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IDStewardship

Ciprofloxacin

Ciprofloxacin oral

Ciprofloxacin IV

KEY POINTS

  • Ciprofloxacin (Cipro) is a fluoroquinolone antibiotic that interferes with bacterial DNA synthesis in susceptible organisms by inhbiting DNA gyrase (topoisomerase II) and topoisomerase IV
  • Possesses activity versus a variety of Gram negative bacilli, including Pseudomonas aeruginosa
    • One of the few oral antibiotics with activity versus Pseudomonas sp.
  • Ciprofloxacin is NOT Considered a “respiratory fluoroquinolone” because of its limited activity versus Streptococcus pneuamoniae as compared to other fluoroquinolones
    • Note that ciprofloxacin achieves decent concentrations in the lungs
  • Should generally be avoided for Enterococcus sp. or Staphylococcus sp. due to resistance issues
  • Possesses activity versus atypical organisms such as Legionella sp. and Mycoplasma sp.
  • Available in oral and injectable formulations
    • Oral formulation will bind to cations (e.g., calcium) so do not administer concomitantly with milk, calcium carbonate or other things that may bind to levofloxacin and prevent its absorption
  • Adjust dose for renal impairment
    • 80% bioavailable
  • A common drug to consider for the treatment of prostatitis due to it’s ability to penetrate the prostate (and activity versus E. coli)
  • Per FDA, should only be used when risks outweigh potential benefits if treating acute sinusitis, acute bronchitis or uncomplicated urinary tract infections
  • FDA boxed warnings: tendonitis, tendon rupture, CNS effects, peripheral neuropathy, can worsen existing myasthenia gravis
  • FDA warnings: hypoglycemia (including coma), altered mental health, aortic dissection
  • Other ADRs to beware: QTC prolongation, photosensitivitity
    • Suicidal thoughts added to drug safety label warning by the FDA in February 2017

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