Clinical beta

FMBM is currently in clinical beta. Content is for professional review/testing and must not replace local protocols, senior clinical judgment, or official prescribing references.

Drug Monograph

Ciprofloxacin

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Ciprofloxacin

Fluoroquinolone (PO, IV)

PseudomonasUTIQTTendon

Indication

Pyelonephritis β€’ complicated UTI β€’ GNR bacteremia adjunct β€’ anthrax β€’ traveler’s diarrhea

At a glance

INDICATIONS (CORE USE)

Gram-negative including **Pseudomonas**; **tendon rupture** + **QT** + **aortic aneurysm** warnings; **avoid in uncomplicated UTI first-line** in many stewardship guidelines.

ADULT DOSE (STANDARD)

250–750 mg PO BID or 400 mg IV q8–12h β€” indication-specific

MAX DOSE

1.5 g/day PO divided in severe; IV 1.2 g/day typical max

Route

PO, IV, otic/ophthalmic

PEDIATRIC DOSE

Reserved peds β€” arthropathy animal model β€” use only when benefit clear (anthrax, CF pseudomonas protocols)

Do not miss

Must-not-miss safety points

Major warning

- **Tendon rupture** (Achilles) β€” risk ↑ steroids, elderly, renal failure - **QT prolongation** + seizures threshold - **Aortic dissection/aneurysm** risk discussion in high-risk patients - Resistance rising β€” verify local UTI antibiogram

Indications

USE IF: Complicated UTI/pyelonephritis, some pseudomonal infections, anthrax, serious GNR when beta-lactam unsuitable. AVOID IF: Uncomplicated cystitis where nitrofurantoin/fosfomycin preferred; children unless protocol; long QT.

Primary

  • Complicated urinary tract infection / pyelonephritis (when local resistance allows)
  • Pseudomonas infection oral step-down when susceptible

Secondary

  • Traveler’s diarrhea bacterial (avoid if dysentery with fever β€” consider other agents)
  • Inhalational anthrax post-exposure / treatment regimens

Other

  • Typhoid fever selected regions (resistance-dependent)

Dosing

STANDARD (ADULT PO)

250–500 mg PO q12h (UTI) OR 500–750 mg PO q12h (pyelo); IV 400 mg q8–12h

ADULT DOSE

Uncomplicated UTI sometimes 250–500 mg BID short course β€” stewardship dependent Pyelonephritis often 500–750 mg BID PO or IV equivalent

PEDIATRIC DOSE

Specialist-only dosing.

MAX DOSE

Follow renal adjustment tables β€” do not exceed adjusted max.

Practical Note

Separate from divalent cations 2–4 h.

Warnings

Clinical warnings

  • Peripheral neuropathy
  • Psychiatric effects
  • Hypoglycemia with hypoglycemics

Adverse effects

  • nausea
  • diarrhea
  • C. diff
  • headache

Contraindications

  • History quinolone allergy
  • Concurrent tizanidine (ciprofloxacin contraindicated)

Drug interactions

  • Warfarin β€” INR
  • Theophylline β€” toxicity
  • NSAIDs + FQ β€” seizure synergy theoretical

Special populations

Pediatrics

Reserved peds β€” arthropathy animal model β€” use only when benefit clear (anthrax, CF pseudomonas protocols)

Pregnancy

Avoid pregnancy (cartilage toxicity animal)

Lactation

relative infant dose low but caution.

Renal impairment

CrCl <30 β†’ extend interval / reduce per label. **CrCl scaffold (FMBM β€” titrate to FDA/SFDA label + institutional pharmacy nomogram):** - **CrCl β‰₯50** β†’ standard (agent-specific) - **CrCl 10–50** β†’ extend interval or ↓ dose (**moxifloxacin:** often minimal CrCl change β€” hepatic clearance) - **CrCl <10** β†’ label tables (cipro/levo often q24–48h); **seizure/QT risk** if accumulated; **HD:** consult pharmacy

Hepatic impairment

Severe hepatic failure β€” caution accumulation.

Elderly

Tendon + QT + fall risk.

Administration

PO with water; avoid antacids same time.

Monitoring

  • Monitor: - QT risk factors β†’ **ECG**; hypokalemia / hypomagnesemia β†’ **replete** - Diabetes on insulin / sulfonylurea β†’ **glucose checks** (dysglycemia) - Tendon pain or Achilles symptoms β†’ **stop FQ**; steroids + elderly + CKD β†’ highest tendon risk - QT if risk factors - Glucose on hypoglycemic agents - Tendon pain β†’ stop drug
  • Recheck: - No clinical improvement at 48–72h β†’ reassess diagnosis, resistance, source control, and drug interactions - If targets not met after reassessment of dose, organ function, and interactions β†’ escalate per protocol (DO NOT continue blindly)

Overdose / toxicity

Clinical Picture

**Life-threatening (first):** **seizures**; **torsades** (QT); **suicidal ideation** with agitation. **Secondary:** tendinopathy; GI symptoms.

Immediate Actions

Stop FQ β†’ seizure precautions; ECG; correct electrolytes; glucose check if altered MS

Antidote

No specific antidote; treat complications (e.g. anaphylaxis β†’ epinephrine per ACLS)

Decontamination

Recent PO overdose β†’ charcoal if early

Escalation

Seizures, torsades, severe agitation β†’ **ICU** / psychiatry; **severe toxicity with renal failure β†’ consider hemodialysis** (limited for many FQs but case-by-case + supportive AKI) β€” nephrology + pharmacy

Clinical pearls

Common mistakes, resistance logic, and bedside traps

High-Yield Summary

**Pseudomonas PO** option. **Tendon + QT + psych** triad. Stewardship: **not** first-line simple cystitis in many hospitals.

Clinical pearls

De-escalation to beta-lactam when cultures allow. Resistance: regional E. coli FQ rates may make empiric cipro irrational. Avoid FQ if aortic aneurysm history when alternatives exist. *Stewardship (all antimicrobials):* Empiric choice β†’ syndrome severity + **local antibiogram**; shortest effective course.

Stewardship & safety

  • Tendon
  • QT
  • Tizanidine never

Pharmacy Tool

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Ciprofloxacin 50 mg/mL oral suspension

suspension Β· oral

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Pharmacokinetics

Good oral bioavailability; renal elimination predominant; penetrates prostate.

Mechanism of action

DNA gyrase / topoisomerase IV inhibition β€” concentration-dependent killing.

Common brand names

Global data (no country-specific data available)

Saudi Arabia

(placeholder β€” verify local formulary)

Common trade names are curated examples only β€” formulations and availability vary. Verify the exact product name with your local pharmacy and national regulator before prescribing or dispensing.

Country practice notes

  • Empiric choice β†’ tie to syndrome, severity, and local antibiogram β€” not habit.
  • IV β†’ PO step-down when oral bioavailability and susceptibility allow.
  • Do not use antibiotics for uncomplicated viral illness β€” stewardship.

References

Saudi Arabia

  • SFDA (Saudi Food & Drug Authority)
  • Saudi National Formulary / MOH (where available)

International

  • WHO Model List of Essential Medicines (verify current edition)
  • US FDA or EU EMA product information (when national SmPC is unavailable)
  • Sanford Guide
  • IDSA / ESCMID (indication-specific)
  • Local antimicrobial stewardship / hospital formulary
  • FDA / SFDA / regional product labeling
  • Sanford Guide
  • IDSA / ESCMID (indication-specific)
  • Local antimicrobial stewardship / hospital formulary
  • FDA / SFDA / regional product labeling

Do not miss

  • Uncomplicated viral URI/bronchitis β†’ antibiotics rarely indicated
  • Narrow or stop when susceptibilities + clinical stability allow
  • Patient on steroid + elderly + cipro β†’ Achilles watch.
  • Hypoglycemia on sulfonylurea + FQ.
  • Tendon
  • QT
  • Tizanidine never