Ciprofloxacin hydrochloride Dosage Form: Medically reviewed on September 3, Cipro is indicated in adult patients for treatment of skin and skin structure infectionscaused by Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Proteus mirabilis, Proteus vulgaris, Providencia stuartii, Morganella morganii, Citrobacter freundii, Pseudomonas aeruginosa, methicillin-susceptible Staphylococcus aureus, methicillin-susceptible Staphylococcus epidermidis, or Streptococcus pyogenes.
Cipro is indicated in adult patients for treatment of bone and joint infectionscaused by Enterobacter cloacae, cipro and breastfeeding, Cipro and breastfeeding marcescens, or Pseudomonas aeruginosa. Cipro is indicated in adult patients for treatment of complicated intra-abdominal infections used in combination with metronidazole caused by Escherichia coli, Pseudomonas aeruginosa, Proteus mirabilis, Klebsiella pneumoniae, or Cipro and breastfeeding fragilis.
Cipro is indicated in adult patients for treatment of typhoid fever enteric fever caused by Salmonella typhi. The efficacy of Ciprofloxacin in the eradication of the chronic typhoid carrier state has not been demonstrated. Cipro is indicated in adult patients for treatment of uncomplicated cervical and urethral gonorrhea due to Neisseria gonorrhoeae [see Warnings and Precautions 5. Cipro is indicated in adults and pediatric patients from birth to 17 years of age for inhalational anthrax post-exposure to reduce the incidence or progression of disease following exposure to aerosolized Bacillus anthracis.
Ciprofloxacin serum concentrations achieved in humans served as a surrogate endpoint reasonably likely to predict clinical benefit and provided the initial basis for approval of this indication. Cipro is indicated for treatment of plague, including pneumonic and septicemic plague, due to Yersinia pestis Y. Efficacy studies of Ciprofloxacin could not be conducted in humans with plague for feasibility reasons.
Therefore this indication is based on an efficacy study conducted in animals only [see Combining atenolol and liprinosil Studies Cipro is indicated in adult patients for treatment of chronic bacterial prostatitiscaused by Escherichia coli or Proteus mirabilis. Cipro is indicated in adult patients for treatment of lower respiratory tract infectionscaused by Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, cipro and breastfeeding, Proteus mirabilis, Pseudomonas aeruginosa, Haemophilus influenzae, Haemophilus parainfluenzae, or Streptococcus pneumoniae.
Cipro is not a drug of first choice in the treatment of presumed or confirmed pneumonia secondary to Streptococcus pneumoniae. Cipro is indicated for the treatment of acute exacerbations of chronic bronchitis AECB caused by Moraxella catarrhalis. Because fluoroquinolones, including Cipro, have been associated with serious adverse reactions [see Warnings and Precautions 5. Cipro is indicated in adult patients for treatment of urinary tract infectionscaused by Escherichia coliKlebsiella pneumoniaeEnterobacter cloacaeSerratia marcescensCipro and breastfeeding mirabilisProvidencia rettgeriMorganella morganiiCipro and breastfeeding koseri cipro and breastfeeding, Citrobacter freundiiPseudomonas aeruginosamethicillin-susceptible Staphylococcus epidermidisStaphylococcus saprophyticusor Enterococcus faecalis.
Cipro is indicated in adult female patients for treatment of acute uncomplicated cystitis caused by Escherichia coli or Staphylococcus saprophyticus. Cipro is indicated in pediatric patients aged one to 17 years of age for treatment of complicated urinary tract infections cUTI and pyelonephritis due to Escherichia coli [see Use in Specific Populations 8. Cipro, like other fluoroquinolones, is associated with arthropathy and histopathological changes in weight-bearing joints of juvenile animals [see Warnings and Precautions 5.
Cipro is indicated in adult patients for treatment of acute sinusitiscaused by Haemophilus influenzae,Streptococcus pneumoniae, or Moraxella catarrhalis, cipro and breastfeeding. To reduce the development of drug-resistant bacteria and maintain the effectiveness of Cipro and other antibacterial drugs, Cipro should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria.
When culture cipro and breastfeeding susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy. If anaerobic organisms are suspected of contributing to the infection, appropriate therapy should be administered.
Appropriate culture and susceptibility tests should be performed before treatment in order to isolate and identify organisms causing infection and to determine their susceptibility to Ciprofloxacin. Therapy with Cipro may be initiated before results of these tests are known; once results become available appropriate therapy should be continued.
As with other drugs, some isolates of Pseudomonas aeruginosa may develop resistance fairly rapidly during treatment with Ciprofloxacin. Culture and susceptibility testing performed periodically during therapy will provide information not only on the therapeutic effect of the antimicrobial agent but also on the possible emergence of bacterial resistance.
Cipro Tablets and Oral Suspension should be administered orally as described in the appropriate Dosage Guidelines tables. Cipro Tablets or Oral Suspension may be administered to adult patients when clinically indicated at the discretion of the physician. Administer Cipro for Oral Suspension using the co-packaged graduated spoon [see Dosage and Administration 2.
Patients whose therapy is started with Cipro IV may be switched to Cipro Tablets or Oral Suspension when clinically indicated at the discretion of the physician Table 2 [see Clinical Pharmacology Dosing and initial route of therapy that is, IV or oral for cUTI or pyelonephritis should be determined by the severity of the infection.
Cipro should be administered as described in Table 3. Ciprofloxacin is eliminated primarily by renal excretion; however, the drug is also metabolized and partially cleared through the biliary system of the liver and through the intestine. These alternative pathways of drug elimination appear to compensate for the reduced renal excretion in patients with renal impairment. Nonetheless, some modification of dosage is recommended, erythromycin and protonix for patients with severe renal dysfunction.
Dosage guidelines for use in patients with renal impairment are shown in Table 4. When only the serum creatinine concentration is known, the following formulas may be used to estimate creatinine clearance:. In patients with birth control and amoxicillin infections and severe renal impairment, a unit dose of mg may be administered at the intervals noted above.
Patients should be carefully monitored. Pediatric patients with moderate to severe renal insufficiency cipro and breastfeeding excluded from the clinical trial of cUTI cipro and breastfeeding pyelonephritis.
Concomitant administration of Cipro with dairy products like milk or yogurt or calcium-fortified juices alone should be avoided since decreased absorption is possible; however, Cipro may be taken with a meal that contains these products. Assure adequate hydration of patients receiving Cipro to prevent the formation of highly concentrated urine. Crystalluria has been reported with quinolones, cipro and breastfeeding. Instruct the patient of the appropriate Cipro administration [see Patient Counseling Information 17 ], cipro and breastfeeding.
Cipro oral suspension is composed of two components microcapsules and diluent that must be combined prior to dispensing. The small bottle contains the microcapsules, the large bottle contains the cipro and breastfeeding. Press down according to instructions on the cap while turning to the left.
Pour the microcapsules completely into the larger bottle of diluent. Do not add water to the suspension. No additions should be made to the mixed final Ciprofloxacin suspension. Cipro Oral Suspension should not be administered through feeding or NG nasogastric tubes due to its physical characteristics. Complicated Urinary Tract or Pyelonephritis patients from 1 to 17 years of age 1, cipro and breastfeeding. Cipro is contraindicated in persons with a cipro and breastfeeding of hypersensitivity to Ciprofloxacin, any member of the quinolone class of antibacterials, or any of the product components [see Warnings and Precautions 5.
Concomitant administration with tizanidine is contraindicated [see Drug Interactions 7 ], cipro and breastfeeding. Fluoroquinolones, including Cipro, have been associated with disabling and potentially irreversible serious adverse reactions from different body systems that can occur together in the same patient.
Commonly seen adverse reactions include tendinitis, tendon rupture, arthralgia, myalgia, peripheral neuropathy, and central nervous system effects hallucinations, anxiety, depression, insomnia, severe headaches, and confusion. These reactions can occur within hours to weeks after starting Cipro.
Patients of any age or without pre-existing risk factors have experienced these adverse reactions [see Warnings and Precautions 5. Discontinue Cipro and breastfeeding immediately at the first signs or symptoms of any serious adverse reaction, cipro and breastfeeding.
In addition, avoid the use of fluoroquinolones, including Cipro, in patients who have experienced any of these serious adverse reactions associated with fluoroquinolones.
Fluoroquinolones, including Cipro, have been associated with an increased risk of tendinitis and tendon rupture in all ages [see Warnings and Precautions 5. This adverse reaction most frequently involves the Achilles tendon, and has also been reported with the rotator cuff the shoulderthe hand, the biceps, the thumb, and other tendons.
Tendinitis or tendon rupture can occur, cipro and breastfeeding, within hours or days of starting Cipro, or as long as several months after completion of fluoroquinolone therapy. Tendinitis and tendon rupture can occur bilaterally. The risk of developing fluoroquinolone-associated tendinitis and tendon rupture is increased in patients over 60 years of age, in patients taking corticosteroid drugs, and in patients with kidney, heart or lung transplants.
Other factors that may independently increase the risk of tendon rupture include strenuous physical activity, renal failure, and previous tendon disorders such as rheumatoid arthritis.
Tendinitis and tendon rupture have also occurred in patients taking fluoroquinolones who do not have the above risk factors. Discontinue Cipro immediately if the patient experiences pain, swelling, inflammation or rupture of a tendon. Avoid fluoroquinolones, including Cipro, cipro and breastfeeding, in patients who have a history of tendon disorders or have experienced tendinitis or tendon rupture [see Adverse Reactions 6. Fluoroquinolones, including Cipro, have been associated with an increased risk of peripheral neuropathy.
Symptoms may occur soon after initiation of Cipro and may be irreversible in some patients [see Warnings and Precautions 5. Avoid fluoroquinolones, including Cipro, in patients who have previously experienced peripheral neuropathy [see Adverse Reactions 6. Fluoroquinolones, including Cipro, have been associated with an increased risk of central nervous system CNS effects, including.
These reactions may occur following the first dose. Advise patients receiving Cipro to inform their healthcare provider immediately if these reactions occur, discontinue the drug, and institute appropriate care. Cipro, like other fluoroquinolones, is known to trigger seizures or lower the seizure threshold.
As with all fluoroquinolones, use Cipro with caution in epileptic patients and patients with known or suspected CNS disorders that may predispose to seizures or lower the seizure threshold for example, severe cerebral arteriosclerosis, previous history of convulsion, cipro and breastfeeding, reduced cerebral blood flow, altered brain structure, or strokeor in the presence of other risk factors that may predispose to seizures or lower the seizure threshold for example, certain drug therapy, cipro and breastfeeding, renal dysfunction.
Use Cipro when the benefits of treatment exceed the risks, since these patients are endangered cipro and breastfeeding of possible undesirable CNS side effects. Cases of status epilepticus have cipro and breastfeeding reported. If seizures occur, discontinue Cipro [see Adverse Reactions 6. Fluoroquinolones, including Cipro, have neuromuscular blocking activity and may exacerbate muscle weakness in patients with myasthenia gravis.
Postmarketing serious adverse reactions, including deaths and requirement for ventilatory support, have been associated with fluoroquinolone use in patients with myasthenia gravis. Avoid Cipro in patients with known history of myasthenia gravis [see Adverse Reactions 6. Other serious and sometimes fatal adverse reactions, some due to hypersensitivity, and some due to uncertain etiology, cipro and breastfeeding been reported in patients receiving therapy with quinolones, including Cipro.
These events may be severe and generally occur following the administration of multiple doses. Clinical manifestations may include one or more of the following:. Discontinue Cipro immediately at the first appearance of a skin rash, jaundice, or any other sign of hypersensitivity and supportive measures instituted [see Adverse Reactions 6. Serious and occasionally fatal hypersensitivity anaphylactic reactions, cipro and breastfeeding, some following the first dose, have been reported in patients receiving fluoroquinolone therapy, including Cipro.
Some reactions were accompanied by cardiovascular collapse, loss of consciousness, tingling, pharyngeal or facial edema, dyspnea, urticaria, and itching. Only a few patients had a history of hypersensitivity reactions.
Serious anaphylactic reactions require immediate emergency treatment with epinephrine and other resuscitation measures, including oxygen, intravenous fluids, intravenous antihistamines, cipro and breastfeeding, corticosteroids, pressor amines, and airway management, cipro and breastfeeding, including intubation, as indicated [see Adverse Reactions 6. Cases of severe hepatotoxicity, cipro and breastfeeding, including hepatic necrosis, life-threatening hepatic failure, and fatal events, have been reported with Cipro.
Acute liver injury is rapid in onset range 1—39 daysand is often associated with hypersensitivity. The pattern of injury can be allergy medication and urinary retention, cholestatic, or mixed.