Index Ciprofloxacin

7/30/2019 Index Ciprofloxacin

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CIPROFLOXACIN

Cipro, Cipro XR, Proquin XR

CLASSIFICATION(S)

Therapeutic:anti-infectives

Pharmacologic:fluoroquinolones

Pregnancy Category C

INDICATIONS

PO: IV: Treatment of the following bacterial infections:

Urinary tract and gynecologic infections, including cystitis, gonorrhea, and prostatitis

Respiratory tract infections including acute sinusitis, acute exacerbations of chronic bronchitis, and pne

Skin and skin structure infections

Bone and joint infections

Infectious diarrhea

Complicated intra-abdominal infections (with metronidazole) Typhoid fever

Post-exposure prophylaxis of inhalational anthrax

Cutaneous anthrax

Unlabelled Uses:

Febrile neutropenia

ACTION

Inhibits bacterial DNA synthesis by inhibiting DNA gyrase enzyme

Therapeutic Effects: Death of susceptible bacteria

Spectrum:

Active against gram-positive pathogens, including:


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Staphylococcus aureus

Staphylococcus epidermidis

Staphylococcus saprophyticus

Streptococcus pyogenes

Streptococcus pneumoniae

Enterococcus faecalis

Bacillus anthracis(anthrax)

Gram-negative spectrum notable for activity against:

Escherichia coli

Klebsiella pneumoniae

Enterobacter cloacae

Salmonella typhi

Shigellaspp

Proteus mirabilis

Proteus vulgarisProvidencia stuarti

Providencia rettgeri

Morganella morganii

Pseudomonas aeruginosa

Serratia marcescens

Haemophilus influenzae

Neisseria gonorrhoeae

Moraxella catarrhalisCampylobacter jejuni

PHARMACOKINETICS


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Absorption: 70% absorbed after oral administration; IV administration results in complete bioavailability

Distribution: Widely distributed. High tissue and urinary levels are achieved. Crosses the placenta; enters breas

Metabolism and Excretion: --15% metabolized by the liver, 40-50% excreted unchanged by the kidneys

Half-life: 4 hr

TIME OF ACTION

blood levels

ROUTE ONSET PEAK DURATION

PO rapid 1-2 hr 12 hr

PO-ER rapid 1-4 hr 24 hr

IV rapid end of infusion 12 hr

CONTRAINDICATIONS/PRECAUTIONS

Contraindicated in:

Hypersensitivity (cross-sensitivity within class may exist)

OB:Pregnancy

Pedi:Children


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OB:Lactation (safety not established, except for treatment of anthrax)

ADVERSE REACTIONS/SIDE EFFECTS*

*CAPITALS indicate life threatening; underlines indicate most frequent.

CNS: SEIZURES, dizziness, drowsiness, headache, insomniaagitation, confusion,

GI: PSEUDOMEMBRANOUS COLITIS, abdominal pain, diarrhea, abnormal liver enzymes , nausea,

GU: vaginitis,

Derm: photosensitivity, rash,

Endo: hyperglycemia, hypoglycemia,

Hemat: eosinophilia ,

Local: phlebitis at IV site,

MS: tendonitis, tendon rupture,

Neuro: peripheral neuropathy,Misc: hypersensitivity reactions including :ANAPHYLAXIS ,

INTERACTIONS

Drug-Drug:

Concurrent use with theophylline may result in increased theophylline concentrations and therefore seriou

potentially fatal reactions due to theophylline toxicity; if concurrent use cannot be avoided serum theophyllin

should be monitoredAdministration with antacids, iron salts, bismuth subsalicylate , sucralfate , and zinc salts absorption

May alter the effects ofwarfarin

May blood levels and effectiveness ofphenytoin


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Serum levels may be by antineoplastics

Cimetidine may interfere with elimination

Beneficial effects may be antagonized by nitrofurantoin

Probenecid renal elimination

May risk ofnephrotoxicity from cyclosporine

Concurrent use with foscarnet may risk of seizures

Concurrent therapy with corticosteroids may risk of tendon rupture

Drug-Natural:

Fennel decreases bioavailability

Drug-Food:

Absorption is impaired by concurrent enteral feeding (because of metal cations)

Absorption of norfloxacin is decreased by food and/ordairy products (take 1 hr before or 2 hr after)

ROUTE AND DOSAGE

Most infectionsPO (Adults ): 500-750 mg q 12 hr

IV (Adults ): --400 mg q 12 hr

Urinary tract infections

PO (Adults ): 250-500 mg q 12 hr; or1000 mg q 24 hr for 10-14 days as extended-release tablets.Uncompl

urinary tract infections--100 mg q 12 hr for 3 days or500 mg q 24 hr for 3 days as extended-release tablets

PO (Children 1-17 yr): Complicated urinary tract infections --10-20 mg/kg every 12 hr (not to exceed 750 m

10-21 days

IV (Adults ): 200 mg q 12 hrIV (Children 1-17 yr): Complicated urinary tract infections --6-10 mg/kg every 8 hr (not to exceed 400 mg/d

21 days


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Gonorrhea

PO (Adults ): 250 mg single dose

Inhalational Anthrax

PO, IV (Adults ): 400 mg q 12 hr IV, change to 500 mg PO twice daily when clinically appropriate for a total

one or two other anti-infectives may be added initially, depending on clinical situation

PO, IV (Children ): 10-15 mg/kg q 12 hr IV, change to 10-15 mg/kg PO q 12 hr when clinically appropriate fo

60 days; one or two other anti-infectives may be added initially, depending on clinical situation

Cutaneous anthrax

PO (Adults ): 500 mg twice daily for 60 days; some patients may require intravenous therapy initially dependclinical situation (for IV dose see inhalational anthrax above)

PO (Children ): 10-15 mg/kg q 12 hr for 60 days; some patients may require intravenous therapy initially dep

clinical situation (for IV dose see inhalational anthrax above)

AVAILABILITY

Tablets:100 mg, 250 mg, 500 mg, 750 mg

Extended-release tablets:500 mg , 1000 mg

Cost:Cipro XR-500 mg 866.25/100 , 1000 mg 986.25/100Oral suspension (strawberry flavor) :250 mg/5 ml in 100 ml bottle, 500 mg/5 ml in 100 ml bottle

Injection:200 mg/20 ml, 400 mg/40 ml, 200 mg/100 ml premixed in D5W, 400 mg/200 ml premixed in D5W

mg/120 ml bulk package


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NURSING IMPLICATIONS

ASSESSMENT

Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC; urinalysis; frequency

urgency of urination; cloudy or foul-smelling urine) at beginning of and throughout therapy

Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receivin

Observe for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue dr

notify physician or other health care professional immediately if these problems occur. Keep epinephrine, an

antihistamine, and resuscitation equipment close by in case of an anaphylactic reaction

Lab Test Considerations:

May cause serum AST, ALT, LDH, bilirubin, and alkaline phosphatase

May also cause or serum glucose

IMPLEMENTATION

PO:

Administer on an empty stomach 1 hr before or 2 hr after meals, with a full glass of water. Products or f

containing calcium, magnesium, aluminum, iron, or zinc should not be ingested for 4 hr before and 2 hr

administration

If gastric irritation occurs, ciprofloxacin may be administered with meals. Food slows and may slightly d

absorption

Regular tablets can be crushed for patients unable to swallow. Extended-release (XR) tablets should beswallowed whole; do not split, crush, or chew

Do not administer 5% or 10% oral solution through an enteral feeding tube or with enteral feeds; may d

absorption


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Intermittent Infusion: Dilute to a concentration of 1-2 mg/ml with 0.9% NaCl or D5W. Stable for 14 days at

refrigerated or room temperature Rate:Administer over 60 min into a large vein to minimize venous irritation

Y-Site Compatibility: amifostine amiodarone aztreonam bivalirudin calcium gluconate ceftazidime

cisatracurium dexmedetomidine digoxin diltiazem diphenhydramine dobutamine docetaxel dopamin

doxorubicin liposome etoposide fenoldopam gemcitabine gentamicin granisetron lidocaine linezolid

lorazepam LR metoclopramide midazolam midodrine milrinone piperacillin potassium acetate pota

chloride promethazine quinupristin-dalfopristin ranitidine remifentanil 0.9% NaCL tacrolimus teniposi

thiotepa tobramycin verapamil

Y-Site Incompatibility: Manufacturer recommends temporarily discontinuing other solutions when administe

ciprofloxacin

PATIENT/FAMILY TEACHING

Instruct patient to take medication as directed at evenly spaced times and to finish drug completely, even if fe

better. Take missed doses as soon as possible, unless almost time for next dose. Do not double doses. Adv

that sharing of this medication may be dangerous Advise patients to notify health care professional immediately if they are taking theophylline

Encourage patient to maintain a fluid intake of at least 1500-2000 ml/day to prevent crystalluria

Advise patient that antacids or medications containing calcium, magesium, aluminum, iron, or zinc will decre

absorption and should not be taken within 4 hr before and 2 hr after taking this medication

May cause dizziness and drowsiness. Caution patient to avoid driving or other activities requiring alertness u

response to medication is known

Caution patient to use sunscreen and protective clothing to prevent phototoxicity reactions during and for 5 d

therapy Instruct patient to consult health care professional before taking any other Rx or OTC medications

Advise patient to report signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge,

foul-smelling stools)


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Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blo

mucus. Advise patient not to treat diarrhea without consulting health care professional

Instruct patient to notify health care professional immediately if rash or tendon pain or inflammation occur. Th

should be discontinued

EVALUATION/DESIRED OUTCOMES

Resolution of the signs and symptoms of bacterial infection. Time for complete resolution depends on organ

site of infection

Avoidance of signs and symptoms of inhalational anthrax (post-exposure treatment)

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Index Ciprofloxacin