Ver el código de «Ciprofloxacin»

==General==
*Type: [[Is Generation:: 2nd generation]] [[Is DrugClass::Fluoroquinolones]]
*Dosage Forms: IV; PO (Standard: 100, 250, 500; ER 500, 1000)
*Common Trade Names: Cipro, Ciloxan (ophthalmic)

'''Given the multiple adverse effects listed below, there has been a recent move away from prescribing this and other fluoroquinolones as first line antibiotics for many indications (such as UTI or pneumonia).'''

==Adult Dosing==
===General===
*'''PO'''
**250-750mg PO q12h
**First Dose: 250-750mg PO x1 
*'''IV'''
**200-400mg IV q12
**First Dose: 400mg IV x 1
**Alt: 400mg IV q8h

===[[UTI]]===
*'''Uncomplicated'''
**500mg ER PO q24h x 3 days
**Alt: 250mg PO q12h x 3 days
*'''Complicated'''
**'''IV:''' 400mg IV q12h x 7-14 days
**'''PO:''' 1000mg ER PO q24h x 7-14 days
***Alt: 500mg PO q12h x 7-14 days

===[[Anthrax]]===
*'''Inhalational, GI, Oropharyngeal'''
**400mg IV q12h OR 500mg PO q12 x 60 days
**First dose: 400mg IV + 1-2 additional antibiotics
*'''Cutaneous'''
**400mg IV q12h OR 500mg PO q12 x 7-10 days
**Info: Give x 60 days if [[bioterrorism]] suspected
*'''Post-Exposure Prophylaxis'''
**500mg PO q12h x 60 days (or exposure excluded)

===[[Traveler's Diarrhea]]<ref>Sanford 2014</ref>===
*750mg PO BID x 1-3 days

===[[Typhoid Fever]]===
*500mg PO q12h x 2 weeks

===[[Chancroid]]===
*500mg PO q12h x 3 days

===[[Salmonella]]===
*'''Acute'''
**500-750mg PO q12h x 3-7 days
**Extend treatment x 1 week if immunocompromised
*'''Chronic Carrier'''
**750mg PO q12h x 1 month

===[[Otitis externa]]===
*Cipro HC otic: 3 drops in affected ear BID x 7 days
**Contains hydrocortisone
**Not recommended for perforation since non-sterile preparation
*Ciprodex: 4 drops in affected ear BID x 7 days
**Similar to Cipro HC but contains [[dexamethasone]]
**Safe with perforation
**More expensive and not covered by many insurance companies

==Pediatric Dosing==
===General===
*'''PO'''
**20-30mg/kg/day PO divided q12h
**First Dose: 10-15mg/kg PO x 1
**Max: 750mg/dose PO
*'''IV'''
**15-30mg/kg/day IV divided q8-12h
**First Dose: 5-15mg/kg IV x 1
**Max: 400mg/dose IV

===[[Anthrax]]===
''Max (All): 400mg/dose IV or 500mg/dose PO''

*'''Inhalational, GI, Oropharyngeal'''
**20-30mg/kg/day IV/PO divided q12h x 60 days
**First Dose: 10-15mg/kg IV x 1 (give with 1-2 additional antibiotics) 
*'''Cutaneous'''
**20-30mg/kg/day IV/PO divided q12h x 7-10 days 
**First Dose: 10-15mg/kg IV/PO x 1
**Info: Give x 60 days if [[bioterrorism]] suspected
*'''Post-Exposure Prophylaxis'''
**20-30mg/kg/day PO divided q12h x 60 days (or exposure excluded)
**First Dose: 10-15mg/kg PO x 1

===[[UTI]], Complicated (1-17 Years Old)===
''Not first line given adverse effects''
*'''IV'''
**6-10mg/kg IV q8h
**First Dose:
**Max: 400mg/dose IV
*'''PO'''
**10-20mg/kg PO q12h
**First Dose:
**Max: 750mg/dose PO

==Special Populations==
*[[Drug ratings in pregnancy]]: C (but indicated for [[anthrax]])
*[[Lactation risk categories]]: Probably safe
*Renal Dosing
**Adult: renal impairment less than creatinine clearance 30 mL/min, q24hrs instead of q12hrs
**Pediatric
*Hepatic Dosing - no dose adjustments needed

==Contraindications==
*Allergy to class/drug
*Administration with Tizanidine

==Adverse Reactions==
===Serious===
*Prolonged QT interval and Syncope/Torsades de pointes
*Photosensitivity
*Stevens-Johnson syndrome/Toxic epidermal necrolysis
*Clostridium difficile diarrhea, Pseudomembranous enterocolitis
*Tendonitis or tendon rupture (black box warning) - increased risk in age >60, immunosuppressed, corticosteroid use
*peripheral neuropathy
*severe hypoglycemia <ref>FDA updates warnings for fluoroquinolone antibiotics on risks of mental health and low blood sugar adverse reactions. US Food and Drug Administration. https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm612995.htm. Updated July 10, 2018. Accessed Oct 22, 2018.</ref>
*mental health effects

===Common===
*Rash
*[[Diarrhea]]/Nausea/Vomiting

==Pharmacology==
*Half-life: 4 hours
*Metabolism: Liver
*Excretion: Urine, Feces
*Mechanism of Action: Bactericidal. Inhibits DNA gyrase

==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''Group'''
| align="center" style="background:#f0f0f0;"|'''Organism'''
| align="center" style="background:#f0f0f0;"|'''Sensitivity'''
|-
| Gram Positive||[[Strep. Group A, B, C, G]]||I
|-
| ||[[Strep. Pneumoniae]]||I
|-
| ||[[Viridans strep]]||R
|-
| ||Strep. anginosus gp||R
|-
| ||[[Enterococcus faecalis]]||U
|-
| ||[[Enterococcus faecium]]||R
|-
| ||[[MSSA]]||'''S'''
|-
| ||[[MRSA]]||R
|-
| ||[[CA-MRSA]]||I
|-
| ||[[Staph. Epidermidis]]||'''S'''
|-
| ||[[C. jeikeium]]||R
|-
| ||[[L. monocytogenes]]||'''S'''
|-
| Gram Negatives||[[N. gonorrhoeae]]||I
|-
| ||[[N. meningitidis]]||'''S'''
|-
| ||[[Moraxella catarrhalis]]||'''S'''
|-
| ||[[H. influenzae]]||'''S'''
|-
| ||[[E. coli]]||'''S'''
|-
| ||[[Klebsiella]] sp||'''S'''
|-
| ||E. coli/Klebsiella ESBL+||'''S'''
|-
| ||E coli/Klebsiella KPC+||R
|-
| ||[[Enterobacter]] sp, AmpC neg||'''S'''
|-
| ||[[Enterobacter]] sp, AmpC pos||'''S'''
|-
| ||[[Serratia]] sp||'''S'''
|-
| ||Serratia marcescens||X1
|-
| ||[[Salmonella]] sp||'''S'''
|-
| ||[[Shigella]] sp||'''S'''
|-
| ||[[Proteus mirabilis]]||'''S'''
|-
| ||[[Proteus vulgaris]]||'''S'''
|-
| ||[[Providencia sp.]]||'''S'''
|-
| ||[[Morganella sp.]]||'''S'''
|-
| ||[[Citrobacter freundii]]||'''S'''
|-
| ||[[Citrobacter diversus]]||'''S'''
|-
| ||[[Citrobacter sp.]]||'''S'''
|-
| ||[[Aeromonas sp]]||'''S'''
|-
| ||[[Acinetobacter sp.]]||I
|-
| ||[[Pseudomonas aeruginosa]]||'''[[Has Antipseudomonal::S]]'''
|-
| ||[[Burkholderia cepacia]]||R
|-
| ||[[Stenotrophomonas maltophilia]]||R
|-
| ||[[Yersinia enterocolitica]]||'''S'''
|-
| ||[[Francisella tularensis]]||X1
|-
| ||[[Brucella sp.]]||X1
|-
| ||[[Legionella sp.]]||'''S'''
|-
| ||[[Pasteurella multocida]]||'''S'''
|-
| ||[[Haemophilus ducreyi]]||X1
|-
| ||[[Vibrio vulnificus]]||X1
|-
| Misc||[[Chlamydophila sp]]||'''S'''
|-
| ||[[Mycoplasm pneumoniae]]||'''S'''
|-
| ||[[Rickettsia sp]]||X1
|-
| ||[[Mycobacterium avium]]||X1
|-
| Anaerobes||[[Actinomyces]]||R
|-
| ||[[Bacteroides fragilis]]||R
|-
| ||[[Prevotella melaninogenica]]||R
|-
| ||[[Clostridium difficile]]||R
|-
| ||[[Clostridium (not difficile)]]||I
|-
| ||[[Fusobacterium necrophorum]]||X1
|-
| ||[[Peptostreptococcus sp.]]||I
|}

===Key===
{{Template:Antibacterial Spectra Key}}

==See Also==
*[[Antibiotics (Main)]]

==References==
<references/>

[[Category:Pharmacology]]
[[Category:ID]]