ciprofloxacin hydrochloride: clinical use

Prescribing considerations

• Reserve systemic ciprofloxacin for situations in which commonly recommended alternatives are inappropriate because of resistance, contraindication, intolerance or treatment failure.
• Review culture, susceptibility and local resistance information; some indications require additional antibacterial cover.
• Use particular caution with previous quinolone reactions, renal impairment, older age, transplantation, corticosteroid exposure, tendon disease, seizure risk, psychiatric history, diabetes, QT risk, aortic disease, heart-valve disease, myasthenia gravis or G6PD deficiency.
• Paediatric systemic treatment should be initiated by clinicians experienced in cystic fibrosis or severe childhood infection.

Contraindications and cautions

• Hypersensitivity to ciprofloxacin, another quinolone or a formulation excipient.
• Concomitant oral ciprofloxacin and tizanidine.

Monitoring

• Assess renal function before and during systemic treatment when clinically indicated.
• Monitor for tendon, neurological, psychiatric, sensory, hepatic and severe gastrointestinal adverse effects; stop systemic therapy promptly if a serious fluoroquinolone reaction develops.
• Monitor blood glucose in people with diabetes and consider ECG or electrolyte assessment where QT risk exists.
• Use targeted monitoring for interacting medicines, including INR, theophylline, phenytoin and ciclosporin-related creatinine changes.
• Reassess persistent or worsening eye or ear infection and consider superinfection or resistance.

Clinical pharmacology

Ciprofloxacin is bactericidal through inhibition of bacterial DNA gyrase and topoisomerase IV. Oral bioavailability is approximately 70–80%; it distributes widely, is eliminated substantially unchanged by the kidneys and moderately inhibits CYP1A2.

Formulation and product differences

• Tablets produce systemic exposure and therefore carry the full fluoroquinolone interaction and serious-adverse-effect profile.
• Eye drops are licensed for corneal ulcers and superficial bacterial eye infections. They contain benzalkonium chloride, may cause transient blurred vision and can produce corneal deposits during ulcer treatment.
• Ear drops are preservative-free single-dose containers licensed for acute otitis externa with an intact tympanic membrane. Systemic exposure is expected to be negligible.

Eye drops

Route: Ophthalmic

Strengths: 0.3% w/v

Tablet

Route: Oral

Strengths: 250 mg, 500 mg, 750 mg