Antimicrobials
Ciprofloxacin

Ciprofloxacin

High
Excellent

Dosing

General Information

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

Pregnancy:

  • Ciprofloxacin crosses the placenta.
  • Ciprofloxacin use during pregnancy has not been associated with congenital malformations or evidence of cartilage damage or tendon rupture in newborns.
  • Ciprofloxacin and its effect on joint development are still being studied.
  • Fluoroquinolones should only be used during pregnancy in the absence of other alternatives to treat the infection.

Breastfeeding:

  • The amount of ciprofloxacin transfer into breast milk is reported as low.
  • There has been one case report of pseudomembranous colitis in an infant of a mother who self medicated with ciprofloxacin for 6 days while breastfeeding.
  • Use of ciprofloxacin is acceptable in breastfeeding with monitoring of the infant for possible effects on the gastrointestinal flora, such as diarrhea.
  • Maternal use of an ear drop or eye drop that contains ciprofloxacin presents negligible risk for the nursing infant.

Monitor QTc in patients with increased risk

  • QTc prolongation
  •  Dysglycemia
  •  CNS toxicity including confusion, psychosis
  • Tendinopathy and rupture
  • GI upset
  • Weakness exacerbation in myasthenia gravis
  • Rash
  • Retinal detachment
  • CYP1A2 inhibitor - multiple interactions possible
  •  QTc prolongation - Increased risk with other agents that prolong QTc
  •  Di- & Trivalent cations including Al, Ca, Fe, Mg (antacids, dairy products, iron supplements, some enteral feeds) - decreased absorption
  •  Cyclosporine - increased levels of cyclosporine
  •  Warfarin - increased INR
  •  Decreases phenytoin levels

FDA Black Box warning against use in uncomplicated UTI, acute bacterial sinusitis, and acute exacerbation of chronic bronchitis where alternatives exist due to serious adverse side effects May exacerbate muscle weakness in persons with myasthenia gravis. Avoid Use.

Antimicrobial class: Fluoroquinolone

Average serum half life: 4.0

Biliary penetration: Therapeutic

CSF penetration: Moderate

Lung penetration: Therapeutic

Urine penetration: Therapeutic