Ciprofloxacin

C. diff Risk

High

Oral Bioavailability

NA

Approximate Cost

IV-$4/d PO-$3/d

Dosing

10-40 mg/kg/24h IV divided q12h

Renally cleared, requires dosage adjustment with changes in renal function. Consult a pharmacist for renal dosing.

Shigella dysentry15 mg/kg/dose PO q12h x 3 days

Salmonella GE, UTI5-10 mg/kg/dose PO q12h x 5 days

Salmonella GE4-7 mg/kg/dose IV q12h x 5 days

IE20-30 mg/kg/day IV q12h x 4-6 wks

250-500 mg PO q12h

General Information

Common Usage

Cystic fibrosis, Pseudomonal infection

Drug Monitoring

  • Renal and liver function

  • CBC

  • QTc in patients with increased risk

  • Tendinopathy and rupture have been reported.

Adverse Effects

  • Dizziness

  • Insomnia

  • Rash

  • Nausea, vomiting, abdominal pain

  • Tendinopathy and rupture

  • QTc prolongation have been reported

Major Interactions

  • Strong CYP1A2 inhibitor and weak CYP3A4 inhibitor - Multiple interactions possible

  • QTc prolongation - Increased risk with other agents that prolong QTc

  • Increased risk of tendon rupture especially with concomitant use of corticosteroids.

  • Monitor INR with warfarin.

  • Avoid concurrent oral administration with calcium, antacids, iron. Administer ciprofloxacin 2 hours before or 4 hours after dose of calcium, antacids and iron.

  • Ciprofloxacin suspension should never be given through an enteral feeding tube. Ciprofloxacin immediate-release tablets can be given via tube, but should not be administered concurrently with enteral feedings. Discontinue feed for 1-2 hours prior to and after ciprofloxacin administration.

Additional Information

Not first-line therapy in children.

Pharmacology

Antimicrobial class: Fluoroquinolone

Average serum half life: Pediatrics: 4-5 hours

Route of Elimination: 30% to 50% excreted as unchanged drug in urine via glomerular filtration and active tubular secretion;
20% to 40% excreted in feces primarily from biliary excretion;
<1% excreted in bile as unchanged drug