Cipro, Cipro IV, Cipro XR, Proquin XR
Classifications: quinolone antibiotic; Therapeutic: quinolone antibiotic
Pregnancy Category: C
100 mg, 250 mg, 500 mg, 750 mg tablets; 500 mg extended-release tablets; 50 mg/mL, 100 mg/mL suspension; 200 mg, 400 mg injection; 3.5 mg/mL ophth solution
Synthetic quinolone that is a broad-spectrum bactericidal agent. Inhibits DNA-gyrase, an enzyme necessary for bacterial DNA
replication and some aspects of transcription, repair, recombination, and transposition.
Effective against many gram-positive and aerobic gram-negative organisms. Not active against anaerobes.
UTIs, lower respiratory tract infections, skin and skin structure infections, bone and joint infections, GI infection or
infectious diarrhea, chronic bacterial prostatitis, nosocomial pneumonia, acute sinusitis. Post-exposure prophylaxis for
anthrax. Ophthalmic: Corneal ulcers, bacterial conjunctivitis caused by Staphylococci, Streptococci, and Pseudomonas aeruginosa.
Known hypersensitivity to ciprofloxacin or other quinolones, syphilis, viral infection; tendon inflammation or tendon pain;
pregnant women (category C).
Known or suspected CNS disorders (i.e., severe cerebral arteriosclerosis or seizure disorders); myasthenia gravis; myocardial
ischemia, atrial fibrillation, QT prolongation, CHF; GI disease, colitis; CVA; uncorrected hypokalemia; patients receiving
theophylline derivatives or caffeine, severe renal impairment and crystalluria during ciprofloxacin therapy, and patients
on coumarin therapy; children.
Route & Dosage
Adult: PO 250 mg q12h or 500 mg XR q.d. x 3 d IV 200 mg q12h x 714 d
Adult: PO 1000 mg XR q.d. x 714 d IV 400 mg q12h x 714 d
Adult: PO 500 mg b.i.d. x 10 d
Moderate to Severe Systemic Infection
Adult: PO 500750 mg q12h IV 200400 mg q812h
Clcr 3050 mL/min: PO 250500 mg q12h, IV no change in dose; <30 mL/min: PO 250500 mg q18h, IV 200400 mg q1824h
Adult: Ophthalmic 12 drops in conjunctival sac q2h while awake for 2 d, then 12 drops q4h while awake for the next 5 d Ointment ?-inch ribbon into conjunctival sac t.i.d. x 2 d, then b.i.d. x 5 d
Adult: Ophthalmic 2 drops q15min for 6 h, 2 drops q30min for the next 18 h, then 2 drops q1h for 24 h, then 2 drops q4h for 14 d
- For patients with renal impairment, oral and IV doses are lowered according to creatinine clearance.
- Do not give an antacid within 4 h of the oral ciprofloxacin dose.
PREPARE: Intermittent: Dilute in NS or D5W to a final concentration of 0.52 mg/mL. Typical dilutions are 200 mg in 100250 mL and 400
mg in 250500 mL.
ADMINISTER: Intermittent: Give slowly over 60 min. Avoid rapid infusion and use of a small vein.
INCOMPATIBILITIES Solution/additive: Aminophylline, amoxicillin, amoxicillin/clavulanate potassium, amphotericin B, ampicillin/sulbactam, ceftazidime, cefuroxime, clindamycin, heparin, metronidazole, piperacillin, sodium bicarbonate, ticarcillin. Y-site: Aminophylline, ampicillin, ampicillin/sulbactam, azithromycin, cefepime, dexamethasone, drotrecogin alfa, furosemide, heparin, hydrocortisone, lansoprazole, phenytoin, propofol, sodium bicarbonate, theophylline, TPN, warfarin.
- Discontinue other IV infusion while infusing ciprofloxacin or infuse through another site.
- Reconstituted IV solution is stable for 14 d refrigerated.
Adverse Effects (≥1%)GI:
Nausea, vomiting, diarrhea
, cramps, gas, pseudomembranous colitis
Transient increases in liver transaminases, alkaline phosphatase, lactic dehydrogenase, and eosinophilia count. Musculoskeletal:
Tendon rupture, cartilage erosion. CNS:
Headache, vertigo, malaise, peripheral neuropathy, seizures (especially with rapid IV
Rash, phlebitis, pain, burning, pruritus, and erythema at infusion site. Special Senses: Local burning and discomfort, crystalline precipitate on superficial portion of cornea,
lid margin crusting, scales, foreign body sensation, itching, and conjunctival hyperemia.
Diagnostic Test Interference
Ciprofloxacin does not interfere with urinary glucose determinations using cupric sulfate solution or with glucose oxidase tests; may cause false positive on opiate screening tests.
May increase theophylline
levels 1530%; antacids
, sulcralfate, iron
decrease absorption of ciprofloxacin; may increase PT for patients on warfarin. Food:
Calcium decreases the levels of ciprofloxacin.
6080% from GI tract. Ophthalmic:
Minimal absorption through cornea or conjunctiva. Onset:
Topical 0.52 h. Duration:
Topical 12 h. Peak:
Immediate release: 0.52 h; Cipro XR: 12.5 h; Proquin XR: 3.58.7 h. Distribution:
Widely distributed including prostate, lung, and bone; crosses placenta; distributed into breast milk. Elimination:
Primarily in urine with some biliary excretion. Half-Life:
Assessment & Drug Effects
- Report tendon inflammation or pain. Drug should be discontinued.
- Lab tests: Culture and sensitivity tests should be done prior to initial dose. Treatment may be implemented pending results.
- Monitor urine pH; it should be less than 6.8, especially in the older adult and patients receiving high dosages of ciprofloxacin,
to reduce the risk of crystalluria.
- Monitor I&O ratio and patterns: Patients should be well hydrated; assess for S&S of crystalluria.
- Monitor plasma theophylline concentrations, since drug may interfere with half-life.
- Administration with theophylline derivatives or caffeine can cause CNS stimulation.
- Assess for S&S of GI irritation (e.g., nausea, diarrhea, vomiting, abdominal discomfort) in clients receiving high dosages
and in older adults.
- Monitor PT and INR in patients receiving coumarin therapy.
- Assess for S&S of superinfections (see Appendix F).
Patient & Family Education
- Immediately report tendon inflammation or pain. Drug should be discontinued.
- Fluid intake of 23 L/d is advised, if not contraindicated.
- Report sudden, unexplained joint pain.
- Restrict caffeine due to the following effects (e.g., nervousness, insomnia, anxiety, tachycardia).
- Report possible toxicity. If taking theophylline derivatives, there is potential for adverse effects.
- Report nausea, diarrhea, vomiting, and abdominal pain or discomfort.
- Use caution with hazardous activities until reaction to drug is known. Drug may cause light-headedness.