Ciprofloxacin

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Fluoroquinolone antibiotic, Antibacterial

Ciprofloxacin

Cipro, Cipro XR, Ciloxan (ophthalmic)

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Titration strategies

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Summary

Classes

Fluoroquinolone antibiotic, Antibacterial

Common uses

Complicated UTI / pyelonephritis0, Bacterial prostatitis0, Bacterial gastroenteritis (selected)0, Pseudomonal coverage (selected)0, Anthrax prophylaxis and treatment0, Bacterial conjunctivitis/keratitis (topical)0

Pharmacy

Starting dose

500-750 mg PO BID; 400 mg IV q8-12h

Preparations

250, 500, 750 mg IR tablets; 500, 1000 mg ER tablets (XR); 250, 500 mg/5 mL oral suspension; 200, 400 mg IV; 0.3% ophthalmic solution and ointment; 0.2% otic

US FDA Max

~1500 mg/d (oral); 1200 mg/d (IV)

Pharmacology

Routes

Oral, IV, topical ophthalmic, otic

Onset

Hours

Duration

8-12 hours

Half-life

4 hours^[1]

Bioavailability

~70% (oral; reduced by divalent cations — antacids, iron, calcium, dairy)^[1]

Pregnancy

Avoid in pregnancy where alternatives exist (animal cartilage toxicity; class-wide concern); use only when benefit clearly outweighs.^{[citation needed]}

Legal status

Rx-only in US. Carries Boxed Warnings for tendinitis/tendon rupture (especially elderly, corticosteroid co-use, post-transplant), peripheral neuropathy (sometimes irreversible), CNS effects (psychosis, seizure), and worsening of myasthenia gravis^[1]

Purported mechanism

Ciprofloxacin inhibits bacterial DNA gyrase (topoisomerase II, dominant in gram-negatives) and topoisomerase IV (dominant in gram-positives), preventing supercoiling and decatenation needed for DNA replication; the result is bactericidal at clinically achievable concentrations.0 CYP1A2 inhibitor — clinically meaningful interactions with theophylline, caffeine, and tizanidine. QT prolongation, hypoglycemia (especially with sulfonylureas), and aortic aneurysm/dissection signals add to the class-wide reasons FDA has progressively restricted fluoroquinolone use to indications where alternatives have failed^[1].

References

↑ ^1.0 ^1.1 ^1.2 ^1.3 FDA Prescribing Information, Cipro (ciprofloxacin), Bayer, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/019537s086,019847s060,019857s062,020780s041lbl.pdf

[cipro-label-1] 1.0 ^1.1 ^1.2 ^1.3 FDA Prescribing Information, Cipro (ciprofloxacin), Bayer, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/019537s086,019847s060,019857s062,020780s041lbl.pdf

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