Cipro (Ciprofloxacin)

Generic Name: Ciprofloxacin

Brand Name: Cipro

Uses:

Ciprofloxacin (Cipro) is a prescription broad-spectrum antibacterial agent highly active against Gram-negative bacteria. Ciprofloxacin is often prescribed to treat urinary tract infections (uncomplicated cystitis, kidney infection), prostatitis, gonorrhea, Pseudomonas infections. It is a preferable treatment for all clinical forms of anthrax.

Ciprofloxacin is a good antibiotic for traveler's diarrhea and food poisoning due to its activity against food-borne bacteria such as Vibrio cholera, Campylobacter jejuni, Yersinia, Salmonella and Shigella.

Ciprofloxacin has unreliable activity against the pneumococcus and is not a good choice for pneumonia.

Cipro dosage:

Usual dosage ranges: Adults: 250-750 mg every 12 hours.

Lower respiratory tract, skin infections: 500-750 mg twice daily for 7-14 days.

Urinary tract infection:
Cystitis (uncomplicated): 250 mg every 12 hours for 3 days.
Complicated (including pyelonephritis): 500 mg every 12 hours for 7-14 days.

Sinusitis: 500 mg every 12 hours for 10 days.

Infectious diarrhea:
Salmonella: 500 mg twice daily for 5-7 days.
Shigella: 500 mg twice daily for 3 days.
Traveler's diarrhea: 500 mg twice daily for 3 days.
Cholera (Vibrio cholerae): 1 g for one dose.

Prostatitis (chronic, bacterial): 500 mg every 12 hours for 28 days.

Bone, joint infections: 500-750 mg twice daily for 4-6 weeks.

Anthrax:
Inhalational (postexposure prophylaxis): 500 mg every 12 hours for 60 days.
Cutaneous (treatment, CDC guidelines): 500 mg every 12 hours for 60 days.

Chancroid: 500 mg twice daily for 3 days.

Gonorrhea:
Uncomplicated urethral, cervical, and pharyngeal gonorrhea (due to N. gonorrhoeae): 250-500 mg as a single dose.
Note: As of April 2007, the CDC no longer recommends fluoroquinolones for gonococcal disease, unless no other options exist and susceptibility can be confirmed via culture.

Typhoid fever (due to Salmonella typhi): 500 mg every 12 hours for 10 days.

Cipro side effects:

Gastrointestinal: nausea (2.5%), diarrhea (1.6%), vomiting (1%), abdominal discomfort.

Central nervous system: insomnia (3%), dizziness (2%), restlessness (1%).

Hypersensitivity: rash (2%); allergic reaction.

Precautions:

Tendinopathy and tendon rupture: There have been reports of tendon inflammation (commonly Achilles, shoulder, or hand tendons) and rupture with fluoroquinolones. The risk is increased in older adults ( > 60 years of age), individuals receiving concurrent corticosteroids. Other factors that may independently predispose to tendon rupture include strenuous physical activity, renal failure, and previous tendon disorders.

Children: Do not use ciprofloxacin in children younger than 18 years of age because of increased incidence of disorders related to joints and cartilage.

Prolonged QT interval. Fluoroquinolones may prolong QTc interval. Patients with a history of QTc prolongation, uncorrected hypokalemia, or hypomagnesemia are at higher risk.

Phototoxicity: Avoid excessive sunlight; may cause moderate-to-severe phototoxicity reactions.

Crystalluria: Rarely, crystalluria has occurred. Ensure adequate hydration.

Peripheral sensory disturbances: Discontinue if symptoms sensory or sensorimotor disturbances occur, including paresthesias, hypoesthesias, dysesthesias, and weakness.

Drug interactions

• Antacids (aluminum- and magnesium-containing), calcium, sucralfate, didanosine, iron salts, zinc salts: decreased absorption of ciprofloxacin. Cipro should be administered 2 hours before or 6 hours after antacids, sucralfate, or supplements containing calcium, iron, or zinc.
• Theophylline: increased serum levels of theophylline; additive CNS stimulation and risk of seizures.
• Tizanidine: serum levels of tizanidine may be raised 7-fold. Concurrent administration is contraindicated.
• BCG or Typhoid live vaccines: ciprofloxacin may decrease the therapeutic effect of live vaccine.
• CYP1A2 substrates: ciprofloxacin may increase the levels of CYP1A2 substrates.
• Glyburide: possible severe hypoglycemia.
• QTc-prolonging agents: prolongation of the QT interval.

Pregnancy & Lactation:
Pregnancy Risk Factor: C
Cipro crosses the placenta and concentrates in amniotic fluid; maternal serum levels may be decreased during pregnancy. Reports of arthropathy (observed in immature animals and reported rarely in humans) have limited the use of fluoroquinolones in pregnancy. According to the FDA, the Teratogen Information System concluded that therapeutic doses during pregnancy are unlikely to produce substantial teratogenic risk. In general, reports of exposure have been limited to short durations of therapy in the first trimester. When considering treatment for life-threatening infection and/or prolonged duration of therapy (such as in anthrax), the potential risk to the fetus must be balanced against the severity of the potential illness.

Breast-Feeding:
Cipro is excreted in breast milk. However, AAP suggests maternal use of ciprofloxacin is compatible with breast-feeding since absorption of ciprofloxacin by nursing infants would be negligible.

References:

• 1. U.S. Ciprofloxacin (Cipro) Prescribing Information