Ciprofloxacin (Cipro) 500 mg, 750 mg
- Generic name: Ciprofloxacin hydrochloride
- Trade names: Cipro, Ciprobay, Ciproxin,
Ciproxine, Ciflox, Proquin
Tablets 250 mg, 500 mg, 750 mg
Powder for oral suspension 250 mg/5 mL (5%) (when reconstituted);
500 mg/5 mL (10%) (when reconstituted)
Tablets, extended-release 500 mg, 1000 mg
Injection (premixed) 200 mg, 400 mg; Injection (concentrate) 10 mg/mL
- Pharmacologic category: Fluoroquinolone antibiotic, RX only
- FDA approved: October 22, 1987
- Pregnancy risk factor: C
Ciprofloxacin is a broad-spectrum a fluoroquinolone antibiotic marketed by Bayer under the brand name Cipro.
Ciprofloxacin indicated uses include:
- Urinary tract infections: urethritis (infection of the urethra),
cystitis (infection of the bladder), pyelonephritis (infection of the kidneys).
- Acute uncomplicated cystitis in women.
- Chronic bacterial prostatitis.
- Lower respiratory infections (pneumonia, bronchitis, tracheobronchitis).
- Acute sinusitis.
- Skin and skin structure infections: cellulitis (infection
of the dermis and subcutaneous tissue), erysipelas (superficial
form of cellulitis), folliculitis, furuncles,
carbuncles, abscesses, impetigo (large vesicles or honey-crusted
sores), infected ulcers and burns and other.
- Bone and joint infections.
- Complicated intra-abdominal infections (used in combination
- Infectious diarrhea: Escherichia coli infection, campylobacteriosis, salmonellosis, and shigellosis.
- Typhoid fever (enteric fever).
- STDs: gonorrhea.
- Complicated UTIs and pyelonephritis in children (1 to 17 years of age).
- Post-exposure prophylaxis of anthrax (in adults and children).
- Absorption: Rapid (50% to 85%).
- Metabolism: Partially hepatic; forms 4 metabolites.
- Elimination half-life: 3-5 hours.
- Excretion: Urine (30% to 50% as unchanged drug); feces (15% to 43%).
Cipro (Ciprofloxacin) for urinary tract infections
Antibiotics are the mainstay treatment for all UTIs. The choice of antibiotic and length of treatment depend on the
patient's history and the urine tests that identify the offending bacteria. The sensitivity test is especially useful in
helping select the most effective medication.
Escherichia coli is the leading cause of urinary tract infections, followed by
Fluoroquinolones are the standard alternatives to Sulfonamides (TMP-SMX), and sometimes are preferred antibacterials for UTI.
Ciprofloxacin is frequently used to treat urinary infections because of its excellent activity against majority of urinary tract
pathogenic bacteria, and particularly E. coli. In fact, ciprofloxacin is often the first choice where there are the high
rates of bacterial resistance to TMP-SMX.
Ciprofloxacin has a success rate of about 90-96% in eradicating bacteriuria16.
Dosage for Urinary Tract Infections:
Acute uncomplicated cystitis (simple bladder infection): the recommended dosage is 250 mg twice daily for 3 days. In
severe condition the duration of therapy is extended up to 7-10 days. Seven-day regimen is recommended for older
Prophylaxis regimen for women with recurrent UTIs: 125 mg taken after
Uncomplicated pyelonephritis (kidney infection) in adults: the recommended ciprofloxacin dosage is 500-750 mg twice daily for 7-14 days.
- Convenient twice daily dosing regimen.
- Broad spectrum of antimicrobial activity.
- Does not cause a significant QT interval prolongation 14.
- Very effective antibiotic against P. aeruginosa (bacteria
that causes infections of the pulmonary tract, external ear, urinary tract, burns, and wounds)
- Low cost due to generic availability.
- Tendon rupture, tendonitis and arthropathies. Rupture may
occur several months after medication has been discontinued.
Fluoroquinolone-associated tendinitis most commonly involves
the Achilles tendon, but the quadriceps, peroneus brevis, extensor
pollicis longus, the long head of the biceps, and rotator cuff tendons have also been reported.
- Peripheral neuropathy (nerve damage). The symptoms of neuropathy
include pain, burning, tingling, numbness, weakness, deficits
in light touch, temperature, position sense, vibratory
sensation. Ciprofloxacin should be stopped if person experiences
these symptoms in order to prevent the irreversible damage.
- Poor activity against Streptococcus pneumoniae - a major cause of pneumonia and meningitis.
- Ciprofloxacin absorption may be significantly reduced by dairy
products. It should not be taken with milk or calcium-fortified
juices alone. However, it may be taken with a meal that contains dairy products (eg. cereal with milk).
- Potential for serious drug interactions with theophylline,
propranolol, warfarin and some other medications.
- Widespread use of Ciprofloxacin, sometimes inappropriate,
has lead to increasing rates of bacterial resistance.
- Very rare cases of vision disturbance 15.
- May delay the fracture healing 1.
- Chlamydia 11. Ciprofloxacin is a poor
choice for Chlamydia. Although ciprofloxacin has good activity against Chlamydia in test tubes,
in practice it is insufficient for the treatment of chlamydia and often results in relapsing infection.
- Gynecological infections (pelvic inflammatory
disease, post-partum endometritis) 12,
13. Pelvic inflammatory disease
can affect the cervix (cervicitis), uterus (endometritis), fallopian tubes (salpingitis) and ovaries (oophoritis).
Ciprofloxacin not always provides optimal effective treatment for pelvic inflammatory disease if used alone.
- Cystic fibrosis 6.
Ciprofloxacin is effective and well-tolerated maintenance antipseudomonal
antibiotic in cystic fibrosis. There is increasing evidence that
prevention of chronic P. aeruginosa infection is important for people with cystic fibrosis.
- Cat-scratch disease 2.
This benign infectious disease caused by the intracellular parasite
Bartonella usually resolves spontaneously and does not require
antibiotic. In more serious cases treatment with ciprofloxacin is effective.
- Brucellosis 3-5.
Brucellosis is an infectious disease transmitted from animals
to humans. Despite ciprofloxacin is highly active in-vitro (in
test tube) against Brucella, it does not provide optimal
treatment for acute brucellosis and should be used in combination with other antibacterials.
- Tuberculosis 7-8.
Ciprofloxacin is a second-line choice for tuberculosis in
persons who cannot use conventional anti-tuberculosis medications or for drug-resistant tuberculosis.
- Chronic ear disease (chronic suppurative otitis
media) 9. Ciprofloxacin
appears to be effective for chronic otitis media, and superior to amoxycillin/clavulanic acid.
Mode of action
Ciprofloxacin is a synthetic, broad-spectrum antibacterial that inhibits (prevents the activity) DNA gyrase and topoisomerase IV.
DNA gyrase is an essential enzyme that is involved in the replication, transcription, and repair of bacterial DNA. Topoisomerase
IV is an enzyme known to play a key role in the partitioning of the chromosomal DNA during bacterial cell division.
Discussion Boards & Forums
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- 3. Lopez-Merino A, Contreras-Rodri'guez A, Migranas-Ortiz R, et al. Susceptibility of Mexican
brucella isolates to moxifloxacin, ciprofloxacin and other antimicrobials used in human brucellosis.
Scand J Infect Dis. 2004;36(9):636-8.
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Jan;16(1):106-11; discussion 123-6. PubMed
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nongonococcal urethritis. Am J Med. 1987 Apr 27;82(4A):311-6. PubMed
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for postpartum endometritis. J Reprod Med. 1991 Dec;36(12):857-61.
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for acute pelvic inflammatory disease. Am J Med. 1989 Nov 30;87(5A):142S-147S.
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- 15. Samarakoon N, Harrisberg B, Ell J. Ciprofloxacin-induced toxic optic neuropathy. Clin Experiment
Ophthalmol. 2007 Jan-Feb;35(1):102-4.
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Last modified: February 10, 2015
- Ciprofloxacin is the fluoroquinolone most studied in children, mostly when used to treat pulmonary exacerbations of cystic