Ciprofloxacin: Uses, Dosage, Side Effects and More

Generic Medicine Info Patient Medicine Information

This information is not country-specific. Please refer to the Singapore prescribing information.

Generic Medicine Info

Indications and Dosage

Intravenous
Lower respiratory tract infections, Skin and soft tissue infections

Adult: 400 mg 8 hourly or 12 hourly via IV infusion over at least 60 minutes for 7-14 days. Dosage and treatment recommendations may vary among countries and between individual products (refer to local or specific product guidelines).

Intravenous
Prostatitis

Adult: For acute or chronic bacterial prostatitis: 400 mg 8 hourly or 12 hourly. Usual treatment duration: 2-4 weeks. Duration of treatment may vary depending on the severity of the condition. Dosage and treatment recommendations may vary among countries and between individual products (refer to local or specific product guidelines).

Intravenous
Complicated urinary tract infections

Adult: For the treatment complicated UTIs including pyelonephritis: 200-400 mg 8 hourly or 12 hourly for 7-14 days via IV infusion over at least 60 minutes. Dosage and treatment recommendations may vary among countries and between individual products (refer to local or specific product guidelines).
Child: ≥1 year 6-10 mg/kg 8 hourly up to Max of 400 mg/ per dose. Usual treatment duration: 10-21 days. Dosage and treatment recommendations may vary among countries and between individual products (refer to local or specific product guidelines).

Intravenous
Bone and joint infections

Adult: 400 mg 8 hourly or 12 hourly via IV infusion over at least 60 minutes for 4-8 weeks. Dosage and treatment recommendations may vary among countries and between individual products (refer to local or specific product guidelines).

Intravenous
Complicated intra-abdominal infections

Adult: In combination with metronidazole: 400 mg 12 hourly via IV infusion over at least 60 minutes. Usual treatment duration: 7-14 days. Duration of treatment includes IV plus oral treatment; the timing for the transition from IV to oral treatment depends on the clinical circumstances. Dosage and treatment recommendations may vary among countries and between individual products (refer to local or specific product guidelines).

Intravenous
Acute exacerbations of cystic fibrosis

Child: ≥1 year In cases associated with Pseudomonas aeruginosa: 10 mg/kg (Max of 400 mg per dose) tid via IV infusion over at least 60 minutes . Treatment recommendations may vary among countries and between individual products (refer to local or specific product guidelines).

Intravenous
Inhalational anthrax

Adult: Treatment and post-exposure prophylaxis: 400 mg 12 hourly via IV infusion over at least 60 minutes. Usual treatment duration: 60 days from the confirmation of the exposure. Treatment recommendations may vary among countries and between individual products (refer to local or specific product guidelines).
Child: Treatment and post-exposure prophylaxis: 10 mg/kg (Max of 400 mg per dose) bid. Usual treatment duration: 60 days from the confirmation of the exposure. Dosage and reatment recommendations may vary among countries and between individual products (refer to local or specific product guidelines).

Ophthalmic
Corneal ulcer

Adult: As 0.3% eye drops solution: Instil 2 drops into the affected eye(s) every 15 minutes for the 1st 6 hours, then 2 drops into the affected eye(s) every 30 minutes for the remainder of Day 1. On Day 2, instil 2 drops into the affected eye(s) hourly. On Days 3-14, instil 2 drops into the affected eye(s) 4 hourly. Continue treatment after Day 14 if re-epithelialisation has not occurred.
Child: ≥1 year As 0.3% eye drops solution: Same as adult dose. Age range of use and dosage and treatment recommendations may vary among countries and between individual products (refer to local or specific product guidelines).

Ophthalmic
Bacterial conjunctivitis

Adult: As 0.3% eye drops solution: Instil 1 or 2 drops into the conjunctival sac(s) 2 hourly for 2 days during waking hours, then instil 1 or 2 drops 4 hourly during waking hours for the next 5 days. As 0.3% eye ointment: Apply ¹/₂; inch ribbon into the conjunctival sac(s) tid for the first 2 days, then apply ¹/₂; inch ribbon bid for the next 5 days.
Child: As 0.3% eye drops solution: Same as adult dose. As 0.3% eye ointment: ≥2 years Same as adult dose. Age range of use and dosage and treatment recommendations may vary among countries and between individual products (refer to local or specific product guidelines).

Oral
Respiratory tract infections

Adult: As conventional tab or oral susp: 500-750 mg 12 hourly. Usual treatment duration: 7-14 days. Dosage and treatment recommendations and available dosage forms may vary between countries (refer to local or specific product guidelines).

Oral
Complicated urinary tract infections, Pyelonephritis

Adult: As conventional tab or oral susp: 250-500 mg 12 hourly. Usual treatment duration: 7-14 days. As extended-release tab: 1,000 mg 24 hourly. Usual treatment duration: 7-14 days. Dosage and treatment recommendations and available dosage forms may vary between countries and individual products (refer to local or specific product guidelines).
Child: ≥1 year As conventional tab or oral susp: 10-20 mg/kg (up to Max of 750 mg) 12 hourly. Usual treatment duration: 7-14 days. Dosage and treatment recommendations and available dosage forms may vary between countries and individual products (refer to local or specific product guidelines).

Oral
Prostatitis

Adult: For acute or chronic bacterial prostatitis: As conventional tab or oral susp: 500 mg 12 hourly for up to 28 days depending on the severity of the condition. Dosage and treatment recommendations may vary among countries and between individual products (refer to local or specific product guidelines).

Oral
Inhalational anthrax

Adult: Treatment and post-exposure prophylaxis: As conventional tab or oral susp: 500 mg 12 hourly. Usual treatment duration: 60 days from the confirmation of the exposure. Duration of treatment depends on patient's age, clinical condition, and anthrax vaccine status and series completion. Treatment recommendations may vary among countries and between individual products (refer to latest or specific local guidelines).
Child: Treatment and post-exposure prophylaxis: 15 mg/kg (up to Max of 500 mg) 12 hourly. Usual treatment duration: 60 days from the confirmation of the exposure. Dosage and treatment recommendations may vary among countries and between individual products (refer to latest or specific local guidelines).

Oral
Uncomplicated gonorrhoea

Adult: As conventional tab or oral susp: 250-500 mg as a single dose. Dosage and treatment recommendations may vary among countries and between individual products (refer to local or specific product guidelines).

Oral
Diarrhoea

Adult: For infectious cases: As conventional tab or oral susp: 500 mg 12 hourly for 5-7 days depending on the severity and nature of infection. Dosage and treatment recommendations may vary among countries and between individual products (refer to local or specific product guidelines).

Oral
Prophylaxis of surgical infections

Adult: As conventional tab: 750 mg as a single dose given 60 minutes before procedure. Dosage and treatment recommendations may vary among countries and between individual products (refer to local or specific product guidelines).

Oral
Bone and joint infections

Adult: As conventional tab or oral susp: 500-750 mg 12 hourly. Usual treatment duration: 4-8 weeks. Dosage and treatment recommendations may vary among countries and between individual products (refer to local or specific product guidelines).

Oral
Skin and soft tissue infections

Adult: As conventional tab or oral susp: 500-750 mg 12 hourly. Usual treatment duration: 7-14 days. Dosage and treatment recommendations may vary among countries and between individual products (refer to local or specific product guidelines).

Oral
Acute uncomplicated cystitis

Adult: As conventional tab or oral susp: 250 mg 12 hourly for 3 days. As extended-release tab: 500 mg 24 hourly for 3 days. Dosage and treatment recommendations and available dosage forms may vary between countries (refer to local or specific product guidelines).

Oral
Acute exacerbations of cystic fibrosis

Child: In cases due to Pseudomonas aeruginosa: As conventional tab or oral susp: 5-17 years 20 mg/kg bid up to Max of 750 mg per dose. Max: 1,500 mg daily. Usual treatment duration: 10-14 days. Starting age of use and dosage and treatment recommendations may vary among countries and between individual products (refer to local or specific product guidelines).

What are the brands available for Ciprofloxacin in Singapore?

Ciprobay

Other Known Brands

Cetraxal
Ciloxan
Ciplus
Ciprofloxacin Sandoz
Cycin
Enoxin
Microflox
Neofloxin
Novaflox
PT Indofarma-Ciprofloxacin
Qupron
Serviflox
Topistin
Viprolox 500

Renal Impairment

Oral:
Respiratory tract infections; Acute uncomplicated cystitis; Prostatitis; Uncomplicated gonorrhoea; Diarrhoea; Skin and soft tissue infections; Bone and joint infections; Inhalational anthrax

Patients on haemodialysis or peritoneal dialysis:As conventional tab or oral susp: 500 mg daily as a single dose after dialysis.

CrCl (mL/min)	Dosage
<30	As conventional tab or oral susp: Max: 500 mg daily.
30-60	As conventional tab or oral susp: Max: 1,000 mg daily.

Prophylaxis of surgical infections

Patients on haemodialysis or peritoneal dialysis: As conventional tab: 500 mg daily as a single dose after haemodialysis.

CrCl (mL/min)	Dosage
<30	As conventional tab: Max: 500 mg daily.
30-60	As conventional tab: Max: 1,000 mg daily.

Complicated urinary tract infections; Pyelonephritis

Patients on haemodialysis or peritoneal dialysis: As conventional or extended-release tab or oral susp: 500 mg daily as a single dose after dialysis.

CrCl (mL/min)	Dosage
<30	As conventional or extended-release tab or oral susp: Max: 500 mg daily.
30-60	As conventional tab or oral susp: Max: 1,000 mg daily.

Intravenous:
Lower respiratory tract infections; Skin and soft tissue infections; Complicated urinary tract infections; Prostatitis; Complicated intra-abdominal infections; Inhalational anthrax; Bone and joint infections

Patients on haemodialysis: 200-400 mg 24 hourly after haemodialysis on haemodialysis days. Patients on peritoneal dialysis: 200-400 mg 24 hourly.

CrCl (mL/min)	Dosage
<30	200-400 mg 24 hourly.
30-60	200-400 mg 12 hourly.

Dosage and treatment recommendations may vary among countries and between individual products (refer to local or specific product guidelines).

Administration

Ciprofloxacin May be taken with or without food. May be taken w/ food to reduce GI discomfort. Administer at least 2 hr before or 6 hr after polyvalent cation-containing products.

Reconstitution

Concentrate for IV infusion: Dilute with an appropriate volume of either NaCl 0.9%, lactated Ringer's inj, dextrose 5% in water, dextrose 10% in water, or sterile water for inj to a final concentration of 1-2 mg/mL.

Incompatibility

Incompatible with penicillin and heparin solutions.

Contraindications

Hypersenstivity. Oral: Concomitant use with tizanidine.

Special Precautions

Patient with solid organ transplants, positive family history of aneurysm disease or congenital heart valve disease, pre-existing aortic aneurysm and/or dissection or heart valve disease, conditions predisposing to aortic aneurysm and dissection and/or heart valve regurgitation including hypertension, Turner syndrome, connective tissue disorder (e.g. Marfa syndrome, Ehlers-Danlos syndrome, Behcet’s disease, rheumatoid arthritis), vascular disorders (e.g. Takayasu arteritis, giant cell arteritis, atherosclerosis), Sjogren's syndrome, infective endocarditis; history of tendon disease or disorder related to quinolones; CNS disorders; risk factors for QT prolongation (e.g. congenital long QT syndrome, uncorrected electrolyte imbalance [e.g. hypokalaemia, hypomagnesaemia], cardiac disease [e.g. heart failure, MI, bradycardia]; diabetes; G6PD deficiency, myasthenia gravis; known or suspected ear perforation or risk of perforation of the tympanic membrane (otic). Ciprofloxacin may only be used in situations where other usual recommended antibiotics are considered inappropriate: There is resistance to other 1st-line antibiotics, other 1st-line antibiotics are contraindicated or have caused adverse effects requiring treatment discontinuation, and 1st-line treatment has failed; refer to official local guidelines for latest recommendations. Discontinue treatment immediately and avoid use in patients who have experienced tendinitis, tendon rupture, peripheral neuropathy, and CNS effects. Ciprofloxacin extended-release tab is not interchangeable with the conventional tab or oral susp. Renal impairment. Children and elderly. Pregnancy and lactation.

Adverse Reactions

Significant: Tendinitis, tendinopathy, tendon rupture; sensory or sensorimotor polyneuropathy resulting in paraesthesia, hypaesthesia, dysesthesia or weakness; aortic and mitral valve regurgitation; vision disorders; photosensitivity; status epilepticus, psychiatric reactions (e.g. depression or psychoses which may progress to suicidal ideations or thoughts); blood glucose disturbances, including symptomatic hyperglycaemia and hypoglycaemia (particularly in diabetic patients receiving antidiabetic agents); may exacerbate muscle weakness (in patients with myasthenia gravis); QT prolongation and ventricular arrhythmias (e.g. torsades de pointes); fungal or bacterial superinfection (prolonged use); inj and infusion site reactions. Rarely, haemolytic reactions (in patients with G6PD deficiency), crystalluria. Ophthalmic: Delayed corneal healing.
Blood and lymphatic system disorders: Eosinophilia.
Cardiac disorders: Chest pain.
Ear and labyrinth disorders: Pruritus of ear (otic).
Eye disorders: Lid margin crusting, crystals or scales, foreign body sensation, itching, eye discomfort (including burning sensation of the eyes), conjunctival hyperaemia (ophthalmic).
Gastrointestinal disorders: Nausea, diarrhoea, vomiting, abdominal pain, dyspepsia, flatulence, taste disorders; unpleasant taste after instillation (ophthalmic).
General disorders and administration site conditions: Asthenia, fever; application site pain (otic).
Infections and infestations: Mycotic superinfections.
Investigations: Increased transaminases, bilirubin, and blood alkaline phosphatase.
Metabolism and nutrition disorders: Decreased appetite.
Musculoskeletal and connective tissue disorders: Extremity pain, back pain, arthralgia.
Nervous system disorders: Headache, dizziness, sleep disorders.
Psychiatric disorders: Psychomotor hyperactivity or agitation.
Renal and urinary disorders: Renal impairment.
Skin and subcutaneous tissue disorders: Rash, pruritus, urticaria.
Potentially Fatal: Hypersensitivity and allergic reactions including anaphylaxis and anaphylactoid reactions; aortic aneurysm and dissection complicated by rupture; Clostridioides difficile-associated diarrhoea; hepatic necrosis and hepatic failure.

Pregnancy Category (US FDA)

IV/Ophth/Otic/Parenteral/PO: C

Patient Counseling Information

This drug may affect reaction time (oral/IV) or cause temporary blurred vision (ophthalmic), if affected, do not drive or operate machinery. Avoid excessive exposure to sunlight or artificial UV light (e.g. sunlamps, tanning beds) during treatment. Ensure adequate hydration. Ophthalmic: Wearing of contact lenses during treatment of an eye infection is not recommended.

Monitoring Parameters

Perform culture and susceptibility tests; consult local institutional recommendations before treatment initiation due to antibiotic resistance risks. Monitor CBC, renal, and hepatic function (during prolonged treatment). Assess for signs and symptoms of disordered glucose regulation (particularly in patients with diabetes mellitus), altered mental status, tendinopathy, peripheral neuropathy, and hypersensitivity reaction. In patients with gonorrhoea, conduct a test for syphilis at the time of diagnosis and 3 months after treatment.

Overdosage

Symptoms: Dizziness, tremor, headache, tiredness, seizures, hallucinations, confusion, abdominal discomfort, renal and hepatic impairment, cystalluria, haematuria.

Management: Symptomatic and supportive treatment. Perform ventricular emptying followed by medical carbon. May administer Ca or Mg-containing antacids to reduce absorption. Monitor ECG and renal function (e.g. urinary pH).

Drug Interactions

Increased risk of tendinitis or tendon rupture with corticosteroids. Increased risk of QT prolongation with drugs that prolong QT interval (e.g. class IA or III antiarrhythmics, TCAs, macrolides, antipsychotics). Concomitant use with multivalent cation-containing agents and mineral supplements, polymeric phosphate binders (e.g. sevelamer, lanthanum carbonate), sucralfate, antacids, highly buffered agents (e.g. didanosine) containing magnesium, aluminium, or calcium may reduce the absorption of oral ciprofloxacin. Increased risk of hypoglycaemia with oral hypoglycaemic agents (e.g. glibenclamide, glimepiride) or insulin. May increase the serum concentration of drugs metabolised by CYP1A2 (e.g. clozapine, olanzapine, ropinirole, duloxetine, agomelatine), methotrexate, sildenafil, zolpidem. Increased serum concentration with probenecid. May increase or decrease the serum concentration of phenytoin. Concomitant use with ciclosporin may result in transient increase of serum creatinine. May augment the anticoagulant effect of vitamin K antagonist (e.g. warfarin, acenocoumarol). Decreases clearance of IV lidocaine. Increased risk of seizure with NSAIDs.
Potentially Fatal: May increase the serum concentration of tizanidine and potentiate its hypotensive and sedative effects. May increase serum concentration of theophylline.

Food Interaction

Decreased absorption with dairy products or mineral-fortified drinks (e.g. milk, yoghurt, calcium-fortified orange juice).

Lab Interference

May result in false-positive urine screening for opioids using commercially-available immunoassay kits.

Action

Description:
Mechanism of Action: Ciprofloxacin is a fluoroquinolone antibiotic. It inhibits both type II topoisomerase (DNA gyrase) and topoisomerase IV which is required for bacterial DNA replication, transcription, repair, and recombination.
Pharmacokinetics:
Absorption: Rapidly and well absorbed from the gastrointestinal tract. Bioavailability: 70-80% (oral). Time to peak plasma concentration: 0.5-2 hours (immediate-release).
Distribution: Widely distributed in the body and tissues particularly in the kidneys, gallbladder, liver, lungs, gynaecological tissues and prostatic tissues; enters CSF. Crosses the placenta and enters breast milk. Volume of distribution: 1.74-5 L/kg. Plasma protein binding: 20-40%.
Metabolism: Partially metabolised in liver.
Excretion: Via urine (35-70% as unchanged drug); faeces (15-35%; <1% as unchanged drug). Elimination half-life: 4-6 hours.

Chemical Structure

Storage

Oral:
Tab: Store between 15-30°C. Reconstituted oral susp: May be stored at room temperature (up to 30°C) or between 2-8°C. Do not freeze.

IV:
Solution for infusion: Store below 25°C. Protect from light. Diluted solution for infusion: May be stored for up to 14 days when refrigerated or stored at room temperature.

Ophthalmic:
Ophthalmic solution: Store below 25°C. Do not refrigerate or freeze. Protect from light. Ophthalmic ointment: Store between 2-25°C.

Otic:
Otic solution: Store between 15-25°C. Protect from light.

MIMS Class

Ear Anti-Infectives & Antiseptics / Eye Anti-Infectives & Antiseptics / Quinolones

ATC Classification

S01AE03 - ciprofloxacin ; Belongs to the class of quinolone antiinfectives. Used in the treatment of eye infections.
S03AA07 - ciprofloxacin ; Belongs to the class of antiinfectives used in ophthalmologic and otologic preparations.
S02AA15 - ciprofloxacin ; Belongs to the class of antiinfectives used in the treatment of ear infections.
J01MA02 - ciprofloxacin ; Belongs to the class of fluoroquinolones. Used in the systemic treatment of infections.

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