Ciprofloxacin (Cipro) is a fluoroquinolone used 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.

Indications

• 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: STDs caused by N. gonorrheae

Contraindications and cautions

• Contraindicated with allergy to ciprofloxacin, norfloxacin or other fluoroquinolones, pregnancy, lactation.
• Use cautiously with renal dysfunction, seizures, tendinitis or tendon rupture associated with fluoroquinolone use

Dosages

ADULTS

• Uncomplicated UTIs: 100–250 mg PO q 12 hr for 3 days or 500 mg PO daily (ER tablets) for 3 days.
• Mild to moderate UTIs: 250 mg PO q 12 hr for 7–14 days or 200 mg IV q 12 hr for 7–14 days.
• Complicated UTIs: 500 mg bid PO q 12 hr for 7–14 days or 400 mg IV q 12 hr or 1,000 mg (ER tablets) PO daily for 7–14 days.
• Chronic bacterial prostatitis: 500 mg PO q 12 hr for 28 days or 400 mg IV q 12 hr for 28 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.
• Acute sinusitis: 500 mg PO q 12 hr or 400 mg IV q 12 hr for 10 days.
• Acute uncomplicated pyelonephritis: 1,000 mg ER tablets PO daily 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 or 1/2-inch ribbon of ointment into conjunctival sac tid on first 2 days, then apply 1/2-inch ribbon bid for next 5 days.
• Acute otitis externa: 4 drops in infected ear, tid–qid.

Adverse effects

• CNS: Headache, dizziness, insomnia, fatigue, somnolence, depression, blurred vision
• CV: Arrhythmias, hypotension, angina
• EENT: Dry eye, eye pain, keratopathy
• 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

Nursing Assessment

• History: Allergy to ciprofloxacin, norfloxacin or other quinolones; renal dysfunction; seizures; lactation
• Physical: Skin color, lesions; orientation, reflexes, affect; mucous membranes, bowel sounds; renal and liver function tests

Nursing Interventions

• 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 hrs 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.

Patient Education

• Educate patient not to touch tip of eye ointment or solution for this may contaminate the product.
• Encourage patient to drink plenty of fluids while taking this drug.
• Educate patient on these side effects: Nausea, vomiting, abdominal pain (eat frequent small meals); diarrhoea or constipation; drowsiness, blurring of vision, dizziness (observe caution when driving or using dangerous equipment).
• Encourage patient to report rash, visual changes, severe GI problems, weakness, tremors.