ciprofloxacin: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
ciprofloxacin: clinical details
Prescribing considerations
- Use systemic ciprofloxacin only when commonly recommended antibiotics are inappropriate because of resistance, contraindication, intolerance or treatment failure.
- Review microbiology and resistance information; monotherapy is unsuitable where important Gram-positive or anaerobic pathogens are likely.
- Assess previous serious quinolone reactions, tendon-risk factors, renal function, seizure risk, QT-risk factors, dysglycaemia, myasthenia gravis, G6PD deficiency and aortic or valvular disease.
- Paediatric use requires clinicians experienced in cystic fibrosis or severe childhood infection.
Contraindications and cautions
- Hypersensitivity to ciprofloxacin, another quinolone or an excipient.
- Concurrent tizanidine use.
- For the suspension: hereditary fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase deficiency.
- Avoid after previous serious quinolone-associated reactions or tendon disease unless exceptional circumstances justify use.
Monitoring
- Clinical response and culture or susceptibility results.
- Renal function.
- Blood glucose in patients with diabetes.
- INR, theophylline, phenytoin or other relevant concentrations when interacting treatment is unavoidable.
- New serious musculoskeletal, neurological, psychiatric, sensory, hepatic, gastrointestinal or hypersensitivity symptoms.
Clinical pharmacology
Ciprofloxacin is bactericidal through inhibition of bacterial DNA gyrase and topoisomerase IV. Oral bioavailability is approximately 70–80%, protein binding is low, distribution is extensive and elimination is substantially renal. It inhibits CYP1A2.
Formulation and product differences
- The product is granules and solvent reconstituted into an oral suspension.
- Shake vigorously and use only the supplied graduated measuring spoon.
- It contains sucrose and benzyl alcohol, creating formulation-specific cautions.
- Visible droplets or particles may remain after mixing; swallow the granules without chewing.
ciprofloxacin preparations and strengths
Oral suspension
Route: Oral
Strengths: 250 mg/5 mL
ciprofloxacin interactions
Check prescription, non-prescription and supplement use before systemic ciprofloxacin. Important interactions include:
Tizanidine
Contraindicated because ciprofloxacin can greatly increase tizanidine exposure, causing excessive sedation and low blood pressure.
Antacids, sucralfate, phosphate binders and calcium, magnesium, aluminium, iron or zinc products
These can reduce ciprofloxacin absorption. Ask a prescriber or pharmacist about separation.
Theophylline
Ciprofloxacin can increase concentrations and cause serious toxicity.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.