Adult Dosing
Lower respiratory tract infections
- Mild/Moderate: 400 mg IV q12 hrs x 7-14 days
- Severe/complicated: 400 mg IV q8 hrs x 7-14 days
Urinary tract infections
- Mild/Moderate: 200 mg IV q12 hrs x 7-14 days
- Severe/Complicated: 400 mg IV q12 hrs x 7-14 days
Nosocomial pneumonia
- 400 mg IV q8 hrs x 10-14 days
Skin & Skin structure infections
- Mild/Moderate: 400 mg IV q12 hrs x 7-14 days
- Severe/complicated: 400 mg IV q8 hrs x 7-14 days
Bone/Joint infections
- Mild/Moderate: 400 mg IV q12 hrs for at least 4-6 wks
- Severe/complicated: 400 mg IV q8 hrs for at least 4-6 wks
Complicated intra-abdominal infections
- 400 mg IV q12 hrs x 7-14 days in combination with metronidazole
Chronic bacterial prostatits; mild to moderate
- 400 mg IV q12 hrs x 28 days
Inhalational Anthrax; post exposure
- 400 mg IV q12 hrs; switch to 500 mg PO bid when clinically appropriate for a total of 60 days
Notes:
- Dose and duration of therapy varies with the type of infection, severity and clinical condition of the individual patient
Pediatric Dosing
Bacterial infections
Child (Not FDA approved)
- 15-30 mg/kg/day IV divided q8-12 hrs. [Max: 400 mg/dose]
Complicated UTI/pyelonephritis
Child (1-17 yrs)
- 6-10 mg/kg IV q8 hrs. [Max: 400 mg/dose]
- Switch to 10-20 mg/kg PO q12 hrs as clinical condition permits
- Duration: 10-21 days
Inhalational Anthrax; post exposure
- Child: 10 mg/kg IV q12 hrs. [Max: 400 mg/dose]; switch to 15 mg/kg PO q12 hrs as soon as clinical condition permits for a total duration of 60 days
Notes:
- Dose and duration of therapy varies with the type of infection, severity and clinical condition of the individual patient
Cellulitis [Non-FDA Approved]
- 20-30 mg/kg/day q8-12 hr, max; 1.2 g/day
Bronchiectasis [Not FDA Approved]
- 30 mg/kg/day IV divided tid × 7–10 days
Pharyngitis (Acute)[Non-FDA Approved]
- 30 mg/kg/day IV divided tid × 7-10 days
[Outline]
Renal Dose Adjustment: (Based on CrCl)
- > 30 mL/min: Use usual dosage
- 5-29 mL/min: 200-400 mg IV q18-24 hrs
Hepatic Dose Adjustment
- Use with caution; dose adjustment not defined
- Ciprofloxacin may increase risk of tendinitis and tendon rupture in all ages. Discontinue treatment if pain or inflammation in a tendon occurs
- Serious and occasionally fatal hypersensitivity and/or anaphylactic reactions have been reported in patients receiving therapy with fluoroquinolones, including ciprofloxacin
- Safety and effectiveness of ciprofloxacin in pregnant and lactating women have not been established
- Prolongation of the QT interval and isolated cases of torsade de pointes have been reported
- Avoid use in patients with known QT prolongation, those with hypokalemia, and with other drugs that prolong the QT interval
- Clostridium difficile-associated diarrhea (CDAD) has been reported with use the drug and may range in severity from mild diarrhea to fatal colitis.
- An increased incidence of musculoskeletal disorders (arthralgia, arthritis, tendonopathy, and gait abnormality) compared to controls has been observed in pediatric patients treated with this drug. It is not drug of first choice in children due to increased adverse reactions related to joints and surrounding tissue. Do not use in patients < 18 yrs of age, except for listed indications
- Seizures, increased ICP and toxic psychosis have been reported in patients taking ciprofloxacin. It may also cause nervousness, agitation, insomnia, anxiety, nightmares, paranoia, dizziness, confusion, tremors, hallucinations, depression
- Moderate to severe photosensitivity reactions have occurred with some fluoroquinolones. Avoid excessive sunlight exposure
- Monitor creatinine at baseline, then periodically if elderly or prolonged therapy
- Monitor CBC, LFTs if prolonged therapy
- Cases of sensory or sensorimotor axonal polyneuropathy affecting small and/or large axons resulting in paresthesias, hypoesthesias, dysesthesias and weakness have occurred in patients
- Discontinue therapy if the patient experiences symptoms of neuropathy including pain, burning, tingling, numbness, and/or weakness or other alterations of sensation including light touch, pain, temperature, position sense, and vibratory sensation in order to prevent the development of an irreversible condition
Cautions: Use cautiously in
- Renal impairment (refer dose adjustment section)
- Hepatic impairment
- Kidney, heart or lung transplant
- QT prolongation
- Seizure disorder
- CNS disorder
- Dehydration
- Diabetes mellitus
Pregnancy Category:C
Breastfeeding: Fluoroquinolones have not been used in infants because of concern about adverse effects on the infants developing joints. Avoid breastfeeding for 3 to 4 hours after a dose to decrease the exposure of the infant to ciprofloxacin in breastmilk. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT). This drug is compatible and considered safe with breastfeeding based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776 last accessed 17 August 2009)
