What is Ciprofloxacin?
Ciprofloxacin is a fluoroquinolone (flor-o-KWIN-o-lone) antibiotic, it is used to treat different types of bacterial infections. It is also used to treat people who have been exposed to anthrax or certain types of plague. Ciprofloxacin extended-release is only approved for use in adults.
Fluoroquinolone antibiotics can cause serious or disabling side effects that may not be reversible
Ciprofloxacin should be used only for infections that cannot be treated with a safer antibiotic.
Warnings
Ciprofloxacin can cause serious side effects, including tendon problems, nerve damage, serious mood or behavior changes, or low blood sugar.
Stop using ciprofloxacin and call your doctor at once if you have: headache, hunger, irritability, numbness, tingling, burning pain, confusion, agitation, paranoia, problems with memory or concentration, thoughts of suicide, or sudden pain or movement problems in any of your joints.
In rare cases, ciprofloxacin may cause damage to your aorta, which could lead to dangerous bleeding or death. Get emergency medical help if you have severe and constant pain in your chest, stomach, or back.
You may not be able to use this medicine if you have a muscle disorder. Tell your doctor if you have a history of myasthenia gravis.
Before taking this medicine
You should not use ciprofloxacin if you are allergic to it, or if:
you also take tizanidine; or
you are allergic to other fluoroquinolones (levofloxacin, moxifloxacin, norfloxacin, ofloxacin).
Ciprofloxacin may cause swelling or tearing of a tendon (the fiber that connects bones to muscles in the body), especially in the Achilles' tendon of the heel. This can happen during treatment or several months after you stop taking ciprofloxacin. Tendon problems may be more likely in children and older adults, or people who use steroid medicine or have had an organ transplant.
To make sure ciprofloxacin is safe for you, tell your doctor if you have ever had:
arthritis or problems with your tendons, bones or joints (especially in children);
diabetes, low blood sugar;
nerve problems;
an aneurysm or blood circulation problems;
heart problems, or a heart attack;
muscle weakness, myasthenia gravis;
liver or kidney disease;
a seizure, head injury, or brain tumor;
trouble swallowing pills;
long QT syndrome (in you or a family member); or
low levels of potassium in your blood (hypokalemia).
Do not give this medicine to a child without medical advice.
It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant.
You should not breastfeed while taking ciprofloxacin and for 2 days after your last dose. Ask your doctor about breastfeeding if you take this medicine for anthrax exposure.
How should I take ciprofloxacin?
Take ciprofloxacin exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets.
Take ciprofloxacin at the same time each day, with or without food.
Shake the oral suspension (liquid) for 15 seconds before you measure a dose. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon). Do not give ciprofloxacin oral suspension through a feeding tube.
Swallow the extended-release tablet whole and do not crush, chew, or break it.
Drink plenty of liquids while you are taking this medicine.
Use ciprofloxacin for the full prescribed length of time, even if your symptoms quickly improve. Skipping doses can increase your risk of infection that is resistant to medication. Ciprofloxacin will not treat a viral infection such as the flu or a common cold.
Do not share this medicine with another person.
Store at room temperature away from moisture and heat. Do not allow the liquid medicine to freeze. Throw away any unused liquid after 14 days.
What to avoid:
Do not take ciprofloxacin with dairy products such as milk or yogurt, or with calcium-fortified juice. You may eat or drink these products with your meals, but do not use them alone when taking this medicine.
Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, call your doctor before using anti-diarrhea medicine.
Ciprofloxacin could make you sunburn more easily. Avoid sunlight or tanning beds. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors. Tell your doctor if you have severe burning, redness, itching, rash, or swelling after being in the sun.
Avoid driving or hazardous activity until you know how ciprofloxacin will affect you. Your reactions could be impaired.
Ciprofloxacin side effects
Get emergency medical help if you have signs of an allergic reaction to ciprofloxacin (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling).
Ciprofloxacin can cause serious side effects, including tendon problems, damage to your nerves (which may be permanent), serious mood or behavior changes (after just one dose), or low blood sugar (which can lead to coma).
Stop taking this medicine and call your doctor at once if you have:
low blood sugar - headache, hunger, irritability, dizziness, nausea, fast heart rate, or feeling shaky;
nerve damage symptoms - numbness, tingling, burning pain in your hands, arms, legs, or feet:
serious mood or behavior changes - nervousness, confusion, agitation, paranoia, hallucinations, memory problems, trouble concentrating, thoughts of suicide; or
signs of tendon rupture - sudden pain, swelling, bruising, tenderness, stiffness, movement problems, or a snapping or popping sound in any of your joints (rest the joint until you receive medical care or instructions).
In rare cases, ciprofloxacin may cause damage to your aorta, the main blood artery of the body. This could lead to dangerous bleeding or death. Get emergency medical help if you have severe and constant pain in your chest, stomach, or back.
Also, stop using this medicine and call your doctor at once if you have:
severe stomach pain, diarrhea that is watery or bloody;
fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness (like you might pass out);
any skin rash, no matter how mild;
muscle weakness, breathing problems;
little or no urination;
jaundice (yellowing of the skin or eyes); or
increased pressure inside the skull - severe headaches, ringing in your ears, dizziness, nausea, vision problems, pain behind your eyes.
Common ciprofloxacin side effects may include:
nausea, vomiting, diarrhea, stomach pain;
headache; or
abnormal liver function tests.
What other drugs will affect ciprofloxacin?
Some medicines can make ciprofloxacin much less effective when taken at the same time. If you take any of the following medicines, take your ciprofloxacin dose 2 hours before or 6 hours after you take the other medicine.
the ulcer medicine sucralfate, or antacids that contain calcium, magnesium, or aluminum (such as Maalox, Milk of Magnesia, Mylanta, Pepcid Complete, Rolaids, Tums, and others);
didanosine (Videx) powder or chewable tablets;
vitamin or mineral supplements that contain calcium, iron, magnesium, or zinc.
Tell your doctor about all your other medicines, especially:
clozapine, cyclosporine, methotrexate, phenytoin, probenecid, ropinirole, sildenafil, or theophylline;
a blood thinner (warfarin, Coumadin, Jantoven);
heart medication or a diuretic or "water pill";
oral diabetes medicine;
products that contain caffeine;
medicine to treat depression or mental illness;
steroid medicine (such as prednisone); o
NSAIDs (nonsteroidal anti-inflammatory drugs) - aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others;
Ciprofloxacin Dosage
*Applies to the following strengths: 100 mg; 250 mg; 500 mg; 750 mg; 200 mg/100 mL-5%; 400 mg/200 mL-5%; 250 mg/5 mL; 500 mg/5 mL; 10 mg/mL; 1000 mg
Usual Adult Dose for Inhalation Bacillus anthracis
IV: 400 mg IV every 12 hours
Oral: 500 mg orally every 12 hours
Duration of Therapy: 60 days
Comments:
- Therapy should be started as soon as possible after suspected/confirmed exposure.
- Indication based on efficacy studies in animals.
Use: For treatment of inhalational anthrax (postexposure) to reduce incidence/progression of disease after exposure to aerosolized Bacillus anthracis
US CDC Recommendations:
- IV: 400 mg IV every 8 hours
- Oral: 500 mg orally every 12 hours
Duration of Therapy:
Postexposure prophylaxis for B anthracis infection: 60 days
Systemic anthrax:
- With possible/confirmed meningitis: At least 2 to 3 weeks or until patient is clinically stable (whichever is longer)
- When meningitis has been excluded: At least 2 weeks or until patient is clinically stable (whichever is longer)
- Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial regimen of 60 days from onset of illness.
Cutaneous anthrax without systemic involvement:
- Bioterrorism-related cases: 60 days
- Naturally acquired cases: 7 to 10 days
Comments:
- The preferred drug for pregnant women
- Recommended as a preferred oral drug for postexposure prophylaxis and for the treatment of cutaneous anthrax without systemic involvement
- Recommended as the preferred IV drug for the treatment of systemic anthrax
- Recommended for all strains (regardless of penicillin susceptibility or if susceptibility unknown) when used for postexposure prophylaxis, systemic anthrax when meningitis has been excluded, or cutaneous anthrax without systemic involvement
- Recommended for use with a protein synthesis inhibitor when used for systemic anthrax; the addition of a bactericidal beta-lactam is recommended with possible/confirmed meningitis.
- Systemic anthrax includes anthrax meningitis, inhalation anthrax, injection anthrax, gastrointestinal anthrax, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
- Current guidelines should be consulted for additional information.
Usual Adult Dose for Cutaneous Bacillus anthracis
IV: 400 mg IV every 12 hours
Oral: 500 mg orally every 12 hours
Duration of Therapy: 60 days
Comments:
- Therapy should be started as soon as possible after suspected/confirmed exposure.
- Indication based on efficacy studies in animals.
Use: For treatment of inhalational anthrax (postexposure) to reduce incidence/progression of disease after exposure to aerosolized Bacillus anthracis
US CDC Recommendations:
- IV: 400 mg IV every 8 hours
- Oral: 500 mg orally every 12 hours
Duration of Therapy:
Postexposure prophylaxis for B anthracis infection: 60 days
Systemic anthrax
- With possible/confirmed meningitis: At least 2 to 3 weeks or until patient is clinically stable (whichever is longer)
- When meningitis has been excluded: At least 2 weeks or until patient is clinically stable (whichever is longer)
- Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial regimen of 60 days from onset of illness.
Cutaneous anthrax without systemic involvement:
- Bioterrorism-related cases: 60 days
- Naturally acquired cases: 7 to 10 days
Comments:
- The preferred drug for pregnant women
- Recommended as a preferred oral drug for postexposure prophylaxis and for the treatment of cutaneous anthrax without systemic involvement
- Recommended as the preferred IV drug for the treatment of systemic anthrax
- Recommended for all strains (regardless of penicillin susceptibility or if susceptibility unknown) when used for postexposure prophylaxis, systemic anthrax when meningitis has been excluded, or cutaneous anthrax without systemic involvement
- Recommended for use with a protein synthesis inhibitor when used for systemic anthrax; the addition of a bactericidal beta-lactam is recommended with possible/confirmed meningitis.
- Systemic anthrax includes anthrax meningitis, inhalation anthrax, injection anthrax, gastrointestinal anthrax, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
- Current guidelines should be consulted for additional information.
Usual Adult Dose for Anthrax Prophylaxis
IV: 400 mg IV every 12 hours
Oral: 500 mg orally every 12 hours
Duration of Therapy: 60 days
Comments:
- Therapy should be started as soon as possible after suspected/confirmed exposure.
- Indication based on efficacy studies in animals.
Use: For treatment of inhalational anthrax (postexposure) to reduce incidence/progression of disease after exposure to aerosolized Bacillus anthracis
US CDC Recommendations:
- IV: 400 mg IV every 8 hours
- Oral: 500 mg orally every 12 hours
Duration of Therapy:
Postexposure prophylaxis for B anthracis infection: 60 days
Systemic anthrax:
- With possible/confirmed meningitis: At least 2 to 3 weeks or until the patient is clinically stable (whichever is longer)
- When meningitis has been excluded: At least 2 weeks or until patient is clinically stable (whichever is longer)
- Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial regimen of 60 days from onset of illness.
- Bioterrorism-related cases: 60 days
- Naturally acquired cases: 7 to 10 days
- The preferred drug for pregnant women
- Recommended as a preferred oral drug for postexposure prophylaxis and for the treatment of cutaneous anthrax without systemic involvement
- Recommended as the preferred IV drug for the treatment of systemic anthrax
- Recommended for all strains (regardless of penicillin susceptibility or if susceptibility unknown) when used for postexposure prophylaxis, systemic anthrax when meningitis has been excluded, or cutaneous anthrax without systemic involvement
- Recommended for use with a protein synthesis inhibitor when used for systemic anthrax; the addition of a bactericidal beta-lactam is recommended with possible/confirmed meningitis.
- Systemic anthrax includes anthrax meningitis, inhalation anthrax, injection anthrax, gastrointestinal anthrax, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
- Current guidelines should be consulted for additional information.
Usual Adult Dose for Febrile Neutropenia
Empirical therapy: 400 mg IV every 8 hours for 7 to 14 days
Comments:
- Recommended for use with piperacillin (50 mg/kg IV every 4 hours)
Use: In combination with piperacillin, for the treatment of febrile neutropenia
Usual Adult Dose for Intraabdominal Infection
IV: 400 mg IV every 12 hours
Oral: 500 mg orally every 12 hours
Duration of Therapy: 7 to 14 days
Use: In combination with metronidazole, for treatment of complicated intraabdominal infections due to Escherichia coli, Pseudomonas aeruginosa, Proteus mirabilis, Klebsiella pneumoniae, or Bacteroides fragilis
Usual Adult Dose for Joint Infection
IV: 400 mg IV every 8 to 12 hours
Oral: 500 to 750 mg orally every 12 hours
Duration of Therapy: 4 to 8 weeks
Uses: For treatment of bone and joint infections due to Enterobacter cloacae, Serratia marcescens, or P aeruginosa
Usual Adult Dose for Osteomyelitis
IV: 400 mg IV every 8 to 12 hours
Oral: 500 to 750 mg orally every 12 hours
Duration of Therapy: 4 to 8 weeks
Uses: For treatment of bone and joint infections due to Enterobacter cloacae, Serratia marcescens, or P aeruginosa
Usual Adult Dose for Plague
IV: 400 mg IV every 8 to 12 hours
Oral: 500 to 750 mg orally every 12 hours
Duration of Therapy: 14 days
Comments:
- Therapy should be started as soon as possible after suspected/confirmed exposure.
- Indication based on efficacy study in animals only.
Uses: For treatment of plague (including pneumonic and septicemic plague) due to Yersinia pestis; for prophylaxis of plague
US CDC Recommendations:
Treatment:
- IV: 400 mg IV every 8 to 12 hours
- Oral: 500 to 750 mg orally twice a day
Postexposure Prophylaxis: 500 mg orally twice a day for 7 days
Comments:
- Appropriate IV therapy should be started as soon as plague is suspected; may switch to oral therapy once patient improves
- Fluoroquinolones and gentamicin are generally first-line treatments in the US.
- Postexposure prophylaxis is recommended for individuals with known exposure to plague (e.g., close contact with pneumonic plague patient, direct contact with infected body fluids/tissues).
- In pregnant women, IV ciprofloxacin is a preferred agent for treatment and oral ciprofloxacin is a preferred agent for postexposure prophylaxis; postexposure prophylaxis is only recommended when benefits outweigh risks.
- Current guidelines should be consulted for additional information.
Usual Adult Dose for Plague Prophylaxis
IV: 400 mg IV every 8 to 12 hours
Oral: 500 to 750 mg orally every 12 hours
Duration of Therapy: 14 days
Comments:
- Therapy should be started as soon as possible after suspected/confirmed exposure.
- Indication based on efficacy study in animals only.
Uses: For treatment of plague (including pneumonic and septicemic plague) due to Yersinia pestis; for prophylaxis of plague
US CDC Recommendations:
Treatment:
- IV: 400 mg IV every 8 to 12 hours
- Oral: 500 to 750 mg orally twice a day
Postexposure Prophylaxis: 500 mg orally twice a day for 7 days
Comments:
- Appropriate IV therapy should be started as soon as plague is suspected; may switch to oral therapy once patient improves
- Fluoroquinolones and gentamicin are generally first-line treatments in the US.
- Postexposure prophylaxis is recommended for individuals with known exposure to plague (e.g., close contact with pneumonic plague patient, direct contact with infected body fluids/tissues).
- In pregnant women, IV ciprofloxacin is a preferred agent for treatment and oral ciprofloxacin is a preferred agent for postexposure prophylaxis; postexposure prophylaxis is only recommended when benefits outweigh risks.
- Current guidelines should be consulted for additional information.
400 mg IV every 8 hours for 10 to 14 days
Comments:
- Initial empiric treatment with broad-spectrum coverage according to the hospital's and/or ICU's antibiogram is recommended if multidrug-resistant organisms are suspected.
Use: For treatment of nosocomial pneumonia due to Haemophilus influenzae or K pneumoniae
Usual Adult Dose for Pneumonia
IV: 400 mg IV every 8 to 12 hours
Oral: 500 to 750 mg orally every 12 hours
Duration of Therapy: 7 to 14 days
Comments:
- This drug is not considered the drug of first choice for the treatment of presumed or confirmed pneumonia secondary to Streptococcus pneumoniae.
- Since fluoroquinolones (including this drug) have been associated with serious side effects and acute exacerbations of chronic bronchitis (AECB) is self-limiting for some patients, this drug should be saved for treatment of AECB in patients with no alternative treatment options.
Usual Adult Dose for Bronchitis
IV: 400 mg IV every 8 to 12 hours
Oral: 500 to 750 mg orally every 12 hours
Duration of Therapy: 7 to 14 days
Comments:
- This drug is not considered the drug of first choice for the treatment of presumed or confirmed pneumonia secondary to Streptococcus pneumoniae.
- Since fluoroquinolones (including this drug) have been associated with serious side effects and acute exacerbations of chronic bronchitis (AECB) is self-limiting for some patients, this drug should be saved for treatment of AECB in patients with no alternative treatment options.
Uses: For treatment of lower respiratory tract infections due to E coli, K pneumoniae, E cloacae, P mirabilis, P aeruginosa, H influenzae, H parainfluenzae, or S pneumoniae; for the treatment of AECB due to Moraxella catarrhalis
Usual Adult Dose for Skin or Soft Tissue Infection
IV: 400 mg IV every 8 to 12 hours
Oral: 500 to 750 mg orally every 12 hours
Duration of Therapy: 7 to 14 days
Use: For treatment of skin and skin structure infections due to E coli, K pneumoniae, E cloacae, P mirabilis, P vulgaris, Providencia stuartii, Morganella morganii, Citrobacter freundii, P aeruginosa, Staphylococcus aureus (methicillin-susceptible), S epidermidis (methicillin-susceptible), or S pyogenes
Infectious Diseases Society of America (IDSA) Recommendations:
Incisional surgical site infection:
- IV: 400 mg IV every 12 hour
- Oral: 750 mg orally every 12 hours
Aeromonas hydrophila necrotizing infection: 400 mg IV every 12 hours
Infection after animal bite:
- IV: 400 mg IV every 12 hour
- Oral: 500 to 750 mg orally every 12 hours
Comments:
- Recommended for use with metronidazole as a combination regimen for treatment of incisional surgical site infections after intestinal or genitourinary tract surgery
- Recommended for use with metronidazole for treatment of incisional surgical site infections after surgery of axilla or perineum; coverage for methicillin-resistant S aureus (MRSA) may be needed.
- In combination with doxycycline, recommended as a preferred IV drug for the treatment of A hydrophila necrotizing infections of the skin, fascia, and muscle
- For animal bites, fluoroquinolones have good activity against Pasteurella multocida but do not provide coverage for MRSA and some anaerobes.
- Current guidelines should be consulted for additional information.
Some Experts Recommend:
- Vibrio vulnificus: 400 mg IV every 12 hours
Comments:
- Recommended for use with ceftazidime (1 to 2 g IV every 8 hours) or cefotaxime (2 g IV every 8 hours)
Usual Adult Dose for Skin and Structure Infection
IV: 400 mg IV every 8 to 12 hours
Oral: 500 to 750 mg orally every 12 hours
Duration of Therapy: 7 to 14 days
Use: For treatment of skin and skin structure infections due to E coli, K pneumoniae, E cloacae, P mirabilis, P vulgaris, Providencia stuartii, Morganella morganii, Citrobacter freundii, P aeruginosa, Staphylococcus aureus (methicillin-susceptible), S epidermidis (methicillin-susceptible), or S pyogenes
Infectious Diseases Society of America (IDSA) Recommendations:
Incisional surgical site infection:
- IV: 400 mg IV every 12 hour
- Oral: 750 mg orally every 12 hours
Aeromonas hydrophila necrotizing infection: 400 mg IV every 12 hours
Infection after animal bite:
- IV: 400 mg IV every 12 hour
- Oral: 500 to 750 mg orally every 12 hours
Comments:
- Recommended for use with metronidazole as a combination regimen for treatment of incisional surgical site infections after intestinal or genitourinary tract surgery
- Recommended for use with metronidazole for treatment of incisional surgical site infections after surgery of axilla or perineum; coverage for methicillin-resistant S aureus (MRSA) may be needed.
- In combination with doxycycline, recommended as a preferred IV drug for the treatment of A hydrophila necrotizing infections of the skin, fascia, and muscle
- For animal bites, fluoroquinolones have good activity against Pasteurella multocida but do not provide coverage for MRSA and some anaerobes.
- Current guidelines should be consulted for additional information.
Some Experts Recommend:
- Vibrio vulnificus: 400 mg IV every 12 hours
Comments:
- Recommended for use with ceftazidime (1 to 2 g IV every 8 hours) or cefotaxime (2 g IV every 8 hours)
Usual Adult Dose for Shigellosis
500 mg orally every 12 hours for 5 to 7 days
Use: When antibacterial therapy is indicated, for treatment of infectious diarrhea due to E coli (enterotoxigenic isolates), Campylobacter jejuni, Shigella boydii, S dysenteriae, S flexneri, or S sonnei
US CDC, National Institutes of Health (NIH), and HIV Medicine Association of the Infectious Diseases Society of America (HIVMA/IDSA) Recommendations for HIV-Infected Patients:
Shigellosis therapy:
- IV: 400 mg IV every 12 hours
- Oral: 500 to 750 mg orally every 12 hours
Duration of Therapy:
- Bacteremia: At least 14 days
- Gastroenteritis: 7 to 10 days
- Recurrent infections: 2 to 6 weeks
Comments:
- Recommended as preferred therapy (if MIC is less than 0.12 mcg/mL) to shorten duration of illness and to possibly prevent spread to others
- Increased resistance of Shigella to fluoroquinolones reported in the US; treatment of Shigella with fluoroquinolones should be avoided if ciprofloxacin MIC is 0.12 mcg/mL or greater, even if isolate identified as sensitive by laboratory.
- Current guidelines should be consulted for additional information.
Usual Adult Dose for Infectious Diarrhea
500 mg orally every 12 hours for 5 to 7 days
Use: When antibacterial therapy is indicated, for treatment of infectious diarrhea due to E coli (enterotoxigenic isolates), Campylobacter jejuni, Shigella boydii, S dysenteriae, S flexneri, or S sonnei
US CDC, National Institutes of Health (NIH), and HIV Medicine Association of the Infectious Diseases Society of America (HIVMA/IDSA) Recommendations for HIV-Infected Patients:
Shigellosis therapy:
- IV: 400 mg IV every 12 hours
- Oral: 500 to 750 mg orally every 12 hours
Duration of Therapy:
- Bacteremia: At least 14 days
- Gastroenteritis: 7 to 10 days
- Recurrent infections: 2 to 6 weeks
Comments:
- Recommended as preferred therapy (if MIC is less than 0.12 mcg/mL) to shorten duration of illness and to possibly prevent spread to others
- Increased resistance of Shigella to fluoroquinolones reported in the US; treatment of Shigella with fluoroquinolones should be avoided if ciprofloxacin MIC is 0.12 mcg/mL or greater, even if isolate identified as sensitive by laboratory.
- Current guidelines should be consulted for additional information.
Usual Adult Dose for Sinusitis
IV: 400 mg IV every 12 hours
Oral: 500 mg orally every 12 hours
Duration of Therapy: 10 days
Comments:
- Since fluoroquinolones (including this drug) have been associated with serious side effects and acute sinusitis is self-limiting for some patients, this drug should be saved for treatment of acute sinusitis in patients with no alternative treatment options.
Use: For treatment of acute sinusitis due to H influenzae, S pneumoniae, or M catarrhalis
Usual Adult Dose for Salmonella Enteric Fever
500 mg orally every 12 hours for 10 days
Comments:
- Efficacy in eradicating the chronic typhoid carrier state has not been established.
US CDC, NIH, and HIVMA/IDSA Recommendations for HIV-Infected Patients:
- IV: 400 mg IV every 12 hours
- Oral: 500 to 750 mg orally every 12 hours
For gastroenteritis without bacteremia:
- If CD4 count at least 200 cells/mm3: 7 to 14 days
- If CD4 count less than 200 cells/mm3: 2 to 6 weeks
- If CD4 count at least 200 cells/mm3: 14 days; longer if persistent bacteremia or complicated infection (e.g., metastatic foci of infection present)
- If CD4 count less than 200 cells/mm3: 2 to 6 weeks
- Recommended as preferred empiric therapy for bacterial enteric infections (pending diagnostic studies) and as preferred therapy for salmonella gastroenteritis with or without bacteremia
- Empiric therapy for bacterial enteric infections recommended for patients with advanced HIV (CD4 count less than 200 cells/mm3 or concomitant AIDS-defining illnesses) and clinically severe diarrhea (at least 6 liquid stools/day or bloody stool and/or associated fever/chills). Fecal samples should be obtained for diagnostic testing before starting therapy; therapy should be adjusted based on those results.
- All HIV-infected patients with salmonellosis should receive antibiotic therapy; increased risk of bacteremia (by 20- to 100-fold) and mortality (by up to 7-fold) compared to HIV-negative subjects.
- Current guidelines should be consulted for additional information.
Usual Adult Dose for Salmonella Gastroenteritis
500 mg orally every 12 hours for 10 days
Comments:
- Efficacy in eradicating the chronic typhoid carrier state has not been established.
US CDC, NIH, and HIVMA/IDSA Recommendations for HIV-Infected Patients:
- IV: 400 mg IV every 12 hours
- Oral: 500 to 750 mg orally every 12 hours
For gastroenteritis without bacteremia:
- If CD4 count at least 200 cells/mm3: 7 to 14 days
- If CD4 count less than 200 cells/mm3: 2 to 6 weeks
- If CD4 count at least 200 cells/mm3: 14 days; longer if persistent bacteremia or complicated infection (e.g., metastatic foci of infection present)
- If CD4 count less than 200 cells/mm3: 2 to 6 weeks
- Recommended as preferred empiric therapy for bacterial enteric infections (pending diagnostic studies) and as preferred therapy for salmonella gastroenteritis with or without bacteremia
- Empiric therapy for bacterial enteric infections recommended for patients with advanced HIV (CD4 count less than 200 cells/mm3 or concomitant AIDS-defining illnesses) and clinically severe diarrhea (at least 6 liquid stools/day or bloody stool and/or associated fever/chills). Fecal samples should be obtained for diagnostic testing before starting therapy; therapy should be adjusted based on those results.
- All HIV-infected patients with salmonellosis should receive antibiotic therapy; increased risk of bacteremia (by 20- to 100-fold) and mortality (by up to 7-fold) compared to HIV-negative subjects.
- Current guidelines should be consulted for additional information.
Usual Adult Dose for Typhoid Fever
500 mg orally every 12 hours for 10 days
Comments:
- Efficacy in eradicating the chronic typhoid carrier state has not been established.
US CDC, NIH, and HIVMA/IDSA Recommendations for HIV-Infected Patients:
- IV: 400 mg IV every 12 hours
- Oral: 500 to 750 mg orally every 12 hours
For gastroenteritis without bacteremia:
- If CD4 count at least 200 cells/mm3: 7 to 14 days
- If CD4 count less than 200 cells/mm3: 2 to 6 weeks
- If CD4 count at least 200 cells/mm3: 14 days; longer if persistent bacteremia or complicated infection (e.g., metastatic foci of infection present)
- If CD4 count less than 200 cells/mm3: 2 to 6 weeks
- Recommended as preferred empiric therapy for bacterial enteric infections (pending diagnostic studies) and as preferred therapy for salmonella gastroenteritis with or without bacteremia
- Empiric therapy for bacterial enteric infections recommended for patients with advanced HIV (CD4 count less than 200 cells/mm3 or concomitant AIDS-defining illnesses) and clinically severe diarrhea (at least 6 liquid stools/day or bloody stool and/or associated fever/chills). Fecal samples should be obtained for diagnostic testing before starting therapy; therapy should be adjusted based on those results.
- All HIV-infected patients with salmonellosis should receive antibiotic therapy; increased risk of bacteremia (by 20- to 100-fold) and mortality (by up to 7-fold) compared to HIV-negative subjects.
- Current guidelines should be consulted for additional information
Usual Adult Dose for Urinary Tract Infection
IV: 200 to 400 mg IV every 8 to 12 hours for 7 to 14 days
Oral:
Immediate-release: 250 to 500 mg orally every 12 hours for 7 to 14 days
Extended-release:
- Uncomplicated infection (Cipro[R] XR, Proquin[R] XR): 500 mg orally every 24 hours for 3 days
- Complicated infection (Cipro[R] XR): 1000 mg orally every 24 hours for 7 to 14 days
- IV, Immediate-release: For treatment of urinary tract infections (UTIs) due to E coli, K pneumoniae, E cloacae, S marcescens, P mirabilis, P rettgeri, M morganii, C koseri, C freundii, P aeruginosa, S epidermidis (methicillin-susceptible), S saprophyticus, or Enterococcus faecalis
- Cipro(R) XR: For the treatment of uncomplicated UTIs due to E coli, P mirabilis, E faecalis, or S saprophyticus; for the treatment of complicated UTIs due to E coli, K pneumoniae, E faecalis, P mirabilis, or P aeruginosa
- Proquin(R) XR: For the treatment of uncomplicated UTIs due to E coli or K pneumoniae
Usual Adult Dose for Pyelonephritis
Cipro(R) XR: 1000 mg orally every 24 hours for 7 to 14 days
Use: For the treatment of acute uncomplicated pyelonephritis due to E coli
Usual Adult Dose for Cystitis
Immediate-release: 250 mg orally every 12 hours
Extended-release: 500 mg orally every 24 hours
Duration of Therapy: 3 days
Comments:
- Since fluoroquinolones (including this drug) have been associated with serious side effects and acute uncomplicated cystitis/uncomplicated UTI (acute cystitis) is self-limiting for some patients, this drug should be saved for treatment of acute uncomplicated cystitis/uncomplicated UTI (acute cystitis) in patients with no alternative treatment options.
- Immediate-release: In female patients, for treatment of acute uncomplicated cystitis due to E coli or S saprophyticus
- Cipro(R) XR: For the treatment of uncomplicated UTI (acute cystitis) due to E coli, P mirabilis, E faecalis, or S saprophyticus
- Proquin(R) XR: For the treatment of uncomplicated UTI (acute cystitis) due to E coli or K pneumoniae
Usual Adult Dose for Prostatitis
IV: 400 mg IV every 12 hours
Oral: 500 mg orally every 12 hours
Duration of Therapy: 28 days
Use: For treatment of chronic bacterial prostatitis due to E coli or P mirabilis
Usual Adult Dose for Gonococcal Infection - Uncomplicated
250 mg orally once
Uses: For treatment of uncomplicated urethral and cervical gonorrhea due to Neisseria gonorrhoeae
US CDC Recommendations:
- Due to high rates of resistance, fluoroquinolones are not recommended for treatment of gonococcal infections in the US; dual therapy with ceftriaxone and azithromycin is the recommended regimen for treatment of gonorrhea in the US.
- Antimicrobial susceptibility patterns should be monitored.
- The patient's sexual partner(s) should also be evaluated/treated.
- Current guidelines should be consulted for additional information.
Usual Adult Dose for Meningococcal Meningitis Prophylaxis
US CDC Recommendations: 500 mg orally once
Usual Adult Dose for Tularemia
IDSA Recommendations:
- Mild to moderate illness: 750 mg orally twice a day for at least 14 days
- IV: 400 mg IV twice a day for 10 days
- Oral: 500 mg orally twice a day for 14 days
- May switch to oral therapy when clinically indicated
- Recommended as an alternative IV drug for treatment of tularemia in a contained casualty setting; recommended as an alternative agent in pregnant women
- Recommended as a preferred oral drug for treatment of tularemia in a mass casualty setting and for postexposure prophylaxis; recommended as a preferred agent in pregnant women
- Current guidelines should be consulted for additional information.
Usual Adult Dose for Chancroid
US CDC Recommendations: 500 mg orally twice a day for 3 days
Comments:
- Alternative therapy recommended during pregnancy and lactation.
- The patient's sexual partner(s) should also be evaluated/treated.
- Current guidelines should be consulted for additional information.
Usual Adult Dose for Granuloma Inguinale
US CDC Recommendations: 750 mg orally twice a day
Duration of Therapy: At least 3 weeks and until all lesions have completely healed
Comments:
- Recommended as an alternative regimen
- The patient's sexual partner(s) should also be evaluated/treated.
- Current guidelines should be consulted for additional information.
Usual Adult Dose for Surgical Prophylaxis
American Society of Health-System Pharmacists (ASHP), IDSA, Surgical Infection Society (SIS), and Society for Healthcare Epidemiology of America (SHEA) Recommendations:
- Preoperative dose: 400 mg IV once, starting within 120 minutes before surgical incision
- A single prophylactic dose is usually sufficient; if prophylaxis is continued postoperatively, duration should be less than 24 hours.
- Readministration may be needed for unusually long procedures to ensure adequate serum and tissue drug levels.
- Redosing may be needed if drug half-life is shortened (e.g., extensive burns) or if prolonged/excessive bleeding during surgery; redosing may not be needed if drug half-life is prolonged (e.g., renal dysfunction).
- Before use, local susceptibility should be reviewed due to increasing resistance of E coli to fluoroquinolones.
- Coadministration with other agents may be recommended, depending on type of procedure.
- Current guidelines should be consulted for additional information.
- Gastroduodenal (as part of an alternative regimen): Procedures involving entry into lumen of gastrointestinal tract (bariatric, pancreaticoduodenectomy); Procedures without entry into gastrointestinal tract (antireflux, highly selective vagotomy) for high-risk patients
- Biliary tract (as part of an alternative regimen): Open procedure; elective, high-risk laparoscopic procedure
- Appendectomy (as part of an alternative regimen): Uncomplicated appendicitis
- Small intestine (as part of an alternative regimen): Nonobstructed; obstructed
- Colorectal (as part of an alternative regimen)
- Hysterectomy (as part of an alternative regimen): Vaginal or abdominal
- Urologic: Lower tract instrumentation with risk factors for infection, including transrectal prostate biopsy (recommended regimen); clean with entry into urinary tract or clean-contaminated (as part of an alternative regimen)
- Transplantation (as part of an alternative regimen): Liver; pancreas; pancreas-kidney
Usual Pediatric Dose for Inhalation Bacillus anthracis
IV: 10 mg/kg IV every 12 hours
Maximum dose: 400 mg/dose
Oral: 15 mg/kg orally every 12 hours
Maximum dose: 500 mg/dose
Recommended dose of the 5% oral suspension using the co-packaged graduated spoon:
- Weight 9 to 12 kg: 125 mg orally every 12 hours
- Weight 13 to 18 kg: 250 mg orally every 12 hours
- Weight 19 to 24 kg: 250 to 375 mg orally every 12 hours
- Weight at least 25 kg: 500 mg orally every 12 hours
- Weight 13 to 24 kg: 250 mg orally every 12 hours
- Weight at least 25 kg: 500 mg orally every 12 hours
Comments:
- Therapy should be started as soon as possible after suspected/confirmed exposure.
- Indication based on efficacy studies in animals.
American Academy of Pediatrics Recommendations:
Up to 4 weeks of age:
- Gestational age 32 to 37 weeks: 10 mg/kg orally or IV every 12 hours
- Term neonate: 15 mg/kg orally or IV every 12 hours
IV: 10 mg/kg IV every 8 hours
Maximum dose: 400 mg/dose
Oral: 15 mg/kg orally every 12 hours
Maximum dose: 500 mg/dose
Duration of Therapy:
Postexposure prophylaxis for B anthracis infection (all ages): 60 days after exposure
Systemic anthrax:
- Severe anthrax (up to 4 weeks of age): At least 2 to 3 weeks or until patient is clinically stable (whichever is longer)
- With possible/confirmed meningitis (1 month or older): At least 2 to 3 weeks or until patient is clinically stable (whichever is longer)
- When meningitis has been excluded (1 month or older): At least 14 days or until patient is clinically stable (whichever is longer)
- Patients will require prophylaxis to complete an antimicrobial regimen of up to 60 days from onset of illness.
- Bioterrorism-related cases: To complete an antimicrobial regimen of up to 60 days from onset of illness
- Naturally acquired cases: 7 to 10 days
- Patients may require prophylaxis to complete an antimicrobial regimen of up to 60 days from onset of illness.
- Recommended as the preferred oral drug for postexposure prophylaxis and for the treatment of cutaneous anthrax without systemic involvement
- Recommended as the preferred IV drug for the treatment of systemic/severe anthrax (including follow-up)
- Recommended for all strains (regardless of penicillin susceptibility or if susceptibility unknown) when used for postexposure prophylaxis, systemic/severe anthrax when meningitis has been excluded, follow-up therapy for severe anthrax, or cutaneous anthrax without systemic involvement
- Recommended for use with a protein synthesis inhibitor when used for systemic anthrax (including follow-up); the addition of a bactericidal beta-lactam (all patients) or a bactericidal glycopeptide (patients 1 month or older) is recommended with possible/confirmed meningitis.
- Systemic/severe anthrax includes anthrax meningitis, inhalation anthrax, injection anthrax, gastrointestinal anthrax, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
- Current guidelines should be consulted for additional information.
Usual Pediatric Dose for Cutaneous Bacillus anthracis
IV: 10 mg/kg IV every 12 hours
Maximum dose: 400 mg/dose
Oral: 15 mg/kg orally every 12 hours
Maximum dose: 500 mg/dose
Recommended dose of the 5% oral suspension using the co-packaged graduated spoon:
- Weight 9 to 12 kg: 125 mg orally every 12 hours
- Weight 13 to 18 kg: 250 mg orally every 12 hours
- Weight 19 to 24 kg: 250 to 375 mg orally every 12 hours
- Weight at least 25 kg: 500 mg orally every 12 hours
- Weight 13 to 24 kg: 250 mg orally every 12 hours
- Weight at least 25 kg: 500 mg orally every 12 hours
Comments:
- Therapy should be started as soon as possible after suspected/confirmed exposure.
- Indication based on efficacy studies in animals.
American Academy of Pediatrics Recommendations:
Up to 4 weeks of age:
- Gestational age 32 to 37 weeks: 10 mg/kg orally or IV every 12 hours
- Term neonate: 15 mg/kg orally or IV every 12 hours
IV: 10 mg/kg IV every 8 hours
Maximum dose: 400 mg/dose
Oral: 15 mg/kg orally every 12 hours
Maximum dose: 500 mg/dose
Duration of Therapy:
Postexposure prophylaxis for B anthracis infection (all ages): 60 days after exposure
Systemic anthrax:
- Severe anthrax (up to 4 weeks of age): At least 2 to 3 weeks or until patient is clinically stable (whichever is longer)
- With possible/confirmed meningitis (1 month or older): At least 2 to 3 weeks or until patient is clinically stable (whichever is longer)
- When meningitis has been excluded (1 month or older): At least 14 days or until patient is clinically stable (whichever is longer)
- Patients will require prophylaxis to complete an antimicrobial regimen of up to 60 days from onset of illness.
- Bioterrorism-related cases: To complete an antimicrobial regimen of up to 60 days from onset of illness
- Naturally acquired cases: 7 to 10 days
- Patients may require prophylaxis to complete an antimicrobial regimen of up to 60 days from onset of illness.
- Recommended as the preferred oral drug for postexposure prophylaxis and for the treatment of cutaneous anthrax without systemic involvement
- Recommended as the preferred IV drug for the treatment of systemic/severe anthrax (including follow-up)
- Recommended for all strains (regardless of penicillin susceptibility or if susceptibility unknown) when used for postexposure prophylaxis, systemic/severe anthrax when meningitis has been excluded, follow-up therapy for severe anthrax, or cutaneous anthrax without systemic involvement
- Recommended for use with a protein synthesis inhibitor when used for systemic anthrax (including follow-up); the addition of a bactericidal beta-lactam (all patients) or a bactericidal glycopeptide (patients 1 month or older) is recommended with possible/confirmed meningitis.
- Systemic/severe anthrax includes anthrax meningitis, inhalation anthrax, injection anthrax, gastrointestinal anthrax, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
- Current guidelines should be consulted for additional information.
Usual Pediatric Dose for Anthrax Prophylaxis
IV: 10 mg/kg IV every 12 hours
Maximum dose: 400 mg/dose
Oral: 15 mg/kg orally every 12 hours
Maximum dose: 500 mg/dose
Recommended dose of the 5% oral suspension using the co-packaged graduated spoon:
- Weight 9 to 12 kg: 125 mg orally every 12 hours
- Weight 13 to 18 kg: 250 mg orally every 12 hours
- Weight 19 to 24 kg: 250 to 375 mg orally every 12 hours
- Weight at least 25 kg: 500 mg orally every 12 hours
- Weight 13 to 24 kg: 250 mg orally every 12 hours
- Weight at least 25 kg: 500 mg orally every 12 hours
Total Duration of Therapy: 60 days
Comments:
- Therapy should be started as soon as possible after suspected/confirmed exposure.
- Indication based on efficacy studies in animals.
American Academy of Pediatrics Recommendations:
Up to 4 weeks of age:
- Gestational age 32 to 37 weeks: 10 mg/kg orally or IV every 12 hours
- Term neonate: 15 mg/kg orally or IV every 12 hours
IV: 10 mg/kg IV every 8 hours
Maximum dose: 400 mg/dose
Oral: 15 mg/kg orally every 12 hours
Maximum dose: 500 mg/dose
Duration of Therapy:
Postexposure prophylaxis for B anthracis infection (all ages): 60 days after exposure
Systemic anthrax:
- Severe anthrax (up to 4 weeks of age): At least 2 to 3 weeks or until patient is clinically stable (whichever is longer)
- With possible/confirmed meningitis (1 month or older): At least 2 to 3 weeks or until patient is clinically stable (whichever is longer)
- When meningitis has been excluded (1 month or older): At least 14 days or until patient is clinically stable (whichever is longer)
- Patients will require prophylaxis to complete an antimicrobial regimen of up to 60 days from onset of illness.
- Bioterrorism-related cases: To complete an antimicrobial regimen of up to 60 days from onset of illness
- Naturally acquired cases: 7 to 10 days
- Patients may require prophylaxis to complete an antimicrobial regimen of up to 60 days from onset of illness.
- Recommended as the preferred oral drug for postexposure prophylaxis and for the treatment of cutaneous anthrax without systemic involvement
- Recommended as the preferred IV drug for the treatment of systemic/severe anthrax (including follow-up)
- Recommended for all strains (regardless of penicillin susceptibility or if susceptibility unknown) when used for postexposure prophylaxis, systemic/severe anthrax when meningitis has been excluded, follow-up therapy for severe anthrax, or cutaneous anthrax without systemic involvement
- Recommended for use with a protein synthesis inhibitor when used for systemic anthrax (including follow-up); the addition of a bactericidal beta-lactam (all patients) or a bactericidal glycopeptide (patients 1 month or older) is recommended with possible/confirmed meningitis.
- Systemic/severe anthrax includes anthrax meningitis, inhalation anthrax, injection anthrax, gastrointestinal anthrax, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
- Current guidelines should be consulted for additional information.
Usual Pediatric Dose for Pyelonephritis
1 year or older:
IV: 6 to 10 mg/kg IV every 8 hours
Maximum dose: 400 mg/dose
Oral: 10 to 20 mg/kg orally every 12 hours
Maximum dose: 750 mg/dose
Recommended dose of the 5% oral suspension using the co-packaged graduated spoon:
- Weight 9 to 12 kg: 125 mg orally every 12 hours
- Weight 13 to 18 kg: 250 mg orally every 12 hours
- Weight 19 to 24 kg: 250 to 375 mg orally every 12 hours
- Weight 25 to 31 kg: 375 to 500 mg orally every 12 hours
- Weight 32 to 37 kg: 375 to 625 mg orally every 12 hours
- Weight at least 38 kg: 500 to 750 mg orally every 12 hours
- Weight 13 to 24 kg: 250 mg orally every 12 hours
- Weight 25 kg: 250 to 500 mg orally every 12 hours
- Weight 26 to 37 kg: 500 mg orally every 12 hours
- Weight at least 38 kg: 500 to 750 mg orally every 12 hours
Total Duration of Therapy: 10 to 21 days
Comments:
- Dose and initial route of therapy should be based on severity of infection.
- Due to an increased incidence of side effects compared to controls (including those related to joints and/or surrounding tissues), this drug is not a drug of first choice in pediatric patients.
Usual Pediatric Dose for Urinary Tract Infection
1 year or older:
IV: 6 to 10 mg/kg IV every 8 hours
Maximum dose: 400 mg/dose
Oral: 10 to 20 mg/kg orally every 12 hours
Maximum dose: 750 mg/dose
Recommended dose of the 5% oral suspension using the co-packaged graduated spoon:
- Weight 9 to 12 kg: 125 mg orally every 12 hours
- Weight 13 to 18 kg: 250 mg orally every 12 hours
- Weight 19 to 24 kg: 250 to 375 mg orally every 12 hours
- Weight 25 to 31 kg: 375 to 500 mg orally every 12 hours
- Weight 32 to 37 kg: 375 to 625 mg orally every 12 hours
- Weight at least 38 kg: 500 to 750 mg orally every 12 hours
- Weight 13 to 24 kg: 250 mg orally every 12 hours
- Weight 25 kg: 250 to 500 mg orally every 12 hours
- Weight 26 to 37 kg: 500 mg orally every 12 hours
- Weight at least 38 kg: 500 to 750 mg orally every 12 hours
Comments:
- Dose and initial route of therapy should be based on severity of infection.
- Due to an increased incidence of side effects compared to controls (including those related to joints and/or surrounding tissues), this drug is not a drug of first choice in pediatric patients.
Usual Pediatric Dose for Plague
IV: 10 mg/kg IV every 8 to 12 hours
Maximum dose: 400 mg/dose
Oral: 15 mg/kg orally every 8 to 12 hours
Maximum dose: 500 mg/dose
Recommended dose of the 5% oral suspension using the co-packaged graduated spoon:
- Weight 9 to 12 kg: 125 mg orally every 8 to 12 hours
- Weight 13 to 18 kg: 250 mg orally every 8 to 12 hours
- Weight 19 to 24 kg: 250 to 375 mg orally every 8 to 12 hours
- Weight 25 to 31 kg: 375 to 500 mg orally every 8 to 12 hours
- Weight 32 to 37 kg: 375 to 625 mg orally every 8 to 12 hours
- Weight at least 38 kg: 500 to 750 mg orally every 8 to 12 hours
Recommended dose of the 10% oral suspension using the co-packaged graduated spoon:
- Weight 13 to 24 kg: 250 mg orally every 8 to 12 hours
- Weight 25 kg: 250 to 500 mg orally every 8 to 12 hours
- Weight 26 to 37 kg: 500 mg orally every 8 to 12 hours
- Weight at least 38 kg: 500 to 750 mg orally every 8 to 12 hours
Total Duration of Therapy: 10 to 21 days
Comments:
- Therapy should be started as soon as possible after suspected/confirmed exposure to Y pestis.
- Indication based on efficacy study in animals only.
US CDC Recommendations:
Treatment:
- IV: 15 mg/kg IV every 12 hours
- Maximum dose: 400 mg/dose
- Oral: 20 mg/kg orally every 12 hours
- Maximum dose: 500 mg/dose
Postexposure Prophylaxis: 20 mg/kg orally twice a day for 7 days
- Maximum dose: 1000 mg/day
- Appropriate IV therapy should be started as soon as plague is suspected; may switch to oral therapy once patient improves
- Fluoroquinolones and gentamicin are generally first-line treatments in the US.
- Postexposure prophylaxis is recommended for individuals with known exposure to plague (e.g., close contact with pneumonic plague patient, direct contact with infected body fluids/tissues).
- Current guidelines should be consulted for additional information.
Usual Pediatric Dose for Plague Prophylaxis
IV: 10 mg/kg IV every 8 to 12 hours
Maximum dose: 400 mg/dose
Oral: 15 mg/kg orally every 8 to 12 hours
Maximum dose: 500 mg/dose
Recommended dose of the 5% oral suspension using the co-packaged graduated spoon:
- Weight 9 to 12 kg: 125 mg orally every 8 to 12 hours
- Weight 13 to 18 kg: 250 mg orally every 8 to 12 hours
- Weight 19 to 24 kg: 250 to 375 mg orally every 8 to 12 hours
- Weight 25 to 31 kg: 375 to 500 mg orally every 8 to 12 hours
- Weight 32 to 37 kg: 375 to 625 mg orally every 8 to 12 hours
- Weight at least 38 kg: 500 to 750 mg orally every 8 to 12 hours
Recommended dose of the 10% oral suspension using the co-packaged graduated spoon:
- Weight 13 to 24 kg: 250 mg orally every 8 to 12 hours
- Weight 25 kg: 250 to 500 mg orally every 8 to 12 hours
- Weight 26 to 37 kg: 500 mg orally every 8 to 12 hours
- Weight at least 38 kg: 500 to 750 mg orally every 8 to 12 hours
Total Duration of Therapy: 10 to 21 days
Comments:
- Therapy should be started as soon as possible after suspected/confirmed exposure to Y pestis.
- Indication based on efficacy study in animals only.
US CDC Recommendations:
Treatment:
- IV: 15 mg/kg IV every 12 hours
- Maximum dose: 400 mg/dose
- Oral: 20 mg/kg orally every 12 hours
- Maximum dose: 500 mg/dose
Postexposure Prophylaxis: 20 mg/kg orally twice a day for 7 days
- Maximum dose: 1000 mg/day
- Appropriate IV therapy should be started as soon as plague is suspected; may switch to oral therapy once patient improves
- Fluoroquinolones and gentamicin are generally first-line treatments in the US.
- Postexposure prophylaxis is recommended for individuals with known exposure to plague (e.g., close contact with pneumonic plague patient, direct contact with infected body fluids/tissues).
- Current guidelines should be consulted for additional information.
Usual Pediatric Dose for Tularemia
Working Group on Civilian Biodefense Recommendations for Management of Tularemia Used as a Biological Weapon:
- IV: 15 mg/kg IV twice a day for 10 days
- Maximum dose: 400 mg/dose
- Oral: 15 mg/kg orally twice a day for 14 days
- Maximum dose: 500 mg/dose
- May switch to oral therapy when clinically indicated
- Recommended as an alternative IV drug for treatment of tularemia in a contained casualty setting
- Recommended as a preferred oral drug for treatment of tularemia in a mass casualty setting and for postexposure prophylaxis
- Current guidelines should be consulted for additional information.
Usual Pediatric Dose for Surgical Prophylaxis
ASHP, IDSA, SIS, and SHEA Recommendations:
1 year or older:
Preoperative dose: 10 mg/kg IV once, starting within 120 minutes before surgical incision
Maximum dose: 400 mg/dose
Comments:
- A single prophylactic dose is usually sufficient; if prophylaxis is continued postoperatively, duration should be less than 24 hours.
- Readministration may be needed for unusually long procedures to ensure adequate serum and tissue drug levels.
- Redosing may be needed if drug half-life is shortened (e.g., extensive burns) or if prolonged/excessive bleeding during surgery; redosing may not be needed if drug half-life is prolonged (e.g., renal dysfunction).
- Before use, local susceptibility should be reviewed due to increasing resistance of E coli to fluoroquinolones.
- Coadministration with other agents may be recommended, depending on type of procedure.
- Pediatric dose should not exceed adult dose.
- Current guidelines should be consulted for additional information.
- Gastroduodenal (as part of an alternative regimen): Procedures involving entry into lumen of gastrointestinal tract (bariatric, pancreaticoduodenectomy); Procedures without entry into gastrointestinal tract (antireflux, highly selective vagotomy) for high-risk patients
- Biliary tract (as part of an alternative regimen): Open procedure; elective, high-risk laparoscopic procedure
- Appendectomy (as part of an alternative regimen): Uncomplicated appendicitis
- Small intestine (as part of an alternative regimen): Nonobstructed; obstructed
- Colorectal (as part of an alternative regimen)
- Hysterectomy (as part of an alternative regimen): Vaginal or abdominal
- Urologic: Lower tract instrumentation with risk factors for infection, including transrectal prostate biopsy (recommended regimen); clean with entry into urinary tract or clean-contaminated (as part of an alternative regimen)
- Transplantation (as part of an alternative regimen): Liver; pancreas; pancreas-kidney
Usual Pediatric Dose for Shigellosis
US CDC, NIH, and HIVMA/IDSA Recommendations for HIV-Infected Adolescents:
Shigellosis therapy:
- IV: 400 mg IV every 12 hours
- Oral: 500 to 750 mg orally every 12 hours
- Bacteremia: At least 14 days
- Gastroenteritis: 7 to 10 days
- Recurrent infections: 2 to 6 weeks
- Recommended as preferred therapy (if MIC is less than 0.12 mcg/mL) to shorten duration of illness and to possibly prevent spread to others
- Increased resistance of Shigella to fluoroquinolones reported in the US; treatment of Shigella with fluoroquinolones should be avoided if ciprofloxacin MIC is 0.12 mcg/mL or greater, even if isolate identified as sensitive by laboratory.
- Current guidelines should be consulted for additional information.
Usual Pediatric Dose for Salmonella Enteric Fever
US CDC, NIH, and HIVMA/IDSA Recommendations for HIV-Infected Adolescents:
- IV: 400 mg IV every 12 hours
- Oral: 500 to 750 mg orally every 12 hours
For gastroenteritis without bacteremia:
- If CD4 count at least 200 cells/mm3: 7 to 14 days
- If CD4 count less than 200 cells/mm3: 2 to 6 weeks
For gastroenteritis with bacteremia:
- If CD4 count at least 200 cells/mm3: 14 days; longer if persistent bacteremia or complicated infection (e.g., metastatic foci of infection present)
- If CD4 count less than 200 cells/mm3: 2 to 6 weeks
- Recommended as preferred empiric therapy for bacterial enteric infections (pending diagnostic studies) and as preferred therapy for salmonella gastroenteritis with or without bacteremia
- Empiric therapy for bacterial enteric infections recommended for patients with advanced HIV (CD4 count less than 200 cells/mm3 or concomitant AIDS-defining illnesses) and clinically severe diarrhea (at least 6 liquid stools/day or bloody stool and/or associated fever/chills). Fecal samples should be obtained for diagnostic testing before starting therapy; therapy should be adjusted based on those results.
- All HIV-infected patients with salmonellosis should receive antibiotic therapy; increased risk of bacteremia (by 20- to 100-fold) and mortality (by up to 7-fold) compared to HIV-negative subjects.
- Current guidelines should be consulted for additional information.
Usual Pediatric Dose for Salmonella Gastroenteritis
US CDC, NIH, and HIVMA/IDSA Recommendations for HIV-Infected Adolescents:
- IV: 400 mg IV every 12 hours
- Oral: 500 to 750 mg orally every 12 hours
For gastroenteritis without bacteremia:
- If CD4 count at least 200 cells/mm3: 7 to 14 days
- If CD4 count less than 200 cells/mm3: 2 to 6 weeks
- If CD4 count at least 200 cells/mm3: 14 days; longer if persistent bacteremia or complicated infection (e.g., metastatic foci of infection present)
- If CD4 count less than 200 cells/mm3: 2 to 6 weeks
- Recommended as preferred empiric therapy for bacterial enteric infections (pending diagnostic studies) and as preferred therapy for salmonella gastroenteritis with or without bacteremia
- Empiric therapy for bacterial enteric infections recommended for patients with advanced HIV (CD4 count less than 200 cells/mm3 or concomitant AIDS-defining illnesses) and clinically severe diarrhea (at least 6 liquid stools/day or bloody stool and/or associated fever/chills). Fecal samples should be obtained for diagnostic testing before starting therapy; therapy should be adjusted based on those results.
- All HIV-infected patients with salmonellosis should receive antibiotic therapy; increased risk of bacteremia (by 20- to 100-fold) and mortality (by up to 7-fold) compared to HIV-negative subjects.
- Current guidelines should be consulted for additional information.
Usual Pediatric Dose for Pneumonia with Cystic Fibrosis
Study (n=67)
5 years or older: 10 mg/kg IV every 8 hours for 1 week followed by 20 mg/kg orally every 12 hours
Total Duration of Therapy: 10 to 21 days
Comments:
- Efficacy for the treatment of acute pulmonary exacerbations in pediatric cystic fibrosis patients has not been established.
Renal Dose Adjustments
Adult Patients:
IV:
- CrCl 5 to 29 mL/min: 200 to 400 mg IV every 18 to 24 hours
Immediate-release:
- CrCl 30 to 50 mL/min: 250 to 500 mg orally every 12 hours
- CrCl 5 to 29 mL/min: 250 to 500 mg orally every 18 hours
Cipro(R) XR:
- CrCl 30 mL/min or less: 500 mg orally every 24 hours
- Mild to moderate renal dysfunction: No adjustment recommended.
- Severe renal dysfunction: Data not available
- CrCl less than 50 mL/min: Data not available
- Patients with severe infections and severe renal dysfunction may be given an oral dose of 750 mg (immediate-release) at the intervals noted above.
- Patients with severe infections and severe renal dysfunction should be monitored carefully.
Precautions
US BOXED WARNING:
SERIOUS SIDE EFFECTS INCLUDING TENDINITIS, TENDON RUPTURE, PERIPHERAL NEUROPATHY, CNS EFFECTS, AND EXACERBATION OF MYASTHENIA GRAVIS:
- Fluoroquinolones (including this drug) have been associated with disabling and potentially irreversible serious side effects that have occurred together (including tendinitis and tendon rupture, peripheral neuropathy, CNS effects). This drug should be discontinued immediately and use of fluoroquinolones (including this drug) should be avoided in patients with any of these serious side effects.
- Fluoroquinolones (including this drug) may exacerbate muscle weakness in patients with myasthenia gravis. This drug should be avoided in patients with known history of myasthenia gravis.
- Since fluoroquinolones (including this drug) have been associated with serious side effects, this drug should be reserved for use in patients with no alternative treatment options for acute exacerbation of chronic bronchitis, acute uncomplicated cystitis/uncomplicated urinary tract infections (acute cystitis), or acute sinusitis.
History of hypersensitivity to the active component, other quinolones, or any of the ingredients; coadministration with tizanidine
Extended-release tablets: Safety and efficacy have not been established in patients younger than 18 years.
Consult WARNINGS section for additional precautions.
Dialysis
Hemodialysis, peritoneal dialysis:
Adult Patients:
IV: Data not available
Oral:
Immediate-release: 250 to 500 mg orally every 24 hours
Extended-release:
- Cipro(R) XR: 500 mg orally every 24 hours
- Proquin(R) XR: Data not available
Comments:
- Dose should be administered after dialysis.
Other Comments
Administration advice:
- Infuse IV doses over at least 60 minutes; slow infusion of dilute solution into larger vein will minimize patient discomfort and reduce risk of venous irritation.
- May switch from IV to oral therapy when clinically indicated at the physician's discretion
- May administer immediate-release tablets and oral suspension and Cipro(R) XR without regard to meals; administer Proquin(R) XR with a main meal, preferably the evening meal.
- In general, continue this drug (immediate-release) for at least 2 days after signs/symptoms of infection have disappeared, except for inhalation anthrax (postexposure).
- Swallow extended-release tablets whole; do not split, crush, or chew.
- Shake the oral suspension vigorously for about 15 seconds before each dose.
- Use the co-packaged graduated spoon to administer the oral suspension; after use, clean under running water with dish detergent and dry thoroughly.
- Swallow the microcapsules in the oral suspension whole; do not chew. May take water afterwards
- Do not administer the oral suspension through feeding or nasogastric tubes.
- May administer oral doses with meals that include dairy products (like milk, yogurt) or calcium-fortified juices; do not administer with such products alone.
- Administer oral doses at least 2 hours before or 6 hours after magnesium/aluminum antacids, polymeric phosphate binders (e.g., sevelamer, lanthanum carbonate), sucralfate, buffered didanosine, other highly buffered drugs, or other products containing calcium, iron, or zinc; administer Proquin(R) XR at least 4 hours before or 2 hours after such products.
- To determine dose and duration, consider the nature and severity of the infection, pathogen susceptibility, integrity of patient's host-defense mechanisms, and renal and liver function status; may administer this drug to adult patients when clinically indicated at physician's discretion.
- Maintain adequate hydration of patients to prevent formation of highly-concentrated urine.
Storage requirements:
- IV injection: Store between 5C to 25C (41F to 77F); protect from light; avoid excessive heat; protect from freezing.
- Oral formulations: Store at 20C to 25C (68C to 77F); excursions permitted to 15C to 30C (59F to 86F). Protect oral suspension from freezing; discard reconstituted suspension after 14 days.
- The manufacturer product information should be consulted.
- Unless otherwise specified, the dose provided is for immediate-release formulations.
- In patients younger than 18 years, this drug is only US FDA-approved for complicated UTIs, prevention of inhalation anthrax (postexposure), and plague.
- Culture and susceptibility information should be considered when selecting/modifying antibacterial therapy or, if no data are available, local epidemiology and susceptibility patterns may be considered when selecting empiric therapy.
- Appropriate culture and susceptibility testing recommended before therapy to isolate and identify infecting organisms and to establish susceptibility to this drug. Therapy may be started before test results are known; appropriate therapy should be continued when results are available.
- If suspected pathogens include anaerobic organisms, appropriate therapy should be used.
- Some isolates of P aeruginosa may develop resistance relatively quickly during therapy.
- The 10% oral suspension is not appropriate for children less than 13 kg.
- Nothing should be added to the mixed final oral suspension.
- The extended-release tablets are not interchangeable with immediate-release tablets or oral suspension; extended-release tablets made by different manufacturers are not interchangeable due to different pharmacokinetics (e.g., Cipro[R] XR and Proquin[R] XR).
Monitoring:
- Infections/Infestations: Culture and susceptibility (periodically during therapy); syphilis serology in gonorrhea patients (at diagnosis and 3 months after therapy)
- Renal: Renal function in elderly patients
Patient advice:
- Read the US FDA-approved patient labeling (Medication Guide).
- Drink plenty of fluids.
- Avoid missing doses and complete the entire course of therapy.
- Stop this drug immediately and contact healthcare provider if a serious side effect occurs.
- Seek medical attention immediately in an emergency room or call 911 if sudden, severe, constant pain in the stomach, chest, or back occurs.
- Stop this drug and contact healthcare provider if tendon pain, swelling, or inflammation develops or you have weakness or are unable to use 1 of your joints; rest and do not exercise. If your child has any joint-related problems during or after therapy, contact your child's physician.
- Stop this drug at once and contact physician if symptoms of peripheral neuropathy develop.
- Contact physician if persistent headache (with or without blurred vision), any symptoms of muscle weakness (including respiratory problems) or QT interval prolongation (including prolonged heart palpitations, loss of consciousness), signs/symptoms of liver injury, or watery and bloody stools occur.
- Stop this drug at first sign of skin rash, hives or other skin reactions, rapid heartbeat, problems swallowing or breathing, swelling suggestive of angioedema, or other symptoms of allergic reaction.
- Do not drive, operate machinery, or engage in other tasks that require mental alertness or coordination until you know how the drug affects you.
- Avoid or minimize exposure to natural or artificial sunlight; use sun protection (e.g., protective clothing, sunscreen) if sun exposure cannot be avoided. Contact physician if sunburn-like reaction or skin eruption develops.
