Select a medication above to begin.
Cipro
ciprofloxacin
Black Box Warnings .
Disabling, Potentially Irreversible Serious Reactions
fluoroquinolones assoc. with tendinitis/tendon rupture, peripheral neuropathy, and CNS effects that may occur together; tendinitis/tendon rupture may occur during tx or months after tx D/C; incr. tendinitis/tendon rupture risk in all ages; risk further incr. in older pts >60 yo, pts taking corticosteroids, and pts w/ kidney, heart, or lung transplant; D/C immediately and avoid fluoroquinolone use in pts w/ these serious reactions
Avoid in Myasthenia Gravis
fluoroquinolones may exacerbate muscle weakness in pts w/ myasthenia gravis
Reserve Fluoroquinolone Use
for pts w/ no alternative tx options for acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis, or uncomplicated UTI
Adult Dosing .
Dosage forms: TAB: 250 mg, 500 mg; SUSP: 250 mg per 5 mL, 500 mg per 5 mL; INJ: various
infections, bacterial
- [PO route]
- Dose: 250-750 mg PO q12h; Info: dose, duration varies w/ infection type, severity
- [IV route]
- Dose: 200-400 mg IV q12h; Alt: 400 mg IV q8h for severe/complicated infection; Info: dose, duration varies w/ infection type, severity
UTI
- [uncomplicated cystitis]
- Dose: 250 mg PO q12h x3 days; Info: for pts w/ no alternative tx options; refer to IDSA guidelines
- [uncomplicated pyelonephritis]
- Dose: 500 mg PO q12h x7 days; Alt: 400 mg IV x1, then 500 mg PO q12h x7 days total; 400 mg IV q12h x7 days; Info: may give w/ ceftriaxone or gentamicin; refer to IDSA guidelines
- [complicated]
- Dose: 500 mg PO q12h x7-14 days; Alt: 400 mg IV q12h x7-14 days
intra-abdominal infections, complicated
- [500 mg PO q12h x7-14 days]
- Alt: 400 mg IV q12h x7-14 days; Info: part of multi-drug regimen
bone/joint infections
- [500-750 mg PO q12h x4-8wk]
- Alt: 400 mg IV q8-12h x4-8wk
prostatitis, chronic bacterial
- [500 mg PO q12h x28 days]
pneumonia, hospital-acquired or ventilator-assoc.
- [400 mg IV q8h x7 days]
- Info: may extend duration based on clinical response; refer to IDSA guidelines
anthrax
- [systemic]
- Dose: 400 mg IV q8h for at least 2wk; Info: 1st-line agent; part of multi-drug regimen; may use as 1st-line agent in pregnant women; switch to PO abx for post-exposure prophylaxis if inhalational exposure
- [cutaneous]
- Dose: 500 mg PO q12h x7-10 days; Info: for non-systemic infection; 1st-line agent; may use as 1st-line agent in pregnant women; use extended duration for post-exposure prophylaxis if bioterrorism suspected
- [post-exposure prophylaxis]
- Dose: 500 mg PO q12h x60 days; Info: 1st-line agent; give in combo w/ anthrax vaccine; may use as 1st-line agent in pregnant women; may give x42 days or x14 days after last vaccine dose in immunocompetent pts 18-65 yo if anthrax vaccine regimen completed
typhoid fever
- [500 mg PO q12h x2wk]
plague
- [500-750 mg PO q12h x2wk]
- Info: for prophylaxis and tx
chancroid (off-label)
- [500 mg PO q12h x3 days]
salmonellosis, acute (off-label)
- [500-750 mg PO q12h x3-7 days]
- Info: may extend tx x1wk if immunocompromised
salmonella, chronic carrier (off-label)
- [750 mg PO q12h x1mo]
shigellosis, severe (off-label)
- [500-750 mg PO q12h]
- Info: duration varies w/ infection severity; refer to CDC guidance
febrile neutropenia, chemo-induced (off-label)
- [500-750 mg PO q12h]
- Info: for empiric tx in low-risk pts not on fluoroquinolone prophylaxis; give w/ amoxicillin/clavulanate
meningococcal prophylaxis (off-label)
- [20 mg/kg/dose PO x1]
- Max: 500 mg; Info: for close contacts of pts w/ invasive meningococcal dz
infection prophylaxis, surgical (off-label)
- [400 mg IV x1]
- Start: w/in 120min preop
endocarditis (off-label)
- [400 mg IV q12h]
- Info: not 1st-line tx; dose, frequency, duration vary w/ pathogen susceptibility, infection severity, valve type; refer to AHA guidelines
renal dosing
- [PO route]
- CrCl 30-50: 250-500 mg PO q12h; CrCl <30: 250-500 mg PO q24h; Info: may give 750 mg/dose if serious infection w/ severe renal impairment
- HD: 250-500 mg PO q24h, on dialysis days admin. after dialysis; no supplement; PD: 250-500 mg PO q24h; no supplement; Info: may give 750 mg/dose if serious infection
- [IV route]
- CrCl <30: 400 mg IV q24h
- HD: 200-400 mg IV q24h, on dialysis days admin. after dialysis; no supplement; PD: 200-400 mg IV q24h; no supplement
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised
Peds Dosing .
- Dosage forms: TAB: 250 mg, 500 mg; SUSP: 250 mg per 5 mL, 500 mg per 5 mL; INJ: various
UTI
- [1-17 yo]
- Dose: 18-30 mg/kg/day IV divided q8h x10-21 days; Max: 400 mg/dose IV; 750 mg/dose PO; Alt: 20-40 mg/kg/day PO divided q12h; Info: for complicated UTI or pyelonephritis; not 1st-line agent
anthrax, systemic
- [neonates >32 wk gestation]
- Dose: 20-30 mg/kg/day IV divided q12h for at least 2wk; Info: 1st-line agent; part of multi-drug regimen; dose depends on gestational and post-natal age; switch to PO abx x60 days total if inhalational exposure
- [1 mo and older]
- Dose: 30 mg/kg/day IV divided q8h for at least 2wk; Max: 400 mg/dose; Info: 1st-line agent; part of multi-drug regimen; switch to PO abx x60 days total if inhalational exposure
anthrax, cutaneous
- [neonates >32 wk gestation]
- Dose: 20-30 mg/kg/day PO divided q12h x7-10 days; Info: for non-systemic infection; 1st-line agent; dose depends on gestational and post-natal age; give abx x60 days total if bioterrorism suspected
- [1 mo and older]
- Dose: 30 mg/kg/day PO divided q12h x7-10 days; Max: 500 mg/dose; Info: for non-systemic infection; 1st-line agent; give abx x60 days total if bioterrorism suspected
anthrax, post-exposure prophylaxis
- [neonates >32 wk gestation]
- Dose: 20-30 mg/kg/day PO divided q12h x60 days; Info: 1st-line agent; dose depends on gestational and post-natal age
- [1 mo and older]
- Dose: 30 mg/kg/day PO divided q12h x60 days; Max: 500 mg/dose; Info: 1st-line agent
plague
- [15 mg/kg/dose PO q8-12h x14 days]
- Max: 500 mg/dose; Info: for prophylaxis and tx
infections, bacterial (off-label)
- [20-30 mg/kg/day PO divided q12h]
- Alt: 15-30 mg/kg/day IV divided q8-12h; Max: 750 mg/dose PO; 400 mg/dose IV
resp. infections, cystic fibrosis pts (off-label)
- [40 mg/kg/day PO divided q12h]
- Alt: 30 mg/kg/day IV divided q8h; Max: 750 mg/dose PO; 400 mg/dose IV
community-acquired pneumonia, mod-severe bacterial (off-label)
- [>3 mo]
- Dose: 30 mg/kg/day IV divided q12h x10 days; Info: may switch to PO regimen when possible to complete course
salmonellosis, acute (off-label)
- [20-30 mg/kg/day PO divided q12h x3-7 days]
- Max: 750 mg/dose; Info: may extend tx x1wk if immunocompromised
salmonella, chronic carrier (off-label)
- [20-30 mg/kg/day PO divided q12h x1mo]
- Max: 750 mg/dose
shigellosis, severe (off-label)
- [1 mo and older]
- Dose: 30 mg/kg/day PO divided q12h; Max: 500 mg/dose; Info: duration varies w/ infection severity; refer to CDC guidance
typhoid fever (off-label)
- [30 mg/kg/day PO/IV divided q12h x1-2wk]
- Max: 500 mg/dose
chancroid (off-label)
- [preadolescents >45 kg and adolescents]
- Dose: 500 mg PO q12h x3 days
febrile neutropenia, chemo-induced (off-label)
- [20-40 mg/kg/day PO divided q12h]
- Max: 750 mg/dose; Info: for empiric tx in low-risk pts not on fluoroquinolone prophylaxis; give w/ amoxicillin/clavulanate
meningococcal prophylaxis (off-label)
- [1 mo and older]
- Dose: 20 mg/kg/dose PO x1; Max: 500 mg; Info: for close contacts of pts w/ invasive meningococcal dz
infection prophylaxis, surgical (off-label)
- [1 yo and older]
- Dose: 10 mg/kg/dose IV x1; Start: w/in 120min preop; Max: 400 mg/dose
renal dosing
- [adjust dose frequency]
- CrCl 10-29: give usual divided dose q18h; CrCl <10: give usual divided dose q24h
- HD: give usual divided dose q24h, on dialysis days admin. after dialysis; no supplement; PD: give usual divided dose q24h; no supplement
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised