ciprofloxacin hydrochloride

ciprofloxacin hydrochloride

Ciloxam, Cipro, Cipro I.V., Cipro XR, Ciproxin (UK)

Pharmacologic class: Fluoroquinolone

Therapeutic class: Anti-infective

Pregnancy risk category C

Action

Inhibits bacterial DNA synthesis by inhibiting DNA gyrase in susceptible gram-negative and gram-positive organisms

Availability

Injection: 200 mg/20 ml, 400 mg/40 ml, 200 mg/100 ml premixed in dextrose 5% in water (D₅W), 400 mg/200 ml premixed in D₅W, 1,200 mg/120-ml bulk package

Ophthalmic ointment: 3.5-g tube

Ophthalmic solution: 2.5-ml and 5-ml plastic dispensers

Oral suspension: 5 g/100 ml (5%), 10 g/100 ml (10%)

Tablets: 250 mg, 500 mg, 750 mg

Tablets (extended-release): 500 mg, 1,000 mg

⊘Indications and dosages

➣ Acute sinusitis

Adults: 500 mg P.O. q 12 hours or 400 mg I.V. q 12 hours for 10 days

➣ Prostatitis

Adults: 500 mg P.O. q 12 hours or 400 mg I.V. q 12 hours for 28 days

➣ Intra-abdominal infections

Adults: 500 mg P.O. q 12 hours or 400 mg I.V. q 12 hours for 7 to 14 days

➣ Febrile neutropenic patients

Adults: 400 mg I.V. q 8 hours for 7 to 14 days

➣ Gonorrhea

Adults: 500 mg P.O. as a single dose

➣ Infectious diarrhea

Adults: 500 mg P.O. q 12 hours for 5 to 7 days

➣ Inhalation anthrax (postexposure)

Adults: 500 mg P.O. q 12 hours for 60 days or 400 mg I.V. q 12 hours for 60 days

Children: 15 mg/kg P.O. q 12 hours for 60 days (not to exceed 500 mg/dose), or 10 mg/kg I.V. q 12 hours for 60 days, not to exceed 400 mg/dose

➣ Infections of lower respiratory tract, skin and skin structures, bones, and joints

Adults: 500 to 750 mg P.O. q 12 hours or 400 mg I.V. q 8 hours for 7 to 14 days. Severe bone and joint infections may necessitate up to 6 weeks of therapy.

➣ Nosocomial pneumonia

Adults: 400 mg I.V. q 8 hours for 10 to 14 days

➣ Typhoid fever

Adults: 500 mg P.O. q 12 hours for 10 days

➣ Urinary tract infections

Adults: 250 to 500 mg P.O. q 12 hours, or 500 to 1,000 mg Cipro XR P.O. daily, or 200 to 400 mg I.V. q 12 hours for 3 days in acute uncomplicated infection or for 7 to 14 days in mild to severe complicated infection

➣ Pyelonephritis

Adults: 1,000 mg Cipro XR P.O. daily for 7 to 14 days

➣ Bacterial conjunctivitis caused by susceptible organisms

Adults: 0.5" ribbon of ophthalmic ointment applied to conjunctival sac t.i.d. on first 2 days, then 0.5" ribbon b.i.d. for 5 days. Or one to two drops of ophthalmic solution applied to conjunctival sac q 2 hours while awake for 2 days, then one or two drops q 4 hours while awake for 5 days.

➣ Corneal ulcers caused by susceptible organisms

Adults: Two drops of ophthalmic solution instilled into affected eye q 15 minutes for first 6 hours, then two drops into affected eye q 30 minutes for remainder of first day. On second day, two drops of ophthalmic solution hourly; on days 3 through 14, two drops q 4 hours.

Dosage adjustment

• Renal impairment or insufficiency

Off-label uses

• Chancroid
• Cystic fibrosis
• Pseudomembranous colitis caused by anti-infectives

Contraindications

• Hypersensitivity to drug or other fluoroquinolones

Precautions

Use cautiously in:
• cirrhosis, renal impairment, underlying CNS disease
• elderly patients
• pregnant or breastfeeding patients
• children younger than age 18.

Administration

• Infuse I.V. dose over at least 1 hour, using pump to ensure 1-hour duration.
☞ Know that too-rapid I.V. infusion increases risk of anaphylaxis and other adverse reactions.
• Be aware that oral suspension isn't suitable for use in nasogastric tube.
• Know that treatment with ophthalmic solution may be continued after 14 days if corneal re-epithelialization hasn't occurred.

Route	Onset	Peak	Duration
P.O.	Rapid	1-2 hr	12 hr
I.V.	Rapid	End of infusion	12 hr
Ophthal.	Unknown	Unknown	Unknown

Adverse reactions

CNS: agitation, headache, restlessness, confusion, delirium, toxic psychosis

CV: orthostatic hypotension, vasculitis

EENT: nystagmus; with ophthalmic use - blurred vision; burning, stinging, irritation, itching, tearing, and redness of eyes; eyelid itching, swelling, or crusting; sensitivity to light

GI: nausea, vomiting, diarrhea, constipation, abdominal pain or discomfort, dyspepsia, dysphagia, flatulence, pancreatitis, pseudomembranous colitis

GU: albuminuria, candiduria, renal calculi

Hematologic: methemoglobinemia, agranulocytosis, hemolytic anemia

Hepatic: jaundice, hepatic necrosis

Metabolic: hyperglycemia, hyperkalemia

Musculoskeletal: myalgia, myoclonus, tendinitis, tendon rupture

Skin: rash, exfoliative dermatitis, toxic epidermal necrolysis, erythema multiforme

Other: altered taste, anosmia, exacerbation of myasthenia gravis, overgrowth of nonsusceptible organisms, hypersensitivity reactions including anaphylaxis and Stevens-Johnson syndrome

Interactions

Drug-drug. Antacids, bismuth subsalicylate, iron salts, sucralfate, zinc salts: decreased ciprofloxacin absorption

Cyclosporine: transient creatinine increase

Hormonal contraceptives: reduced contraceptive efficacy

Oral anticoagulants: increased anticoagulant effects

Phenytoin: increased or decreased phenytoin blood level

Probenecid: decreased renal elimination of ciprofloxacin, causing increased blood level

Theophylline: increased theophylline blood level, greater risk of toxicity

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, cholesterol, glucose, lactate dehydrogenase, potassium, triglycerides: increased levels

Prothrombin time: prolonged

Drug-food. Caffeine: interference with caffeine clearance

Concurrent tube feedings, milk or yogurt (when consumed alone with ciprofloxacin): impaired drug absorption

Drug-herbs. Fennel: decreased drug absorption

Patient monitoring

• In patients with renal insufficiency, assess creatinine level before giving first dose and at least once a week during prolonged therapy. Monitor drug blood level closely.
• Watch for signs and symptoms of serious adverse reactions, including GI problems, jaundice, and hypersensitivity reactions.

Patient teaching

• Tell patient to take drug 2 hours after a meal.
• Advise patient not to take drug with dairy products alone or with caffeinated beverages.
• Instruct patient to swallow microcapsules in oral suspension whole without chewing.
• Advise patient to drink 8 oz of water every hour while awake to ensure adequate hydration.
☞ Instruct patient to stop taking drug and notify prescriber at first sign of rash.
• Advise patient taking hormonal contraceptives to use supplemental birth control method, such as condoms, because drug reduces contraceptive efficacy.
• Inform breastfeeding patient that drug is excreted in breast milk and can affect infant's bone growth. Advise her to consult prescriber before using drug.
• Teach patient how to use eye ointment or solution.
• Tell patient not to touch eye dropper tip to any surface, to avoid contamination.
• Caution patient with bacterial conjunctivitis not to wear contact lenses.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and herbs mentioned above.