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Ciprofloxacin


Pronunciation

 (sip roe FLOKS a sin)


U.S. Brand Names

 Ciloxan®; Cipro®; Cipro® XR


Synonyms

 Ciprofloxacin Hydrochloride


Generic Available

 Yes: Suspension, tablet


Canadian Brand Names

 Ciloxan®; Cipro®; Cipro® XL


Use

Children: Complicated urinary tract infections and pyelonephritis due to E. coli . Note: Although effective, ciprofloxacin is not the drug of first choice in children.

Children and adults: To reduce incidence or progression of disease following exposure to aerolized Bacillus anthracis . Ophthalmologically, for superficial ocular infections (corneal ulcers, conjunctivitis) due to susceptible strains

Adults: Treatment of the following infections when caused by susceptible bacteria: Urinary tract infections; acute uncomplicated cystitis in females; chronic bacterial prostatitis; lower respiratory tract infections (including acute exacerbations of chronic bronchitis); acute sinusitis; skin and skin structure infections; bone and joint infections; complicated intra-abdominal infections (in combination with metronidazole); infectious diarrhea; typhoid fever due to Salmonella typhi (eradication of chronic typhoid carrier state has not been proven); uncomplicated cervical and urethra gonorrhea (due to N. gonorrhoeae ); nosocomial pneumonia; empirical therapy for febrile neutropenic patients (in combination with piperacillin)


Use - Dental

 Useful as a single agent or in combination with metronidazole in the treatment of periodontitis associated with the presence of Actinobacillus actinomycetemcomitans (AA), as well as enteric rods/pseudomonads


Use - Unlabeled/Investigational

 Acute pulmonary exacerbations in cystic fibrosis (children); cutaneous/gastrointestinal/oropharyngeal anthrax (treatment, children and adults); disseminated gonococcal infection (adults); chancroid (adults); prophylaxis to Neisseria meningitidis following close contact with an infected person


Pregnancy Risk Factor

 C


Pregnancy Implications

 Ciprofloxacin crosses the placenta and concentrates in amniotic fluid; maternal serum levels may be decreased during pregnancy. Reports of arthropathy (observed in immature animals and reported rarely in humans) have limited the use of fluoroquinolones in pregnancy. According to the FDA, the Teratogen Information System concluded that therapeutic doses during pregnancy are unlikely to produce substantial teratogenic risk, but data are insufficient to say that there is no risk. In general, reports of exposure have been limited to short durations of therapy in the first trimester. When considering treatment for life-threatening infection and/or prolonged duration of therapy (such as in anthrax), the potential risk to the fetus must be balanced against the severity of the potential illness.


Lactation

 Enters breast milk/not recommended (AAP rates "compatible")


Contraindications

 Hypersensitivity to ciprofloxacin, any component of the formulation, or other quinolones


Warnings/Precautions

 CNS stimulation may occur (tremor, restlessness, confusion, and very rarely hallucinations or seizures). Use with caution in patients with known or suspected CNS disorder. Prolonged use may result in superinfection. Tendon inflammation and/or rupture have been reported with ciprofloxacin and other quinolone antibiotics. Risk may be increased with concurrent corticosteroids, particularly in the elderly. Discontinue at first sign of tendon inflammation or pain. Adverse effects, including those related to joints and/or surrounding tissues, are increased in pediatric patients. Rare cases of peripheral neuropathy may occur.

Severe hypersensitivity reactions, including anaphylaxis, have occurred with quinolone therapy. Quinolones may exacerbate myasthenia gravis, use with caution (rare, potentially life-threatening weakness of respiratory muscles may occur). Use caution in renal impairment. Avoid excessive sunlight; may cause moderate-to-severe phototoxicity reactions.


Adverse Reactions

1% to 10%:

Central nervous system: Neurologic events (children 2%, includes dizziness, insomnia, nervousness, somnolence); fever (children 2%); headache (I.V. administration); restlessness (I.V. administration)

Dermatologic: Rash (children 2%, adults 1%)

Gastrointestinal: Nausea (children/adults 3%); diarrhea (children 5%, adults 2%); vomiting (children 5%, adults 1%); abdominal pain (children 3%, adults <1%); dyspepsia (children 3%)

Hepatic: ALT/AST increased (adults 1%)

Local: Injection site reactions (I.V. administration)

Respiratory: Rhinitis (children 3%)

<1%: Abnormal gait, acute renal failure, agitation, allergic reactions, anaphylaxis, anemia, angina pectoris, angioedema, anorexia, arthralgia, ataxia, atrial flutter, breast pain, bronchospasm, candidiasis, cardiopulmonary arrest, cerebral thrombosis, chills, cholestatic jaundice, confusion, chromatopsia, crystalluria (particularly in alkaline urine), cylindruria, depersonalization, depression, dizziness, drowsiness, dyspnea, edema, eosinophilia, erythema nodosum, fever (adults), gastrointestinal bleeding, hallucinations, headache (oral), hematuria, hyperpigmentation, hyper-/hypotension, insomnia, interstitial nephritis, intestinal perforation, irritability, joint pain, laryngeal edema, lightheadedness, lymphadenopathy, malaise, manic reaction, migraine, MI, nephritis, nightmares, palpitation, paranoia, paresthesia, peripheral neuropathy, petechia, photosensitivity, pulmonary edema, seizure, syncope, tachycardia, thrombophlebitis, tinnitus, tremor, urethral bleeding, vaginitis, ventricular ectopy, visual disturbance, weakness

Postmarketing and/or case reports: Agranulocytosis, albuminuria, anosmia, bone marrow depression (life-threatening), candiduria, constipation, delirium, dyspepsia (adults), dysphagia, erythema multiforme, exfoliative dermatitis, fixed eruption, flatulence, hemolytic anemia, hepatic failure, hepatic necrosis, hyperesthesia, hyperglycemia, hypertonia, jaundice, methemoglobinemia, moniliasis, myalgia, myasthenia gravis, myoclonus, nystagmus, orthostatic hypotension, pancreatitis, pancytopenia (life-threatening or fatal), prolongation of PT/INR, pseudomembranous colitis, psychosis, renal calculi, serum cholesterol increased, serum glucose increased, serum sickness-like reactions, serum triglycerides increased, Stevens-Johnson syndrome, taste loss, tendon rupture, tendonitis, toxic epidermal necrolysis, torsade de pointes, twitching, vaginal candidiasis, vasculitis


Overdosage/Toxicology

 Symptoms of overdose include acute renal failure and seizures. Treatment is supportive. The drug is not removed by peritoneal or hemodialysis.


Drug Interactions

 Inhibits CYP1A2 (strong), 3A4 (weak)

Caffeine: Ciprofloxacin may decrease the metabolism of caffeine

Corticosteroids: Concurrent use may increase the risk of tendon rupture, particularly in elderly patients (overall incidence rare).

CYP1A2 substrates: Ciprofloxacin may increase the levels/effects of CYP1A2 substrates. Example substrates include aminophylline, fluvoxamine, mexiletine, mirtazapine, ropinirole, and trifluoperazine.

Foscarnet: Concomitant use with ciprofloxacin has been associated with an increased risk of seizures.

Glyburide: Quinolones may increase the effect of glyburide. Monitor

Metal cations (aluminum, calcium, iron, magnesium, and zinc) bind quinolones in the gastrointestinal tract and inhibit absorption. Concurrent administration of most antacids, oral electrolyte supplements, quinapril, sucralfate, and some didanosine formulations (chewable/buffered tablets and pediatric powder for oral suspension) should be avoided. Ciprofloxacin should be administered 2 hours before or 6 hours after these agents.

Methotrexate: Ciprofloxacin may decrease renal secretion of methotrexate; monitor.

Phenytoin: Ciprofloxacin may decrease phenytoin levels; monitor.

Probenecid: May decrease renal secretion of quinolones.

Ropivacaine: Ciprofloxacin may decrease the metabolism of ropivacaine.

Theophylline: Serum levels may be increased by ciprofloxacin; in addition, CNS stimulation/seizures may occur at lower theophylline serum levels due to additive CNS effects.

Warfarin: The hypoprothrombinemic effect of warfarin may be enhanced by ciprofloxacin; monitor INR.


Ethanol/Nutrition/Herb Interactions

Food: Food decreases rate, but not extent, of absorption. Ciprofloxacin serum levels may be decreased if taken with dairy products or calcium-fortified juices. Ciprofloxacin may increase serum caffeine levels if taken with caffeine.

Enteral feedings may decrease plasma concentrations of ciprofloxacin probably by >30% inhibition of absorption. Ciprofloxacin should not be administered with enteral feedings. The feeding would need to be discontinued for 1-2 hours prior to and after ciprofloxacin administration. Nasogastric administration produces a greater loss of ciprofloxacin bioavailability than does nasoduodenal administration.

Herb/Nutraceutical: Avoid dong quai, St John's wort (may also cause photosensitization).


Stability

Injection:

Premixed infusion: Store between 5°C to 25°C (41°F to 77°F); protect from light; avoid freezing.

Vial: Store between 5°C to 30°C (41°F to 86°F); protect from light; avoid freezing. May be diluted with NS, D5W, SWFI, D10W, D5 1 /4NS, D5 1 /2NS, LR. Diluted solutions of 0.5-2 mg/mL are stable for up to 14 days refrigerated or at room temperature.

Ophthalmic solution/ointment: Store at 36°F to 77°F (2°C to 25°C); protect from light.

Microcapsules for oral suspension: Prior to reconstitution, store below 25°C (77°F); protect from freezing. Following reconstitution, store below 30°C (86°F) for up to 14 days; protect from freezing.

Tablet:

Immediate release: Store below 30°C (86°F).

Extended release: Store at room temperature of 15°C to 30°C (59°F to 86°F).


Compatibility

 Stable in D5 1 /4NS, D5 1 /2NS, D5W, D10W, LR, NS; variable stability (consult detailed reference) in peritoneal dialysis solution

Y-site administration: Compatible: Amifostine, amino acids (dextrose), aztreonam, calcium gluconate, ceftazidime, cisatracurium, clarithromycin, digoxin, diltiazem, diphenhydramine, dobutamine, docetaxel, dopamine, doxorubicin liposome, etoposide phosphate, gemcitabine, gentamicin, granisetron, hydroxyzine, lidocaine, linezolid, lorazepam, metoclopramide, midazolam, midodrine, piperacillin, potassium acetate, potassium chloride, potassium phosphates, promethazine, ranitidine, remifentanil, Ringer's injection (lactated), sodium chloride, tacrolimus, teniposide, thiotepa, tobramycin, verapamil. Incompatible: Aminophylline, ampicillin/sulbactam, cefepime, dexamethasone sodium phosphate, furosemide, heparin, hydrocortisone sodium succinate, methylprednisolone sodium succinate, phenytoin, propofol, sodium phosphates, warfarin. Variable (consult detailed reference): Magnesium sulfate, sodium bicarbonate, teicoplanin, TPN

Compatibility when admixed: Compatible: Amikacin, aztreonam, ceftazidime, cyclosporine, gentamicin, metronidazole, netilmicin, piperacillin, potassium chloride, ranitidine, tobramycin, vitamin B complex. Incompatible: Aminophylline, clindamycin, floxacillin, heparin


Mechanism of Action

 Inhibits DNA-gyrase in susceptible organisms; inhibits relaxation of supercoiled DNA and promotes breakage of double-stranded DNA


Pharmacodynamics/Kinetics

Absorption: Oral: Immediate release tablet: Rapid (~50% to 85%)

Distribution: Vd: 2.1-2.7 L/kg; tissue concentrations often exceed serum concentrations especially in kidneys, gallbladder, liver, lungs, gynecological tissue, and prostatic tissue; CSF concentrations: 10% of serum concentrations (noninflamed meninges), 14% to 37% (inflamed meninges); crosses placenta; enters breast milk

Protein binding: 20% to 40%

Metabolism: Partially hepatic; forms 4 metabolites (limited activity)

Half-life elimination: Children: 2.5 hours; Adults: Normal renal function: 3-5 hours

Time to peak: Oral: Immediate release tablet: 0.5-2 hours; Extended release tablet: 1-2.5 hours

Excretion: Urine (30% to 50% as unchanged drug); feces (15% to 40%)


Dosage

 Note: Extended release tablets and immediate release formulations are not interchangeable. Unless otherwise specified, oral dosing reflects the use of immediate release formulations.

Children (see Warnings/Precautions):

Oral:

Complicated urinary tract infection or pyelonephritis: Children 1-17 years: 20-30 mg/kg/day in 2 divided doses (every 12 hours) for 10-21 days; maximum: 1.5 g/day

Cystic fibrosis (unlabeled use): Children 5-17 years: 40 mg/kg/day divided every 12 hours administered following 1 week of I.V. therapy has been reported in a clinical trial; total duration of therapy: 10-21 days

Anthrax:

Inhalational (postexposure prophylaxis): 15 mg/kg/dose every 12 hours for 60 days; maximum: 500 mg/dose

Cutaneous (treatment, CDC guidelines): 10-15 mg/kg every 12 hours for 60 days (maximum: 1 g/day); amoxicillin 80 mg/kg/day divided every 8 hours is an option for completion of treatment after clinical improvement. Note: In the presence of systemic involvement, extensive edema, lesions on head/neck, refer to I.V. dosing for treatment of inhalational/gastrointestinal/oropharyngeal anthrax

I.V.:

Complicated urinary tract infection or pyelonephritis: Children 1-17 years: 6-10 mg/kg every 8 hours for 10-21 days (maximum: 400 mg/dose)

Cystic fibrosis (unlabeled use): Children 5-17 years: 30 mg/kg/day divided every 8 hours for 1 week, followed by oral therapy, has been reported in a clinical trial

Anthrax:

Inhalational (postexposure prophylaxis): 10 mg/kg/dose every 12 hours for 60 days; do not exceed 400 mg/dose (800 mg/day)

Inhalational/gastrointestinal/oropharyngeal (treatment, CDC guidelines): Initial: 10-15 mg/kg every 12 hours for 60 days (maximum: 500 mg/dose); switch to oral therapy when clinically appropriate; refer to Adults dosing for notes on combined therapy and duration

Adults: Oral:

Urinary tract infection:

Acute uncomplicated: Immediate release formulation: 100 mg or 250 mg every 12 hours for 3 days

Acute uncomplicated pyelonephritis: Extended release formulation: 1000 mg every 24 hours for 7-14 days

Uncomplicated/acute cystitis: Extended release formulation: 500 mg every 24 hours for 3 days

Mild/moderate: Immediate release formulation: 250 mg every 12 hours for 7-14 days

Severe/complicated:

Immediate release formulation: 500 mg every 12 hours for 7-14 days

Extended release formulation: 1000 mg every 24 hours for 7-14 days

Lower respiratory tract, skin/skin structure infections: 500-750 mg twice daily for 7-14 days depending on severity and susceptibility

Bone/joint infections: 500-750 mg twice daily for 4-6 weeks, depending on severity and susceptibility

Infectious diarrhea: 500 mg every 12 hours for 5-7 days

Intra-abdominal (in combination with metronidazole): 500 mg every 12 hours for 7-14 days

Typhoid fever: 500 mg every 12 hours for 10 days

Urethral/cervical gonococcal infections: 250-500 mg as a single dose (CDC recommends concomitant doxycycline or azithromycin due to developing resistance; avoid use in Asian or Western Pacific travelers)

Disseminated gonococcal infection (CDC guidelines): 500 mg twice daily to complete 7 days of therapy (initial treatment with ceftriaxone 1 g I.M./I.V. daily for 24-48 hours after improvement begins)

Chancroid (CDC guidelines): 500 mg twice daily for 3 days

Sinusitis (acute): 500 mg every 12 hours for 10 days

Chronic bacterial prostatitis: 500 mg every 12 hours for 28 days

Anthrax:

Inhalational (postexposure prophylaxis): 500 mg every 12 hours for 60 days

Cutaneous (treatment, CDC guidelines): Immediate release formulation: 500 mg every 12 hours for 60 days. Note: In the presence of systemic involvement, extensive edema, lesions on head/neck, refer to I.V. dosing for treatment of inhalational/gastrointestinal/oropharyngeal anthrax

Adults: I.V.:

Bone/joint infections:

Mild to moderate: 400 mg every 12 hours for 4-6 weeks

Severe or complicated: 400 mg every 8 hours for 4-6 weeks

Lower respiratory tract, skin/skin structure infections:

Mild to moderate: 400 mg every 12 hours for 7-14 days

Severe or complicated: 400 mg every 8 hours for 7-14 days

Nosocomial pneumonia (mild to moderate to severe): 400 mg every 8 hours for 10-14 days

Prostatitis (chronic, bacterial): 400 mg every 12 hours for 28 days

Sinusitis (acute): 400 mg every 12 hours for 10 days

Urinary tract infection:

Mild to moderate: 200 mg every 12 hours for 7-14 days

Severe or complicated: 400 mg every 12 hours for 7-14 days

Febrile neutropenia (with piperacillin): 400 mg every 8 hours for 7-14 days

Intra-abdominal infection (with metronidazole): 400 mg every 12 hours for 7-14 days

Anthrax:

Inhalational (postexposure prophylaxis): 400 mg every 12 hours for 60 days

Inhalational/gastrointestinal/oropharyngeal (treatment, CDC guidelines): 400 mg every 12 hours. Note: Initial treatment should include two or more agents predicted to be effective (per CDC recommendations). Agents suggested for use in conjunction with ciprofloxacin or doxycycline include rifampin, vancomycin, imipenem, penicillin, ampicillin, chloramphenicol, clindamycin, and clarithromycin. May switch to oral antimicrobial therapy when clinically appropriate. Continue combined therapy for 60 days.

Elderly: No adjustment needed in patients with normal renal function

Ophthalmic:

Solution: Children >1 year and Adults:

Bacterial conjunctivitis: Instill 1-2 drops in eye(s) every 2 hours while awake for 2 days and 1-2 drops every 4 hours while awake for the next 5 days

Corneal ulcer: Instill 2 drops into affected eye every 15 minutes for the first 6 hours, then 2 drops into the affected eye every 30 minutes for the remainder of the first day. On day 2, instill 2 drops into the affected eye hourly. On days 3-14, instill 2 drops into affected eye every 4 hours. Treatment may continue after day 14 if re-epithelialization has not occurred.

Ointment: Children >2 years and Adults: Bacterial conjunctivitis: Apply a 1 /2" ribbon into the conjunctival sac 3 times/day for the first 2 days, followed by a 1 /2" ribbon applied twice daily for the next 5 days

Dosing adjustment in renal impairment: Adults:

Clcr 30-50 mL/minute: Oral: 250-500 mg every 12 hours

Clcr<30 mL/minute: Acute uncomplicated pyelonephritis or complicated UTI: Oral: Extended release formulation: 500 mg every 24 hours

Clcr 5-29 mL/minute:

Oral: 250-500 mg every 18 hours

I.V.: 200-400 mg every 18-24 hours

Dialysis: Only small amounts of ciprofloxacin are removed by hemo- or peritoneal dialysis (<10%); usual dose: Oral: 250-500 mg every 24 hours following dialysis

Continuous arteriovenous or venovenous hemodiafiltration effects: Administer 200-400 mg I.V. every 12 hours


Administration

Oral: May administer with food to minimize GI upset; avoid antacid use; maintain proper hydration and urine output. Administer at least 2 hours before or 6 hours after antacids or other products containing calcium, iron, or zinc (including dairy products or calcium-fortified juices). Separate oral administration from drugs which may impair absorption (see Drug Interactions).

Oral suspension: Should not be administered through feeding tubes (suspension is oil-based and adheres to the feeding tube). Patients should avoid chewing on the microcapsules.

Nasogastric/orogastric tube: Crush immediate-release tablet and mix with water. Flush feeding tube before and after administration. Hold tube feedings at least 1 hour before and 2 hours after administration.

Tablet, extended release: Do not crush, split, or chew. May be administered with meals containing dairy products (calcium content <800 mg), but not with dairy products alone.

Parenteral: Administer by slow I.V. infusion over 60 minutes to reduce the risk of venous irritation (burning, pain, erythema, and swelling); final concentration for administration should not exceed 2 mg/mL


Monitoring Parameters

 Patients receiving concurrent ciprofloxacin, theophylline, or cyclosporine should have serum levels monitored; CBC, renal and hepatic function during prolonged therapy


Reference Range

 Therapeutic: 2.6-3 mcg/mL; Toxic: >5 mcg/mL


Dietary Considerations

Food: Drug may cause GI upset; take without regard to meals (manufacturer prefers that immediate release tablet is taken 2 hours after meals). Extended release tablet may be taken with meals that contain dairy products (calcium content <800 mg), but not with dairy products alone.

Dairy products, calcium-fortified juices, oral multivitamins, and mineral supplements: Absorption of ciprofloxacin is decreased by divalent and trivalent cations. The manufacturer states that the usual dietary intake of calcium (including meals which include dairy products) has not been shown to interfere with ciprofloxacin absorption. Ciprofloxacin may be taken 2 hours before or 6 hours after any of these products.

Caffeine: Patients consuming regular large quantities of caffeinated beverages may need to restrict caffeine intake if excessive cardiac or CNS stimulation occurs.


Patient Education

 Inform prescriber of all prescriptions, OTC medications, or herbal products you are taking, and any allergies you have. Do not take any new medication during therapy unless approved by prescriber. Take exactly as directed, preferably on an empty stomach (2 hours after meals and at least 2 hours before or 6 hours after antacids or other drug products containing calcium, iron, or zinc) to reduce GI upset. Extended release tablet may be taken with meals containing dairy products, but not with dairy products alone; do not crush, split, or chew extended release tablet. Swallow oral suspension; do not chew microcapsules. Shake bottle vigorously with each use. Take entire prescription, even if feeling better. Maintain adequate hydration to avoid concentrated urine and crystal formation (2-3 L/day) unless instructed to restrict fluid intake. You may experience nausea, vomiting, or anorexia (small, frequent meals, frequent mouth care, sucking lozenges, or chewing gum may help); or increased sensitivity to sunlight (use sunscreen, wear protective clothing and dark glasses, and avoid direct exposure to sunlight). If signs of inflammation or tendon pain occur, discontinue use immediately and report to prescriber. If signs of allergic reaction (eg, itching urticaria, respiratory difficulty, facial edema, difficulty swallowing, loss of consciousness, tingling, chest pain, palpitations) occur, discontinue use immediately and report to prescriber. Report unusual fever or chills, vaginal itching or foul-smelling vaginal discharge, easy bruising or bleeding, or tendon or muscle pain. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Do not breast-feed.


Anesthesia and Critical Care Concerns/Other Considerations

 Ciprofloxacin may increase theophylline levels resulting in relevant cardiovascular side effects, including tachycardia.


Cardiovascular Considerations

 Ciprofloxacin may increase theophylline levels resulting in relevant cardiovascular side effects, including tachycardia.


Dental Health: Effects on Dental Treatment

 No significant effects or complications reported


Dental Health: Vasoconstrictor/Local Anesthetic Precautions

 No information available to require special precautions


Mental Health: Effects on Mental Status

 Convulsions and toxic psychosis have been reported with quinolones. May cause dizziness, confusion, hallucinations, depression and rarely suicidal ideation and attempts. These reactions may occur after the first dose. Discontinue drug and institute safety measures. Ciprofloxacin may also cause nervousness, agitation, insomnia, anxiety, nightmares or paranoia, phobia, depersonalization, manic reaction, ataxia, irritability, and drowsiness.


Mental Health: Effects on Psychiatric Treatment

 Inhibits CYP1A2 isoenzyme; use caution with clozapine; monitor for adverse effects. May rarely cause agranulocytosis; monitor with clozapine and carbamazepine. Use caution in patients with CNS disorders that may predispose them to seizures (epilepsy, alcohol/sedative hypnotic withdrawal).


Oncology: Emetic Potential

 Very low (<10%)


Oncology: Vesicant

 No


Dosage Forms

Infusion, [premixed in D5W] (Cipro®): 200 mg (100 mL); 400 mg (200 mL) [latex free]

Injection, solution (Cipro®): 10 mg/mL (20 mL, 40 mL, 120 mL)

Microcapsules for oral suspension (Cipro®): 250 mg/5 mL (100 mL); 500 mg/5 mL (100 mL) [strawberry flavor]

Ointment, ophthalmic, as hydrochloride (Ciloxan®): 3.33 mg/g [0.3% base] (3.5 g)

Solution, ophthalmic, as hydrochloride (Ciloxan®): 3.5 mg/mL [0.3% base] (2.5 mL, 5 mL, 10 mL) [contains benzalkonium chloride]

Tablet [film coated]: 250 mg, 500 mg, 750 mg

Cipro®: 100 mg, 250 mg, 500 mg, 750 mg

Tablet, extended release [film coated] (Cipro® XR): 500 mg [equivalent to ciprofloxacin hydrochloride 287.5 mg and ciprofloxacin base 212.6 mg]; 1000 mg [equivalent to ciprofloxacin hydrochloride 574.9 mg and ciprofloxacin base 425.2 mg]


References

Abramowicz M, "Antimicrobial Prophylaxis in Surgery," Medical Letter on Drugs and Therapeutics, Handbook of Antimicrobial Therapy , 16th ed, New York, NY: Medical Letter, 2002.

"American Academy of Pediatrics Committee on Drugs. The Transfer of Drugs and Other Chemicals Into Human Milk," Pediatrics , 2001, 108(3):776-89.

Bayer A, Gajewska A, Stephens M, et al, "Pharmacokinetics of Ciprofloxacin in the Elderly," Respiration , 1987, 51(4):292-5.

Campoli-Richards DM, Monk JP, Price A, et al, "Ciprofloxacin: A Review of Its Antibacterial Activity, Pharmacokinetic Properties and Therapeutic Use," Drugs , 1988, 35(4):373-447.

Centers for Disease Control and Prevention, "Prevention and Control of Meningococcal Disease. Recommendations of the Advisory Committee on Immunization Practices (ACIP)," MMWR Recomm Rep , 2000, 49(RR-7):1-10. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4907a1.htm. Accessed May 5, 2004.

Centers for Disease Control and Prevention, "Sexually Transmitted Diseases Treatment Guidelines - 2002," MMWR Recomm Rep , 2002, 51(RR-6):1-80. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5106a1.htm. Accessed May 5, 2004.

Centers for Disease Control and Prevention, "Update: Investigation of Bioterrorism-Related Anthrax and Interim Guidelines for Exposure Management and Antimicrobial Therapy, October 2001," MMWR Morb Mortal Wkly Rep , October 26, 2001, 50(42):909-19. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5042a1.htm. Accessed October 26, 2001.

Chung AM, Reed MD, and Blumer JL, "Antibiotics and Breast-feeding: A Critical Review of the Literature," Paediatr Drugs , 2002, 4(12):817-37.

Cohen H and Francisco DH, "Twelve Gram Overdose of Ciprofloxacin With Mild Symptomatology," Ann Pharmacother , 1994, 28(6):805-6.

Davies SP, Azadian BS, Kox WJ, et al, "Pharmacokinetics of Ciprofloxacin and Vancomycin in Patients With Acute Renal Failure Treated by Continuous Haemodialysis," Nephrol Dial Transplant , 1992, 7(8):848-54.

Davis R, Markham A, and Balfour JA, "Ciprofloxacin. An Updated Review of Its Pharmacology, Therapeutic Efficacy and Tolerability," Drugs , 1996, 51(6):1019-74.

Food and Drug Administration (FDA), "CIPRO (Ciprofloxacin) Use by Pregnant and Lactating Women," available at http://www.fda.gov/cder/drug/infopage/cipro/cipropreg.htm. Last accessed August 9, 2004.

Fish DN, Bainbridge JL, and Peloquin CA, "Variable Disposition of Ciprofloxacin in Critically Ill Patients Undergoing Continuous Arteriovenous Hemodiafiltration," Pharmacotherapy , 1995, 15(2):236-45.

Gamboa F, Rivera JM, Gomez Mateos JM, et al, "Ciprofloxacin-Induced Henoch-Sch&ouml;nlein Purpura," Ann Pharmacother , 1995, 29(1):84.

Giamarellou H, Kolokythas E, Petrikkos G, et al, "Pharmacokinetics of Three Newer Quinolones in Pregnant and Lactating Women," Am J Med , 1989, 87(Suppl 5A):49-51.

Guay DRP, Awni WM, Peterson PK, et al, "Single and Multiple Dose Pharmacokinetics of Oral Ciprofloxacin in Elderly Patients," Int J Clin Pharmacol Ther Toxicol , 1988, 26(6):279-84.

Guharoy SR, "Serum Sickness Secondary to Ciprofloxacin Use," Vet Hum Toxicol , 1994, 36(6):540-1.

Hoogkamp-Korstanje JA, " In vitro Activities of Ciprofloxacin, Levofloxacin, Lomefloxacin, Ofloxacin, Pefloxacin, Sparfloxacin, and Trovafloxacin Against Gram-Positive and Gram-Negative Pathogens From Respiratory Tract Infections," J Antimicrob Chemother , 1997, 40(3):427-31.

Hooper DC and Wolfson JS, "Fluoroquinolone Antimicrobial Agents," N Engl J Med , 1991, 324(6):384-94.

Kapila K, Chysky V, Hullman R, et al, "Worldwide Clinical Experience on Safety of Ciprofloxacin in Children on Compassionate Use Basis," Proceedings of Third International Symposium on New Quinolones , Vancouver, Canada, 1990, 9.

Loebstein R, Lalkin A, Addis A, et al, "Pregnancy Outcome After Gestational Exposure to Terfenadine: A Multicenter, Prospective Controlled Study," J Allergy Clin Immunol , 1999, 104(5):953-6.

Lomaestro BM and Bailie GR, "Quinolone-Cation Interactions: A Review," DICP , 1991, 25(11):1249-58.

Mackay AD and Mehta A, "Autoimmune Haemolytic Anemia Associated With Ciprofloxacin," Clin Lab Haematol , 1995, 17(1):97-8.

Mulhall JP and Bergmann LS, "Ciprofloxacin-Induced Acute Psychosis," Urology , 1995, 46(1):102-3.

Nilsson-Ehle I and Ljungberg B, "Quinolone Disposition in the Elderly: Practical Implications," Drugs Aging , 1991, 1(4):279-88.

Paul J and Brown NM, "Tinnitus and Ciprofloxacin," BMJ , 1995, 311(6999):232.

Rams TE and Slots J, "Antibiotics in Periodontal Therapy: An Update," Compendium , 1992, 13(12):1130, 1132, 1134.

Rfidah EI, Findlay CA, and Beattie TJ, "Reversible Encephalopathy After Intravenous Ciprofloxacin Therapy," Pediatr Nephrol , 1995, 9(2):250-1.

Rodriguez WJ, and Wiedermann BL, "The Role of Newer Oral Cephalosporins, Fluoroquinolones, and Macrolides in the Treatment of Pediatric Infections," Adv Pediatr Infect Dis , 1994, 9:125-59.

Rubio TT, Miles MV, Lettieri JT, et al, "Pharmacokinetic Disposition of Sequential Intravenous/Oral Ciprofloxacin in Pediatric Cystic Fibrosis Patients with Acute Pulmonary Exacerbation," Pediatr Infect Dis J , 1997, 16:112-7

Sanders CC, "Ciprofloxacin: In Vitro Activity, Mechanism of Action, and Resistance," Rev Infect Dis , 1988, 10(3):516-27.

Schaad UB, abdus Salam M, Aujard Y, et al, "Use of Fluoroquinolones in Pediatrics: Consensus Report of an International Society of Chemotherapy Commission," Pediatr Infect Dis J , 1995, 14(1):1-9.

Stein GE, "The 4-Quinolone Antibiotics: Past, Present, and Future," Pharmacotherapy , 1988, 8(6):301-14.

Sudip RG, "Serum Sickness Secondary to Ciprofloxacin Use," Vet Hum Toxicol , 36(6):540-1, 1994.

Szarfman A, Chen M, and Blum MD, "More on Fluoroquinolone Antibiotics and Tendon Rupture," N Engl J Med , 1995, 332(3):193.

Villenueve JP, Davies C, and Cote J, "Suspected Ciprofloxacin-Induced Hepatotoxicity," Ann Pharmacother , 1995, 29(3):257-9.

Walker RC and Wright AJ, "The Fluoroquinolones," Mayo Clin Proc , 1991, 66(12):1249-59.

Yew WW, Chau CH, Wong PC, et al, "Ciprofloxacin-Induced Renal Dysfunction in Patients With Mycobacterial Lung Infections," Tuber Lung Dis , 1995, 76(2):173-5.


International Brand Names

 Aceoto® (ES); Aceoto Otologico® (ES); Adco-Ciprin® (ZA); Aflox® (CO); Agyr® (AT); Alcon cilox® (CO, EC, ID); Amiflox® (BD); Ancipro® (BD); Aprocin® (BD); Argeflox® (AR); Aristin-C ® (RO); Atibax C® (AR); Bactiflox® (EC, SI); Bactiflox Lactab® (EG, KW); Bactin® (BD); Bactoflox® (BR); Baquinor® (ID); Baycip® (CL, ES); Belmacina® (ES); Bernoflox® (ID); Biamotil® (BR); Bidiprox® (ID); Carmicina® (PT); Catex® (ES); Ceprimax® (ES); Cetafloxo® (ID); Cetraxal® (CR, DO, ES, GT, HN, PA, SV); Cetraxal Otico® (CR, DO, ES, GT, HN, PA, SV); C-Floxacin® (TH); Cichinol® (RO); Cifin® (DK); Ciflan® (PT); Cifloc® (ZA); Ciflolan® (TH); Ciflos® (ID); Ciflosin® (TR); Cifloxal® (CO); Ciflox® (AT, BD, BR, FR); Cifloxinal® (CZ, RU); Cifloxin® (CL, EC, TH); Ciflox® [inj.] (BR, FR); Cifran® (CZ, HU, IN, PL, RO, RU, TH, ZA); Cigram® (CO); Cilab® (TH); Cilobact® (CO); Cilocin® (BD); CiloQuin® (AU); Ciloxacin® (CL); Ciloxan® (AR, AT, AU, BD, BE, BR, CA, CH, CZ, DE, DK, FR, GB, HU, IL, LU, NL, NZ, PL, RO, RU, SE, SG, SI, TH, TR, ZA); Cilox® (NO); Cimogal® (MX); Cimoxen® (CO); Cinfloxine® (TH); Cinoflax® (BR); Cip eco® (CH); Cipflocin® (TH); Cipflox® (NZ); Ciphin® (CZ, PL, RO); Cipla-Ciprofloxacin® (ZA); Ciplox® (IL, IN, PT, RO); Ciplox® [inj.] (CZ, IN); Ciploxx® (ZA); Cipobacter® (ES); Cipran® (EC); Ciprasid® (TR); Ciprecu® (EC); Ciprenit Otico® (ES); Ciprin® (CH); Ciprinol® (CZ, HR, PL, RO, RU, SI); Ciprinol® [inj.] (CZ, RO, SI); Cipro 1A Pharma® (DE); Cipro-A® (BD); Cipro-acis® (DE); Cipro® (AR, BR, CA, CO); Cipro Basics® (DE); Ciprobay® (CY, CZ, DE, EG, HR, HU, JO, KW, LB, MT, PL, RO, RU, SG, SI, TH, YU, ZA); Ciprobay® [inj.] (CZ, DE, RO, SG, TH); Ciprobay Uro® (SI); Ciprobeta® (DE); Ciprobid Eye Drops® (IN); Ciprobid® [inj.] (IN); Ciprobid® (IN, RO); Ciprobiotic® (DO); Ciprobiotic® [tabs] (MX); Cipro-C® (BD); Ciprocep® (TH); Ciprocinal® (RO, YU); Ciprocin® (BD, BR, EG, JO, KW, LB, RO); Ciprocore® (RO); Ciprocynal® (RU); Ciprodar® (HK, JO, KW, LB, MT, MY, RO); Ciprodoc® (DE); ciprodura® (DE); Ciprofar® (BR); Ciprofat® (DE); Ciprofel® (DO); Ciprofin® (TH); Ciprofloksacin® (YU); Ciprofloxacin 1A Farma® (DK); Ciprofloxacin 1A Pharma® (AT); Ciprofloxacin "2K"® (DK); Ciprofloxacina 200 Soluflex® (AR); Ciprofloxacina Alpharma® (PT); Ciprofloxacina Biochemie® (CO, FI); Ciprofloxacina Biocrom® (AR); Ciprofloxacina® (BR, CR, DO); Ciprofloxacin AbZ® (DE); Ciprofloxacina Calox® (CR, PA); Ciprofloxacina Ciclum® (PT); Ciprofloxacin ACO® (SE); Ciprofloxacina Denver Farma® (AR); Ciprofloxacina Duncan® (AR); Ciprofloxacina Fabra® (AR); Ciprofloxacina Fada® (AR); Ciprofloxacina Lazar® (AR); Ciprofloxacina Lazar® [compr.] (AR); Ciprofloxacin AL® (DE); Ciprofloxacin Alpharma® (DK); Ciprofloxacina Merck® (PT); Ciprofloxacina MK® (CO); Ciprofloxacina Northia® (AR); Ciprofloxacina Northia® [inj.] (AR); Ciprofloxacin Arcana® (AT); Ciprofloxacina Richet® (AR); Ciprofloxacina Richet® [inj.] (AR); Ciprofloxacina Rigar® (PA); Ciprofloxacin AWD® (DE); Ciprofloxacin-axsan® (DE); Ciprofloxacin AZU® (DE); Ciprofloxacin® (BG); Ciprofloxacin Biochemie® (DK, FI, SE); Ciprofloxacin Copyfarm® (DK); Ciprofloxacin® (GB, NO, RO, RU); Ciprofloxacin GEA® (DK, FI, SE); Ciprofloxacin Genericon® (AT); Ciprofloxacin Generics® (FI); Ciprofloxacin HelvePharm® (CH); Ciprofloxacin Heumann® (DE); Ciprofloxacin Hexal® (AT); Ciprofloxacin "Hexal"® (AT); Ciprofloxacin Hexpharm® (ID); Ciprofloxacin Indo Farma® (ID); Ciprofloxacin Interpharm® (AT); Ciprofloxacin KSK® (DE); Ciprofloxacin-Mepha® (CH); Ciprofloxacin NM Pharma® (SE); Ciprofloxacino Alter® (ES); Ciprofloxacino Cinfa® (ES); Ciprofloxacino® (CL, CO, EC); Ciprofloxacino Davur® (ES); Ciprofloxacino Edigen® (ES); Ciprofloxacino Geminis® (ES); Ciprofloxacino Generix® (ES); Ciprofloxacino Genfar® (EC); Ciprofloxacino Grapa® (ES); Ciprofloxacino IFE® (ES); Ciprofloxacino Kern® (ES); Ciprofloxacino Lareq® (ES); Ciprofloxacino Lasa® (ES); Ciprofloxacino L.CH.® (CL); Ciprofloxacino Mabo® (ES); Ciprofloxacino Merck® (ES); Ciprofloxacino MK® (CR, GT, HN, PA, SV); Ciprofloxacino Normon® (ES); Ciprofloxacino Ratiopharm® (ES); Ciprofloxacino Ur® (ES); Ciprofloxacino Vegal® (ES); Ciprofloxacino Vir® (ES); Ciprofloxacin Ranbaxy® (FI, SE); Ciprofloxacin ratiopharm® (AT); Ciprofloxacin-ratiopharm® (DE); Ciprofloxacin ratiopharm® (DK, FI); Ciprofloxacin real® (DE); Ciprofloxacin Sandoz® (CH, DE); Ciprofloxacin Stada® (DE, SE); Ciprofloxacin TAD® (DE); Ciprofloxacin-Teva® (IL); Ciproflox® (BG, CH, JO, KW, LB, MA, MX, MY, SV, SY); Ciproflox® [inj.] (MX); Ciproflox-Puren® (DE); ciproflox von ct® (DE); Ciprofur® [tabs] (MX); Ciprogamma® (DE); Ciprogen® (TH, ZA); Ciprogis® (IL); Ciproglen® (TH); Ciprohexal® (DE); Cipro-Hexal® (ZA); Cipro® [inj.] (AR, CO); Cipro-Kron® (EC); Ciproktan® (TR); Ciprol® (BD); Ciprolet® [inj.] (RO, TH); Ciprolet® (RO, RU, TH); Cipro-Lich® (DE); Ciprolon® (EG, JO, KW, LB, SY, TR); CiproMed® (AT); Cipro-Med® (CH); CiproMed® (FI); Cipromed® (HR, RU); Cipromet® (BD); Ciprom-H® (TH); Cipronex® (PL); Cipro Otico® (AR); Cipropol® (PL); Cipro-Q® (DE); Cipro-Saar® (DE); Ciprostad® (AT); Ciprosun® (RU, TH); Ciprotenk® (AR); Ciproval® (CL, EC); Ciproval Oftalmico® (CL); Ciproval Otico® (CL); Ciprowin® (IN); Cipro-Wolff® (DE); Ciproxan® [inj.] (JP, TH); Ciproxan® (JP); Ciprox® (BD, DE); Ciproxil® (BR); Ciproxina® (EC, MX, PT); Ciproxina® [inj.] (MX); Ciproxin® (AT, AU, CH, DE, DK, FI, GB, HK, ID, IE, IL, IT, NL, NO, NZ, RO, SE, TR); Ciproxine® (BE, LU); Ciproxin® [inj.] (AT, AU, DK, FI, GB, HK, ID, IT, NL, NZ, TR); Cipro® XL (CA); Ciproxyl® (TH); Ciprum® (PL, SI); Cirflox-G® (AR); Ciriax® (AR); Ciriax® [compr.] (AR); Ciroxin® (SG); Citeral® (RO, YU); Civell® (ID); Cloridrato de Ciprofloxacino® (BR); Coroflox® (ID); Corsacin® (ID); CPL Alliance Ciprofloxacin® (ZA); Crisacide® (AR); Cuminol® (RO); Cunesin® (ES); Cycin® (SG); Cyflox® (TH); Cylowam® (ID); D-Floxin® (BD); Dinill® (AR); Disfabac® (ID); Doquin® (BD); Duflomex® (ID); Dumaflox® (BD); Dynafloc® (ZA); Eni® (CR, GT, HN, MX, PA, SV); Estecina® (CR, ES, GT, HN, PA, PT, SV); Euciprin® (RO); Exertial® (AR); Eypro® (BD); Felixene® (ES); Fimoflox® (ID); Fiprox® (BD); Flobact® (CO); Flociprin® [compr.] (IT); Flociprin® [inj.] (IT); Flontin® (BD); Floraxina® (AR); Floroxin® (JO, RO); Floxabid® (BD); Floxacin® (BD); Floxbio® (ID); Floxitab® (BD); Flugram® (GT, HN, PA, SV); Flunase® (AR); Flunase® [inj.] (AR); Forexin® (TH); Geflox® (BD); Girabloc® (ID); Giraflox® (GT, SV); Giraprox® (CO); Giroflox® (PT); Globuce® (ES); Grenis-Cipro® (RO); Grifociprox® (CL); Gyracip® (DE); Gyrastop® (DE); H.G. Ciprocap® (EC); HI-Flox® (BD); HI-Floxin® (BD); H-Next® (CO); Huberdoxina® (ES, YU); Ificipro® (IN); Inciflox® (ID); Interflox® (ID); Isotic Renator® (ID); Italprodin® (EC); Jayacin® (ID); Kapron® (BD); Keciflox® (DE); Keefloxin® (PT); Kenzoflex® (MX); Kifarox® (ID); Lapiflox® (ID); Libracin® (BD); Loxan® (CO); Loxasid® (TR); Lyproquin® (RU); Maprocin® (BD); Marocen® (YU); Mecoquin® (ID); Medociprin® (CZ, RO, RU); Meflosin® (ID); Megaflox® (PT); Mensipox® (ID); Microrgan® [caps] (MX); Mitroken® [tabs] (MX); Neofloxin® (BD); Nilaflox® (ID); Nivoflox® [inj.] (MX, PT); Nivoflox® [tabs] (MX); Nixin® (PT); Nor-Ciprox® (GT, SV); Novidat® (AR); Novoquin® (MX); Ocefax® (AR); Ofitin® (AR); Oftacilox® (ES, IT); Oftaciprox® (CL); Omaflaxina® (AR); Opthaflox® (MX); Orpic® (ZA); Osmoflox® (EC); Otosec® (CO); Panotile Cipro® (DE); Phaproxin® (ID); Piprol® (ES); Plenolyt® (EC, ES); Plusgin® (AR); Poli-Cifloxin® (TH); Poncoflox® (ID); Pralok® (CL); Principrox® (CH); Procin® (BD, BR); Proflox® (BR, EC, TH); Proksi® (GT, HN, SV); Protenil® (EC); Proxacin® (PL, TR); Proxitor® (ID); Q-Flox® (BD); Qilaflox® (ID); Quamiprox® (ID); Quidex® (ID); Quinobact® (IN); Quinobact® [inj.] (IN); Quinobiotic® (ID); Quinoflex® (EC); Quinoflox® (BR, MX); Quinopron® (EC, GT, HN, PA, SV); Quinox® (BD); Quintor® (PL, RO, RU); Quipro® (CZ, EC, ES, RU); Renator® (ID); Rexner® (AR); Rigoran® (ES); Robinex® (CO); Roflazin® (TR); Roxin® (TR); Sancipro® (DK); Sandoz Ciprofloxacin® (ZA); Sanset® (TR); Scanax® (ID); Seflox® (IN); Sepcen® (ES); Septicide® (AR); Septocipro® (ES); Septocipro Otico® (ES); Serviflox® (BD, TH); Sibunar® (DK); Sifloks® (RO, TR); Siprion® (FI); Siprobel® (TR); Siprogut® (TR); Siprosan® (TR); Sispres® (TR); Sophixin® (MX); Spectra® (BD); Strox® (IN); Suiflox® [tabs] (MX); Tam® (ES); Tequinol® (ID); Teriflox® (BD); Truoxin® (IE); Tyflox® (BD); Ufexil® (RO); Ultramicina® (ES); Uniflox® (FR); Uroxin® (SG, TH); Velmonit® (ES); Velmonit Otico® (ES); Vidintal® (ID); Volinol® (ID); Wiaflox® (ID); Ximex Cyclowam® (ID); Zipra® (MX); Zolina® (CR, DO, GT, HN, PA, SV); Zumaflox® (ID)


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