Ciprofloxacin

Ciprofloxacin - is a fluoroquinolone with bactericidal activity against E.coli, Klebsiella spp., Proteus spp., Serratia spp., Salmonella spp., Campylobacter spp., Pseudomonas aeruginosa, Haemophilus influenzae, Neisseria spp. and Staphylococcus spp. Many strains of MRSA in the UK are resistant and the use of ciprofloxacin may be associated with increased rates of MRSA and C. difficile colonisation.Activity against many other Gram ve organisms is poor.

Uses:
Respiratory tract infection – avoid if possibility of pneumococcal
infection
Severe urinary tract infection
Intra-abdominal infections
Meningitis prophylaxis (unlicensed)
Severely ill patients with gastroenteritis
Suspected enteric fever
Sepsis of unknown origin

Administration:
• For infection
IV infusion: 200–400 mg 12 hourly, given over 30–60 min
400 mg 8 hourly dosing may be required for P. aeruginosa and other
less susceptible Gram ve organisms

Available in 100 ml bottle containing 200 mg ciprofloxacin in sodium
chloride 0.9% and 200 ml bottle containing 400 mg ciprofloxacin in
sodium chloride 0.9%. Contains Na 15.4 mmol/100 ml bottle.

Also available in 100-ml bag containing 200 mg ciprofloxacin in
glucose 5% and 200 ml bottle containing 400 mg ciprofloxacin in
glucose 5%.
Oral: 500–750 mg 12 hourly

In renal impairment:

CC (ml/min)	Dose (% of normal dose)
20–50	100
10–20	50–100
<10	50 (100% if necessary for short periods)

• Meningitis prophylaxis
Oral: 500 mg as a single dose or 12 hourly for two days
Child 5–12 years: 250 mg orally, as a single dose

How not to use ciprofloxacin:
Do not put in fridge (crystal formation)
Do not use as sole agent where pneumococcal infection likely

Adverse effects:
Transient increases in bilirubin, liver enzymes and creatinine
Tendon damage and rupture, especially in the elderly and those taking corticosteroids (may occur within 48 hours)

Cautions:
Concurrent administration with theophylline (increased plasma level of theophylline)
Concurrent administration with ciclosporin (transient increase in serum creatinine)
Epilepsy (increased risk of fits)
Concurrent administration of corticosteroids (risk of tendon damage and rupture)

Organ failure:
Renal: reduce dose

Renal replacement therapy:
No further dose modification is required during renal replacement therapy