointment 0.3 %
Contraindications
- Concomitant tizanidine
Cautions
- Disabling/irreversible tendinitis and tendon rupture (higher risk >60 y, corticosteroids, transplant)
- Peripheral neuropathy (may be irreversible)
- CNS and psychiatric effects (seizures, psychosis, suicidal ideation); lowers seizure threshold
- May exacerbate myasthenia gravis (avoid)
- Serious/fatal hypersensitivity and anaphylaxis
- Hepatotoxicity
- QT prolongation and torsade de pointes
- Aortic aneurysm and dissection
- C. difficile-associated diarrhea
- Photosensitivity; hypoglycemia/hyperglycemia
Adverse reactions
- Nausea
- Diarrhea
- Abnormal liver function tests
- Vomiting
- Rash
Pregnancy Decades of human data have not identified a drug-associated risk of major birth defects or miscarriage; no fetal malformations in animals.
Lactation Present in human milk; consider pumping and discarding during treatment and 2 days after; monitor infant for loose/bloody stools and candidiasis.
Cost
Generic entryBy 2023
⚠ BOXED WARNINGS
- Tendinitis and tendon rupture, peripheral neuropathy, CNS effects
- Exacerbation of myasthenia gravis
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityTendon/aortic injury, dysglycemia and CNS effects; QT or CYP1A2 risk varies by agent.
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