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ciprofloxacin
Cipro, Cipro I.V., Ciproxin‡

Pregnancy Risk Category C

How supplied
Tablets (film-coated):
100 mg, 250 mg, 500 mg, 750 mg
Infusion (premixed):
200 mg in 100 ml D5W, 400 mg in 200 ml D5W
Injection:
200 mg, 400 mg

Action
Inhibits bacterial DNA synthesis, mainly by blocking DNA gyrase; bactericidal.

Indications & dosage
Mild to moderate urinary tract infections (UTIs) due to
Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Serratia marcescens, Proteus mirabilis, Providencia rettgeri, Morganella morganii,
Citrobacter diversus, C. freundii, Pseudomonas aeruginosa, Staphylococcus epidermidis, and Enterococcus faecalis-
Adults:
250 mg P.O. or 200 mg I.V. q 12 hours.
Severe or complicated UTIs; mild to moderate bone and joint infections due to
E. cloacae, P. aeruginosa, and S. marcescens; mild to moderate respiratory infections due to E. coli, K. pneumoniae, E. cloacae, P. mirabilis, P. aeruginosa, Haemophilus influenzae, and H. parainfluenzae; mild to moderate skin and skin-structure infections due to E. coli, K. pneumoniae, E. cloacae, P. mirabilis, P. vulgaris, Providencia stuartii, M. morganii, C. freundii, Streptococcus pyogenes, P. aeruginosa, Staphylococcus aureus, and S. epidermidis; infectious diarrhea due to E. coli, Campylobacter jejuni, Shigella flexneri, and S. sonnei; typhoid fever-
Adults:
500 mg P.O. or 400 mg I.V. q 12 hours.
Severe or complicated bone or joint infections, severe respiratory tract infections, severe skin and skin-structure infections-

Adults:
750 mg P.O. q 12 hours.
Chronic bacterial prostatitis due to
E. coli or P. mirabilis-
Adults:
500 mg P.O. q 12 hours for 28 days.
Complicated intra-abdominal infections (used with metronidazole) due to
E. coli, P. aeruginosa, P. mirabilis, K. pneumoniae, or Bacteroides fragilis-
Adults:
500 mg P.O. or 400 mg I.V. q 12 hours for 7 to 14 days.
Acute uncomplicated cystitis-

Adults:
100 mg P.O. q 12 hours for 3 days.
Mild to moderate acute sinusitis-

Adults:
500 mg P.O. q 12 hours for 10 days.
NEW INDICATION:
Mild to moderate acute sinusitis due to H. influenzae, Streptococcus pneumoniae, or Moraxella catarrhalis; mild to moderate chronic bacterial prostatitis due to Escherichia coli or P. mirabilis-
Adults:
400 mg I.V. infusion given over 60 minutes q 12 hours.
Adjust-a-dose:
For patients with renal failure, if creatinine clearance is 30 to 50 ml/minute, give 250 to 500 mg P.O. q 12 hours or the usual I.V. dose; if clearance is 5 to 29 ml/minute, give 250 to 500 mg P.O. q 18 hours or 200 to 400 mg I.V. q 18 to 24 hours. If patient is on hemodialysis, give 250 to 500 mg P.O. q 24 hours (after dialysis)

Adverse reactions
CNS:
headache, restlessness, tremor, dizziness, fatigue, drowsiness, insomnia, depression, light-headedness, confusion, hallucinations, seizures, paresthesia.
GI:
nausea, diarrhea, vomiting, abdominal pain or discomfort, oral candidiasis, pseudomembranous colitis, dyspepsia, flatulence, constipation.
GU:
crystalluria, increased serum creatinine and BUN levels, interstitial nephritis.
Hematologic:
eosinophilia, leukopenia, neutropenia, thrombocytopenia.
Hepatic:
elevated liver enzymes.
Musculoskeletal:
arthralgia, arthropathy, joint or back pain, joint inflammation, joint stiffness, tendon rupture, aching, neck or chest pain.
Skin:
rash, photosensitivity, Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis.
Other:
hypersensitivity; thrombophlebitis, burning, pruritus, erythema, edema.

Interactions
Drug-drug.
Antacids containing aluminum hydroxide or magnesium hydroxide, iron supplements, iron- or zinc-
containing multivitamins, sucralfate:
decreased ciprofloxacin absorption. Separate administration by at least 2 hours.
Probenecid:
may elevate serum level of ciprofloxacin. Monitor for toxicity.
Theophylline:
increased plasma theophylline levels and prolonged theophylline half-life. Monitor blood levels of theophylline and observe for adverse effects.
Drug-herb.
Yerba maté: may decrease clearance of yerba maté's methylxanthines and cause toxicity. Use together cautiously.
Drug-food.
Caffeine: increased effect of caffeine. Monitor closely.
Dairy products, other foods:
delayed peak serum levels. Give drug on an empty stomach.
Drug-lifestyle.
Sun exposure: photosensitivity reactions may occur. Take precautions.

Effects on diagnostic tests
None reported.

Contraindications
Contraindicated in patients sensitive to fluoroquinolone antibiotics.

Nursing considerations

I.V. administration

Patient teaching

*Liquid contains alcohol. **May contain tartrazine.  †Canada  ‡Australia  §U.K.  OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING

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