CIPROFLOXACIN HYDROCHLORIDE

(ci-pro-flox'a-cin)

Cipro, Cipro IV, Cipro XR, Proquin XR
CIPROFLOXACIN OPHTHALMIC
Ciloxan
Classifications: quinolone antibiotic;
Therapeutic: quinolone antibiotic
Pregnancy Category: C

Availability

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

Action

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.

Therapeutic Effect

Effective against many gram-positive and aerobic gram-negative organisms. Not active against anaerobes.

Uses

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.

Contraindications

Known hypersensitivity to ciprofloxacin or other quinolones, syphilis, viral infection; tendon inflammation or tendon pain; pregnant women (category C).

Cautious Use

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

Uncomplicated UTI
Adult: PO 250 mg q12h or 500 mg XR q.d. x 3 d IV 200 mg q12h x 7–14 d

Complicated UTI
Adult: PO 1000 mg XR q.d. x 7–14 d IV 400 mg q12h x 7–14 d

Acute Sinusitis
Adult: PO 500 mg b.i.d. x 10 d

Moderate to Severe Systemic Infection
Adult: PO 500–750 mg q12h IV 200–400 mg q8–12h

Renal Impairment
Cl_cr 30–50 mL/min: PO 250–500 mg q12h, IV no change in dose; <30 mL/min: PO 250–500 mg q18h, IV 200–400 mg q18–24h

Bacterial Conjunctivitis
Adult: Ophthalmic 1–2 drops in conjunctival sac q2h while awake for 2 d, then 1–2 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

Corneal Ulcers
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

Administration

For patients with renal impairment, oral and IV doses are lowered according to creatinine clearance.

Oral

Do not give an antacid within 4 h of the oral ciprofloxacin dose.

Intravenous

PREPARE: Intermittent: Dilute in NS or D5W to a final concentration of 0.5–2 mg/mL. Typical dilutions are 200 mg in 100–250 mL and 400 mg in 250–500 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. Metabolic: 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 infusion). Skin: 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.

Interactions

Drug: May increase theophylline levels 15–30%; antacids, sulcralfate, iron decrease absorption of ciprofloxacin; may increase PT for patients on warfarin. Food: Calcium decreases the levels of ciprofloxacin.

Pharmacokinetics

Absorption: 60–80% from GI tract. Ophthalmic: Minimal absorption through cornea or conjunctiva. Onset: Topical 0.5–2 h. Duration: Topical 12 h. Peak: Immediate release: 0.5–2 h; Cipro XR: 1–2.5 h; Proquin XR: 3.5–8.7 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: 3.5–4 h.

Nursing Implications

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 2–3 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.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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