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Published by: api-3797941 on Oct 17, 2008
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(si proe flox' a sin)
Ciloxan (CAN), Cipro, Cipro HC Otic, Cipro I.V., Cipro XR Pregnancy Category C
Drug classes

Antibacterial Fluoroquinolones
Therapeutic actions

Bactericidal; interferes with DNA replication in susceptible gram-negative bacteria preventing cell reproduction.

• • • • • • •

For the treatment of infections caused by susceptible gram-negative bacteria, including E. coli, P. mirabilis, K. pneumoniae, Enterobacter cloacae, P. vulgaris, P. rettgeri, M. morganii, P. aeruginosa, Citrobacter freundii, S. aureus, S. epidermidis, group D streptococci Otic: Treatment of acute otitis externa Treatment of chronic bacterial prostatitis IV: Treatment of nosocomial pneumonia caused by Haemophilus influenzae, K. pneumoniae Oral: Typhoid fever Oral: Sexually transmitted diseases caused by N. gonorrheae Prevention of anthrax following exposure to anthrax bacilla (prophylactic use in regions suspected of using germ warfare) Unlabeled use: Effective in patients with cystic fibrosis who have pulmonary exacerbations Contraindicated with allergy to ciprofloxacin, norfloxacin, pregnancy, lactation. Use cautiously with renal dysfunction, seizures, tendinitis or tendon rupture associated with fluoroquinolone use.

Contraindications and cautions

• •

Available forms

Tablets—100, 250, 500, 750 mg; ER tablets—500 mg; oral suspension—5, 10 g/100 ml; injection—200, 400 mg; ophthalmic solution—3.5 mg/mL; otic suspension—2 mg/mL
Dosages ADULTS

• •

Uncomplicated urinary tract infections: 100–250 mg PO q 12 hr for 3 days or 500 mg PO daily (ER tablets) for 3 days. Mild to moderate UTI: 250 mg q 12 hr PO for 7–14 days or 200 mg IV q 12 hr for 7–14 days.

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Complicated urinary tract infections: 500 mg bid PO for 10–21 days or 400 mg IV or 1,000 mg (ER tablets) PO daily q 7–14 days. Infectious diarrhea: 500 mg q 12 hr PO for 5–7 days. Anthrax postexposure: 500 mg PO q 12 hr for 60 days or 400 mg IV q 12 hr for 60 days. Respiratory infections 500–750 mg PO or 400 mg IV q 12 hr for 7–14 days. Bone, joint, skin infections: 500–750 mg PO or 400 mg IV q 12 hr for 4–6 wk. Nosocomial pneumonia: 400 mg IV q 8 hr. Ophthalmic infections caused by susceptible organisms not responsive to other therapy: 1 or 2 drops per eye daily or bid. Acute otitis externa: 4 drops in infected ear, tid–qid.


Not recommended; produced lesions of joint cartilage in immature experimental animals. • Inhalational anthrax: 15 mg/kg/dose PO q 12 hr for 60 days or 10 mg/kg/dose IV q 12 hr for 60 days; do not exceed 500 mg/dose PO or 400 mg/dose IV.

For creatinine clearance of 30–50 mL/min, give 250–500 mg PO q 12 hr. For creatinine clearance of 5–29 mL/min, give 250–500 mg PO q 18 hr or 200–400 mg IV q 18–24 hr. For patients on hemodialysis, give 250–500 mg q 24 hr, after dialysis.
Route Oral IV Onset Varies 10 min Peak 60–90 min 30 min Duration 4–5 hr 4–5 hr

Metabolism: Hepatic; T1/2: 3.5–4 hr Distribution: Crosses placenta; enters breast milk Excretion: Urine and bile
IV facts

Preparation: Dilute to a final concentration of 1–2 mg/mL with 0.9% NaCl injection or 5% dextrose injection. Stable up to 14 days refrigerated or at room temperature. Infusion: Administer slowly over 60 min. Incompatibilities: Discontinue the administration of any other solutions during ciprofloxacin infusion. Incompatible with aminophylline, amoxicillin, clindamycin, floxacillin, heparin in solution.
Adverse effects

• • • • •

CNS: Headache, dizziness, insomnia, fatigue, somnolence, depression, blurred vision CV: Arrhythmias, hypotension, angina GI: Nausea, vomiting, dry mouth, diarrhea, abdominal pain Hematologic: Elevated BUN, AST, ALT, serum creatinine and alkaline phosphatase; decreased WBC, neutrophil count, Hct Other: Fever, rash


Drug-drug • Decreased therapetic effect with iron salts, sucralfate • Decreased absorption with antacids, didanosine • Increased serum levels and toxic effects of theophyllines if taken concurrently with ciprofloxacin Drug-alternative therapy • Increased risk of severe photosensitivity reactions if combined with St. John's wort therapy.
Nursing considerations Assessment

• •

History: Allergy to ciprofloxacin, norfloxacin or other quinolones; renal dysfunction; seizures; lactation Physical: Skin color, lesions; T; orientation, reflexes, affect; mucous membranes, bowel sounds; renal and liver function tests Arrange for culture and sensitivity tests before beginning therapy. Continue therapy for 2 days after signs and symptoms of infection are gone. Ensure that patient is well hydrated. Give antacids at least 2 hr after dosing. Monitor clinical response; if no improvement is seen or a relapse occurs, repeat culture and sensitivity. Encourage patient to complete full course of therapy. If an antacid is needed take it at least 2 hr before or after dose. Drink plenty of fluids while you are on this drug. These side effects may occur: Nausea, vomiting, abdominal pain (eat small, frequent meals); diarrhea or constipation; drowsiness, blurring of vision, dizziness (observe caution if driving or using dangerous equipment). Report rash, visual changes, severe GI problems, weakness, tremors.


• • • • • • • • • •

Teaching points

Adverse effects in Italic are most common; those in Bold are life-threatening.

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