Ciprofloxacin

C. diff Risk

High

Oral Bioavailability

NA

Approximate Cost

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

Dosing

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

Use with caution in severe hepatic dysfunction

Severe infection (limited data): IV 20mg/kg/DAY divided q12h

20-30mg/kg/DAY divided q8-12h. Max: 400mg/DOSE

20mg/kg/DAY divided q12h. Max: 500mg/DOSE

30-40mg/kg/DAY divided q12h. Max: 750mg/DOSE<br>Cystic fibrosis Max: 1000mg/DOSE

General Information

Common Usage

Pseudomonal and other gram negative infections of urinary tract, bone/joint, abdomen, and other sites

Drug Monitoring

Renal and liver function, CBC. QTc in patients with increased risk.

Tendinopathy and rupture, retinal detachment, peripheral neuropathy have been reported.

Adverse Effects

Dizziness, insomnia, rash, n/v, abdominal pain.

Tendinopathy and rupture, retinal detachment, peripheral neuropathy & 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

AVOID concomitant administration with antacids, multivitamin & mineral supplements. Space doses by 2 hours.

Increased risk of tendon rupture with concomitant use of corticosteroids.

Monitor INR with warfarin.

Additional Information

Not routinely 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