Drug Guide

Generic Name

Ciprofloxacin

Brand Names Cipro, Cipro In Dextrose 5% In Plastic Container, Cipro In Sodium Chloride 0.9% In Plastic Container, Ciprofloxacin In Dextrose 5%, Ciprofloxacin In Dextrose 5% In Plastic Container, Otiprio

Classification

Therapeutic: Antibacterial, fluoroquinolone

Pharmacological: Topoisomerase II (DNA gyrase) inhibitor

FDA Approved Indications

Bacterial infections caused by susceptible organisms (e.g., urinary tract infections, respiratory tract infections, skin infections, bone and joint infections, gastrointestinal infections)
Otitis media (Otiprio)

Mechanism of Action

Ciprofloxacin inhibits bacterial DNA gyrase and topoisomerase IV, enzymes critical for bacterial DNA replication, transcription, repair, and recombination, leading to bacterial cell death.

Dosage and Administration

Adult: Typically 250-750 mg every 12 hours orally or IV, depending on infection severity and site.

Pediatric: Generally approved for children ≥1 year for complicated urinary tract infections, pyelonephritis, or inhalational anthrax; dosage varies based on weight and infection.

Geriatric: Adjust dose based on renal function; monitor for increased risk of side effects.

Renal Impairment: Reduce dose and/or extend dosing interval according to creatinine clearance.

Hepatic Impairment: No specific adjustment needed, but monitor hepatic function as necessary.

Pharmacokinetics

Absorption: Well absorbed orally, with bioavailability of approximately 70%.

Distribution: Widely distributed; penetrates tissues and fluids, including cerebrospinal fluid.

Metabolism: Primarily metabolized in the liver; minimal active metabolites.

Excretion: Excreted primarily via kidneys (unchanged) and some via biliary route.

Half Life: Approximately 4 hours in healthy individuals, extended in renal impairment.

Contraindications

Hypersensitivity to ciprofloxacin or other quinolones.
History of tendon disorders related to fluoroquinolone use.

Precautions

Patients with a history of tendon disorders, myasthenia gravis, or seizure disorders.
Use with caution in elderly, renal impairment, hepatic impairment, or concomitant corticosteroid therapy.

Adverse Reactions - Common

Nausea (Common)
Diarrhea (Common)
Headache (Common)
Dizziness (Common)

Adverse Reactions - Serious

Tendon rupture or tendinitis (Rare)
Peripheral neuropathy (Rare)
QT prolongation and arrhythmias (Rare)
Hypersensitivity reactions, including anaphylaxis (Rare)

Drug-Drug Interactions

Theophylline, caffeine, tizanidine, warfarin, tinidazole, certain corticosteroids (risk of tendon rupture).

Drug-Food Interactions

Dairy products, calcium-fortified juices, and other calcium-rich foods may impair absorption.

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of infection resolution, adverse reactions, and tendon pain. Assess renal function before and during therapy.

Diagnoses:

Risk for tendon rupture related to fluoroquinolone therapy.
Risk for allergic reactions.

Implementation: Administer as prescribed, either orally or IV. Educate patient on hydration to prevent crystalluria.

Evaluation: Monitor for bacterial eradication, adverse reactions, and compliance.

Patient/Family Teaching

Take medication exactly as prescribed.
Report any tendon pain, swelling, or inflammation.
Avoid excessive sun exposure and wear sunscreen.
Complete the full course even if symptoms improve.

Special Considerations

Black Box Warnings:

Tendon rupture, tendinitis, peripheral neuropathy, and central nervous system effects.

Genetic Factors: None specifically related to ciprofloxacin.

Lab Test Interference: May interfere with some urine cultures; may cause false-positive urinary glucose tests with some dipstick methods.

Overdose Management

Signs/Symptoms: Nausea, vomiting, dizziness, confusion, seizures.

Treatment: Supportive care; gastric lavage and activated charcoal may be used if ingestion was recent; hemodialysis may be considered in severe renal impairment.

Storage and Handling

Storage: Store at room temperature, 20-25°C (68-77°F).

Stability: Stable for the duration of the expiration date when stored properly.