Ciprofloxacin

C. diff Risk

High

Oral Bioavailability

NA

Approximate Cost

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

Dosing

Adult

250-500 mg PO q12h

Neonatal

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

Renal

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

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

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

Average serum half life: Pediatrics: 4-5 hours