Ciprofloxacin (ciprofloxacin HCl)
Last reviewed · Source: First Databank (FDB) drug data
Overview
Ciprofloxacin is a fluoroquinolone anti-infective agent.
Ciprofloxacin is used orally or IV for the treatment of urinary tract infections (UTIs), chronic bacterial prostatitis, acute sinusitis, lower respiratory tract infections (including nosocomial pneumonia and acute exacerbations of chronic bronchitis), GI infections, skin and skin structure infections, or bone and joint infections caused by susceptible gram-negative and gram-positive aerobic bacteria. Ciprofloxacin is used orally or IV for inhalational anthrax (postexposure) following suspected or confirmed exposure to aerosolized Bacillus anthracis spores and also is used for prophylaxis following ingestion of B. anthracis spores+ and for the treatment of inhalational anthrax+, cutaneous anthrax+, or GI and oropharyngeal anthrax+. Ciprofloxacin is used orally or IV for the treatment or prophylaxis of plague.
In addition, ciprofloxacin is used orally or IV in conjunction with metronidazole for the treatment of complicated intra-abdominal infections caused by Escherichia coli, Pseudomonas aeruginosa, Proteus mirabilis, Klebsiella pneumoniae, or Bacteroides fragilis. Because ciprofloxacin is inactive against most anaerobic bacteria, the drug is ineffective in and should not be used alone if a mixed aerobic-anaerobic bacterial infection is suspected. Ciprofloxacin has been used in conjunction with other anti-infectives for empiric anti-infective therapy in febrile neutropenic patients.
Generic name: ciprofloxacin HCl
Pronunciation: (SIP-roe-FLOX-a-sin)
Reference product & biosimilars
No reference, biosimilar or interchangeable associated with this drug.
Today’s intelligence on Ciprofloxacin
Indications
The following indications are listed for Ciprofloxacin:
- Acute Maxillary Haemophilus Influenzae Sinusitis
- Acute Maxillary Moraxella Catarrhalis Sinusitis
- Acute Maxillary Streptococcus Pneumoniae Sinusitis
- Bacterial Diarrhea
- Bacterial Pneumonia
- Bacterial Urinary Tract Infection
- Bone Infection
- Chronic Bacterial Prostatitis
- Citrobacter Urinary Tract Infection
- Complicated Bacteroides Peritonitis
- Complicated E. Coli Peritonitis
- Complicated Klebsiella Peritonitis
- Complicated Proteus Peritonitis
- Complicated Pseudomonas Aeruginosa Peritonitis
- Diarrhea Due To E. Coli
- E. Coli Cystitis
- E. Coli Prostatitis
- E. Coli Pyelonephritis
- E. Coli Urinary Tract Infection
- Enteric Campylobacteriosis
- Enterobacter Cloacae Urinary Tract Infection
- Enterobacter Joint Infection
- Enterobacter Osteomyelitis
- Enterobacter Pneumonia
- Enterococcus Urinary Tract Infection
- Escherichia Coli Pneumonia
- Gastroenteritis Due To Shigella
- Gram-Negative Aerobic Bacillary Pneumonia
- Haemophilus Influenzae Pneumonia
- Haemophilus Parainfluenza Pneumonia
- Infectious Disease Of Abdomen
- Infectious Disorder Of Joint
- Intra-Abdominal Abscess
- Klebsiella Pneumonia
- Klebsiella Urinary Tract Infection
- Lower Respiratory Infection
- Moraxella Catarrhalis Bronchitis
- Morganella Morganii Urinary Tract Infection
- Plague
- Post-Exposure Anthrax Prevention
- Postexposure Plague Prophylaxis
- Proteus Pneumonia
- Proteus Prostatitis
- Proteus Urinary Tract Infection
- Providencia Urinary Tract Infection
- Pseudomonas Aeruginosa Joint Infection
- Pseudomonas Aeruginosa Osteomyelitis
- Pseudomonas Aeruginosa Pneumonia
- Pseudomonas Aeruginosa Urinary Tract Infection
- Serratia Joint Infection
- Serratia Osteomyelitis
- Serratia Urinary Tract Infection
- Skin And Skin Structure Citrobacter Infection
- Skin And Skin Structure E. Coli Infection
- Skin And Skin Structure Enterobacter Infection
- Skin And Skin Structure Infection
- Skin And Skin Structure Klebsiella Infection
- Skin And Skin Structure Morganella Morganii Infection
- Skin And Skin Structure Proteus Infection
- Skin And Skin Structure Providencia Infection
- Skin And Skin Structure Pseudomonas Aeruginosa Infection
- Skin And Skin Structure Streptococcus Pyogenes Infection
- Staphylococcus Aureus Skin And Skin Structure Infection
- Staphylococcus Cystitis
- Staphylococcus Epidermidis Skin And Skin Structure Infection
- Staphylococcus Epidermidis Urinary Tract Infection
- Staphylococcus Saprophyticus Urinary Tract Infection
- Traveler's Diarrhea
- Typhoid Fever
Also known as: Abdominal Abscess, Acute Maxillary Sinusitis Due To B. Catarrhalis, Acute Maxillary Sinusitis Due To Branhamella Catarrhalis, Acute Maxillary Sinusitis Due To Diplococcus Pneumoniae, Acute Maxillary Sinusitis Due To Fraenkel's Pneumococcus, Acute Maxillary Sinusitis Due To H. Flu, Acute Maxillary Sinusitis Due To Haemophilus Influenzae, Acute Maxillary Sinusitis Due To Hemophilus Influenzae, Acute Maxillary Sinusitis Due To Influenza Bacillus, Acute Maxillary Sinusitis Due To Moraxella Catarrhalis, Acute Maxillary Sinusitis Due To Neisseria Catarrhalis, Acute Maxillary Sinusitis Due To Pfeiffer's Bacillus, Acute Maxillary Sinusitis Due To Pneumococcus, Acute Maxillary Sinusitis Due To Pneumonococcus, Acute Maxillary Sinusitis From Streptococcus Pneumoniae, Bacillary Dysentery From Shigella Spp., Bacterial Infection Of Prostate Due To Proteus Species, Bacterial Infection Of The Prostate Due To E. Coli, Bacterial Infectious Diarrhea, Bronchitis Due To B. Catarrhalis, Bronchitis Due To Branhamella Catarrhalis, Bronchitis Due To M. Catarrhalis, Bronchitis Due To Moraxella Catarrhalis, Bronchitis Due To Neisseria Catarrhalis, Campylobacter Diarrhea, Campylobacter Enteritis, Campylobacter Enterocolitis, Campylobacter Gastrointestinal Tract Infection, Complicated Peritonitis Due To Bacteroides Species, Complicated Peritonitis Due To E. Coli, Complicated Peritonitis Due To Escherichia Coli, Complicated Peritonitis Due To Klebsiella Species, Complicated Peritonitis Due To Proteus Species, Complicated Peritonitis Due To Pseudomonas Aeruginosa, Cystitis Due To E. Coli, Cystitis Due To Escherichia Coli, Cystitis Due To Staphylococcus, Diarrhea Due To Escherichia Coli, Diarrheagenic Escherichia Coli, E. Coli Pneumonia, E. Coli Uti, Gastroenteritis Due To Shigella Species, H. Flu Pneumonia, H. Influenzae Pneumonia, Hemophilus Influenzae Pneumonia, Infection Of Skin And/Or Subcutaneous Tissue, Infection Of The Lungs Due To Enterobacter, Infection Of The Lungs Due To Pseudomonas Aeruginosa, Influenza Bacillus Pneumonia, Intestinal Shigella Infection, Intra-Abdominal Infection, Joint Infection, Joint Infection Due To Enterobacter Species, Joint Infection Due To Pseudomonas Aeruginosa, Joint Infection Due To Serratia Species, Klebsiella Uti, Lower Respiratory Tract Infection, M. Morganii Uti, Nephropyelitis Due To Escherichia Coli, Osteomyelitis Due To Aerobacter, Osteomyelitis Due To Enterobacter, Osteomyelitis Due To Enterobacter Species, Osteomyelitis Due To Pseudomonas Aeruginosa, Osteomyelitis Due To Serratia Species, Pfeiffer's Bacillus Pneumonia, Pneumonia Due To E. Coli, Pneumonia Due To Escherichia Coli, Pneumonia Due To Gram-Negative Organism, Pneumonia Due To Haemophilus Influenzae, Pneumonia Due To Haemophilus Parainfluenzae, Pneumonia Due To Hemophilus Parainfluenzae, Pneumonia Due To Klebsiella Species, Pneumonia Due To Klebsiella Spp., Pneumonia Due To Proteus Species, Pneumonia Due To Pseudomonas Aeruginosa, Post Exposure Plague Prophylaxis, Post-Exposure Anthrax Prophylaxis, Post-Exposure Plague Prophylaxis, Prostatitis Due To E. Coli, Prostatitis Due To Escherichia Coli, Prostatitis Due To Proteus Species, Proteus Spp. Pneumonia, Pyelonephritis Due To E. Coli, Pyelonephritis Due To Escherichia Coli, Pyogenic Bone Infection Due To Enterobacter, Pyogenic Bone Infection Due To Pseudomonas Aeruginosa, Pyogenic Bone Infection Due To Serratia Species, Renal & Ureteric Pelvis Infection Due To Escherichia Coli, Renal And Pelvis Renalis Escherichia Coli Infection, Shigellosis, Skin & Skin Soft Tissue Streptococcus Pyogenes Infection, Skin And Skin Soft Tissue Enterobacter Infection, Skin And Skin Soft Tissue Escherichia Coli Infection, Skin And Skin Soft Tissue Infection Due To Aerobacter, Skin And Skin Soft Tissue Infection Due To Citrobacter, Skin And Skin Soft Tissue Infection Due To Enterobacter, Skin And Skin Soft Tissue Infection Due To Klebsiella, Skin And Skin Soft Tissue Infection Due To Morganella Morganii, Skin And Skin Soft Tissue Infection Due To Providencia, Skin And Skin Soft Tissue Proteus Infection, Skin And Skin Soft Tissue Pseudomonas Aeruginosa Infection, Skin And Skin Soft Tissue Staphylococcus Aureus Infection, Skin And Skin Soft Tissue Staphylococcus Epidermidis Infection, Skin And Skin Structure Infection Due To Morganella Morganii, Skin And Soft Tissue Skin Infection, Staphylococcus Epidermidis Uti, Staphylococcus Species Cystitis, Urinary Cystitis Due To Escherichia Coli, Urinary Cystitis Due To Staphylococcus, Urinary Tract Infection Due To Citrobacter Species, Urinary Tract Infection Due To Enterobacter Cloacae, Urinary Tract Infection Due To Enterococcus Species, Urinary Tract Infection Due To Escherichia Coli, Urinary Tract Infection Due To Klebsiella Species, Urinary Tract Infection Due To Morganella Morganii, Urinary Tract Infection Due To Proteus Species, Urinary Tract Infection Due To Providencia Species, Urinary Tract Infection Due To Pseudomonas Aeruginosa, Urinary Tract Infection Due To Serratia Species, Urinary Tract Infection Due To Staphylococcus Epi, Uti Due To Citrobacter Species, Uti Due To Enterobacter Cloacae, Uti Due To Enterococcus Species, Uti Due To Proteus Species, Uti Due To Providencia Species, Uti Due To Pseudomonas Aeruginosa, Uti Due To Serratia Species, Uti Due To Staphylococcus Epidermidis, Uti Due To Staphylococcus Saprophyticus.
Dosing
Dosage of ciprofloxacin hydrochloride and ciprofloxacin is expressed in terms of ciprofloxacin.
Unless otherwise specified, oral ciprofloxacin dosage is for the conventional tablets or oral suspension of the drug.
The extended-release tablets are not interchangeable with the conventional tablets or oral suspension.
Dosage of oral and IV ciprofloxacin is not identical. Based on pharmacokinetic parameters (i.e., area under the plasma concentration-time curve (AUC)), the following oral and IV ciprofloxacin regimens are considered equivalent: 250 mg orally every 12 hours (conventional tablets) is equivalent to 200 mg IV every 12 hours; 500 mg orally every 12 hours (conventional tablets) is equivalent to 400 mg IV every 12 hours; and 750 mg orally every 12 hours (conventional tablets) is equivalent to 400 mg IV every 8 hours.
The duration of ciprofloxacin therapy depends on the type and severity of infection, and should be determined by the clinical and bacteriologic response of the patient.
Ciprofloxacin is administered orally as conventional tablets containing the hydrochloride, as a conventional oral suspension containing the base, and as extended-release tablets containing both the hydrochloride and the base. Ciprofloxacin is given by IV infusion as the base.
Patients receiving initial therapy with IV ciprofloxacin may be switched to oral ciprofloxacin (conventional tablets, oral suspension) when clinically appropriate.
Ciprofloxacin extended-release tablets are used only for the treatment of certain urinary tract infections (UTIs) in adults and should not be used for any indication in pediatric patients. The extended-release tablets are not interchangeable with other oral ciprofloxacin preparations (conventional tablets, oral suspension).
Patients receiving oral or IV ciprofloxacin should be adequately hydrated and should be instructed to drink fluids liberally to prevent highly concentrated urine and formation of crystals in urine.
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Drug interactions
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There are no contraindication interactions for this drug.
There are no severe interactions for this drug.
There are no moderate interactions for this drug.
Contraindications
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There are no contraindication contraindications for this drug.
There are no severe contraindications for this drug.
There are no moderate contraindications for this drug.
Adverse reactions
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There are no severe adverse reactions for this drug.
There are no less severe adverse reactions for this drug.
Precautions
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There are no adequate and controlled studies to date using ciprofloxacin in pregnant women. Because ciprofloxacin, like most other fluoroquinolones, causes arthropathy in immature animals, the drug should not be used in pregnant women unless potential benefits justify potential risks to the fetus and mother.
CDC states that oral ciprofloxacin is the preferred drug for initial anti-infective postexposure prophylaxis in pregnant and postpartum women following a suspected or confirmed exposure to aerosolized B. anthracis spores in the context of biologic warfare or bioterrorism. CDC also states that oral ciprofloxacin is the preferred drug for treatment of uncomplicated cutaneous anthrax and IV ciprofloxacin is the preferred bactericidal component of a multiple-drug regimen for treatment of systemic anthrax in pregnant and postpartum women when such infections occur in the context of biologic warfare or bioterrorism.
An expert review of published data regarding clinical experience with use of ciprofloxacin during pregnancy concluded that therapeutic doses of the drug during pregnancy are unlikely to pose a substantial teratogenic risk, but that data are insufficient to state that there is no risk. Although some safety data are available from several postmarketing epidemiology studies involving short-term, first-trimester exposures to ciprofloxacin, these studies are insufficient to evaluate the risk for less common defects or to permit reliable and definitive conclusions regarding the safety of ciprofloxacin in pregnant women and their developing fetuses. In one controlled prospective observational study of 200 women exposed to fluoroquinolones during pregnancy (68% were first-trimester exposures, 52.5% of exposures involved ciprofloxacin), in utero exposure to fluoroquinolones during embryogenesis did not appear to be associated with an increased risk of major congenital malformations (incidence was 2.2% in the fluoroquinolone group and 2.6% in the control group; background incidence is 1-5%). There also was no evidence of increases in the rates of spontaneous abortion, prematurity, or low birthweight and no clinically important increase in musculoskeletal dysfunction in the ciprofloxacin-exposed children followed to 1 year of age. In another prospective follow-up study that included 549 pregnancies with fluoroquinolone exposure (93% were first-trimester exposures, 70 first-trimester exposures involved ciprofloxacin), there was no increase in the rates of spontaneous abortion, prematurity, or low birthweight, and the malformation rate was similar to the background incidence rate with no evidence of any specific patterns of congenital abnormalities.
Reproduction studies in rats and mice using oral ciprofloxacin dosages up to 100 mg/kg (0.6 and 0.3 times, respectively, the maximum daily human dosage of 1 g based on BSA) have not revealed evidence of harm to the fetus. In rabbits, oral ciprofloxacin dosages of 30 and 100 mg/kg (approximately 0.4 and 1.3 times, respectively, the highest recommended therapeutic dosage based on BSA) caused GI toxicity resulting in maternal weight loss and an increased incidence of abortion, but there was no evidence of teratogenicity. IV ciprofloxacin given to rabbits at dosages up to 20 mg/kg (approximately 0.3 times the highest recommended therapeutic dosage based on BSA) has not resulted in maternal toxicity, embryotoxicity, or teratogenicity.
Ciprofloxacin is distributed into milk, but the amount of the drug absorbed by a nursing infant is unknown. Because of the potential for serious adverse effects of ciprofloxacin (including articular damage) in nursing infants, a decision should be made whether to discontinue nursing or the drug, taking into account the importance of the drug to the woman.
AAP considers ciprofloxacin to be usually compatible with breast-feeding since the amount of the fluoroquinolone potentially absorbed by nursing infants would be small and no observable change in infants associated with such exposure has been reported to date.
CDC states that recommendations for use of ciprofloxacin in breast-feeding women for postexposure prophylaxis following a suspected or confirmed exposure to aerosolized B. anthracis spores in the context of biologic warfare or bioterrorism and for treatment of uncomplicated cutaneous anthrax or systemic anthrax in such situations are the same as those for other adults.
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ICD codes
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Formulary status
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Last reviewed · Source: First Databank (FDB) drug data
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