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Ciprofloxacin: Action Uses Dosage Indication Administration by NJE

Uses Of Ciprofloxacin

Ciprofloxacin: Treatment of susceptible infections due to E. coli, K. pneumoniae, E. cloacae, P.mirabilis, P. vulgaris, P. aeruginosa, H. influenzae, M. catarrhalis, S.pneumoniae, S. aureus (methicillin susceptible), S. epidermidis, S. pyogenes, C.jejuni, Shigella spp., S. typhi including intra-abdominal, bone, joint, lower respiratory tract, skin/skin structure infections; UTIs, infectious diarrhea, prostatitis, sinusitis, typhoid fever, febrile neutropenia.

Ophthalmic: Treatment of superficial ocular infections. 

Otic: Treatment of acute otitis externa due to susceptible strains of P. aeruginosa or S. aureus.

OFF-LABEL: Treatment of chancroid. Acute pulmonary exacerbations in cystic fibrosis, disseminated gonococcal infections, prophylaxis to Neisseria meningitidis following close contact with infected person. Infectious diarrhea (children); periodontitis.

Cipro HC Otic: ciprofloxacin/hydrocortisone (a steroid): 0.2%/1%.

Cipro Dex Otic: ciprofloxacin/dexamethasone (a corticosteroid): 0.3%/0.1%.

PHARMACOTHERAPEUTIC: Fluoroquinolone.

CLINICAL: Antibiotic.

Action Of Ciprofloxacin

Inhibits enzyme, DNA gyrase, in susceptible bacteria, interfering with bacterial cell replication. Therapeutic Effect: Bactericidal.

Ciprofloxacin

Precautions Of Ciprofloxacin

Contraindications: Hypersensitivity to ciprofloxacin, other quinolones. Concurrent use of tiZANidine. Cautions: Renal impairment, CNS disorders, seizures, rheumatoid arthritis, history of QT prolongation, uncorrected hypokalemia, hypomagnesemia, myasthenia gravis. Suspension not used through feeding or gastric tubes. Use in children (due to adverse events tojoints/surrounding tissue).

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Pharmacokinetics Of Ciprofloxacin

Well absorbed from GI tract. Protein binding: 20%–40%. Widely distributed including to CSF. Metabolized in liver. Primarily excreted in urine. Minimal removal by hemodialysis. Half-life: 3–5 hrs (increased in renal impairment,elderly).

Lifespan considerations Of Ciprofloxacin

Pregnancy/Lactation: Unknown if distributed in breast milk. If possible, do not use during pregnancy/lactation (risk of arthropathy to fetus/infant). 

Children: Arthropathy may occur if given to children younger than 18 yrs. 

Elderly: Age-related renal impairment may require dosage adjustment.

Interactions Of Ciprofloxacin

DRUG: Antacids, calcium, magnesium, zinc, iron preparations, sucralfate may decrease absorption. May increase effects of caffeine, oral anticoagulants (e.g., warfarin). May decrease concentration of fosphenytoin, phenytoin. Mayincrease concentration, toxicity of theophylline.

HERBAL: Dong Quai, St. John’s wort may increase photosensitization.

 FOOD: None known. 

LAB VALUES: May increase serum alkaline phosphatase, creatine kinase (CK), LDH, ALT, AST.

Availability Of Ciprofloxacin

(Rx)Infusion, Solution: 200 mg/100 mL, 400 mg/200 mL. 

Injection, Solution (Cipro): 10 mg/mL.

Ophthalmic Ointment (Ciloxan): 0.3%. Ophthalmic Solution (Ciloxan): 0.3%. Otic Solution (Cetraxal): 0.2% (single-dose container: 0.25 mL). 

Suspension, Oral: 250 mg/5 mL, 500 mg/5 mL. Tablets (Cipro): 100 mg, 250 mg, 500 mg, 750 mg.Tablets (Extended-Release): 500 mg, 1,000 mg.

Administration/handling Of Ciprofloxacin

IV

Reconstitution

• Available prediluted in infusion container ready for use. Final concentration notto exceed 2 mg/mL.

Rate of Administration

• Infuse over 60 min (reduces risk of venous irritation).

Storage

• Store at room temperature.

• Solution appears clear, colorless to slightly yellow.

PO

• May be given with food to minimize GI upset.

• Give at least 2 hrs before or 6 hrs after antacids, calcium, iron, zinc-containing products.

• Do not administer suspension through feeding or gastric tubes.

• NG tube: Crush immediate-release tablet and mix with water. Flush tube before/after administration.

Ophthalmic


• Place gloved finger on lower eyelid and pull out until a pocket is formed between eye and lower lid.

• Place ointment or drops into pocket.

• Instruct pt to close eye gently for 1–2 min (so that medication will not be squeezed out of the sac)

.• Instruct pt using ointment to roll eyeball to increase contact area of drug to eye.

• Instruct pt using solution to apply digital pressure to lacrimal sac at inner canthus for 1 min to minimize systemic absorption.

• Do not use ophthalmic solution for injection.

IV incompatibilities Of Ciprofloxacin


Ampicillin and sulbactam (Unasyn), cefepime (Maxipime), dexamethasone (Decadron), furosemide (Lasix), heparin, hydrocortisone (Solu-Cortef), methylPREDNISolone (Solu-Medrol), phenytoin (Dilantin), sodium bicarbonate.

IV Compatibilities


Calcium gluconate, diltiaZEM (Cardizem), DOBUTamine (Dobutrex), DOPamine (Intropin), lidocaine, LORazepam (Ativan), magnesium, midazolam (Versed), potassium chloride.

Indications/routes/dosage Of Ciprofloxacin

Note: Not recommended as first choice in pregnancy/lactation or in children younger than 18 yrs due to adverse events related to joints/surrounding tissue.

Usual Dosage Range

PO: ADULTS, ELDERLY: 250–750 mg q12h. CHILDREN: (Mild to moderate infections): 10 mg/kg twice daily. Maximum: 500 mg/dose. (Severe infections): 15-20 mg/kg twice daily. Maximum: 750 mg/dose.

IV: ADULTS, ELDERLY: 200–400 mg q12h. CHILDREN: 10 mg/kg q8–12h. Maximum: 400 mg/dose.

Usual Ophthalmic Dosage

ADULTS, ELDERLY, CHILDREN: (Solution): 1–2 drops q2h while awake for 2 days, then 1–2 drops q4h while awake for 5 days. (Ointment): Apply 3times/day for 2 days, then 2 times/day for 5 days.

Usual Otic Dosage


ADULTS, ELDERLY, CHILDREN: Otic solution 0.2%. Instill 0.25 mL (0.5 mg) 2 times/day for 7 days.

Dosage in Renal Impairment.

Dosage and frequency are modified based on creatinine clearance and the severity of the infection.

Creatinine Clearance/ Dosage Of Ciprofloxacin

Creatinine Clearance Dosage
Immediate-Release
30–50 mL/minPO: 250–500 mg q12h
5–29 mL/min 250–500 mg q18h
ESRD, HD, PD 250–500 mg q24h
Extended-Release
< 30 mL/min 500 mg q24h
ESRD, HD, PD 500 mg q24h
IV 5–29 mL/min 200–400 mg q18–24h

Side effects Of Ciprofloxacin

Frequent (5%–2%): Nausea, diarrhea, dyspepsia, vomiting, constipation, flatulence, confusion, crystalluria. Ophthalmic: Burning, crusting in corner of eye.

Occasional (less than 2%): Abdominal pain/discomfort, headache, rash. Ophthalmic: Altered taste, the sensation of foreign body in the eye, eyelid redness, itching. 

Rare (less than 1%): Dizziness, confusion, tremors, hallucinations, hypersensitivity reaction, insomnia, dry mouth, paresthesia.

Adverse effects/toxic reactions Of Ciprofloxacin

Superinfection (esp. enterococcal, fungal), nephropathy, cardiopulmonary arrest, cerebral thrombosis may occur. Hypersensitivity reactions (rash, pruritus, blisters, edema, burning skin), photosensitivity have occurred. Sensitization to ophthalmic form may contraindicate later systemic use of ciprofloxacin. May exacerbate muscle weakness in pts with myasthenia gravis. Dermatologic conditions such as toxic epidermal necrolysis, Stevens-Johnson syndrome have been reported. Cases of severe hepatotoxicity have occurred. May increase risk of tendonitis, tendon rupture.

Nursing considerations Of Ciprofloxacin

Baseline assessment

Question for the history of hypersensitivity to ciprofloxacin, quinolones; myasthenia gravis, renal/hepatic impairment.

Intervention/evaluation

Obtain urinalysis for microscopic analysis for crystalluria prior to and during treatment. Evaluate food tolerance. Monitor daily pattern of bowel activity, stool consistency. Encourage hydration (reduces risk of crystalluria). Monitor for dizziness, headache, visual changes, tremors. Assess for chest, joint pain. Ophthalmic: Observe therapeutic response.

Patient/family teaching

• Do not skip doses; take full course of therapy.

• Maintain adequate hydration to prevent crystalluria.

• Do not take antacids within 2 hrs of ciprofloxacin (reduces/destroys effectiveness).

• Shake the suspension well before using; do not chew microcapsules in suspension.

• Sugarless gum, hard candy may relieve bad taste.

• Avoid caffeine.• Report tendon pain or swelling.

• Avoid exposure to sunlight/artificial light (may cause photosensitivity reaction).

• Report persistent diarrhea.

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