Ciprofloxacin (Cipro) is a fluoroquinolone class of antibiotics 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 cipro includes:

• 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

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 the infected ear, tid–qid.

FOODS TO AVOID

Caffeine-containing Foods/Beverages: When taking ciprofloxacin, it is essential to avoid caffeine-containing foods and beverages. Coadministration with ciprofloxacin may increase the plasma concentrations and pharmacologic effects of caffeine due to inhibition of the CYP450 1A2 metabolism of caffeine resulting in decreased clearance (elimination) of caffeine. This may lead to caffeine toxicity and manifest as nausea, vomiting, anxiety, tachycardia, or seizures.

Calcium-containing foods: Simultaneous ingestion of dairy products (milk, yogurt) or calcium-fortified foods such as cereal and orange juice may decrease the activity of ciprofloxacin. Ciprofloxacin can bind to calcium ions in a mechanism known as chelation, resulting in decreased bioavailability. In the case of orange juice, inhibition of intestinal transport mechanisms (P-glycoprotein or organic anion-transporting polypeptides) by flavones may also be involved.

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

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

Patient Education

• Educate patient not to touch the tip of eye ointment or solution for this may contaminate the product.
• Encourage the 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, and dizziness (observe caution when driving or using dangerous equipment).
• Encourage the patient to report rash, visual changes, severe GI problems, weakness, and tremors.