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ciprofloxacin (injection)

Pronunciation

Generic Name: ciprofloxacin (injection) (SIP roe FLOX a sin)
Brand Name: Cipro I.V.

What is ciprofloxacin?

Ciprofloxacin is an antibiotic in a group of drugs called fluoroquinolones (flor-o-KWIN-o-lones). Ciprofloxacin fights bacteria in the body.

Ciprofloxacin is used to treat different types of bacterial infections. Ciprofloxacin is also used to treat people who have been exposed to anthrax.

Ciprofloxacin may also be used for purposes not listed in this medication guide.

What is the most important information I should know about ciprofloxacin?

You should not use this medicine if you are also taking tizanidine.

You may not be able to use ciprofloxacin if you have a muscle disorder. Tell your doctor if you have a history of myasthenia gravis.

Ciprofloxacin may cause swelling or tearing of a tendon (the fiber that connects bones to muscles in the body), especially in the Achilles' tendon of the heel. This effect may be more likely to occur if you are over 60, if you use steroid medication, or if you have had a kidney, heart, or lung transplant.

Call your doctor at once if you have sudden pain, swelling, bruising, tenderness, stiffness, or movement problems in any of your joints. Rest the joint until you receive medical care or instructions.

What should I discuss with my healthcare provider before using ciprofloxacin?

You should not use ciprofloxacin if you are allergic to it, or if:

  • you are also taking tizanidine; or

  • you are allergic to other fluoroquinolones (gemifloxacin, levofloxacin, moxifloxacin, ofloxacin, norfloxacin, and others).

You may not be able to use ciprofloxacin if you have a muscle disorder. Tell your doctor if you have a history of myasthenia gravis.

To make sure ciprofloxacin is safe for you, tell your doctor if you have:

  • tendon problems, arthritis or other joint problems (especially in children);

  • a muscle or nerve disorder;

  • a heart rhythm disorder, especially if you take medication to treat it;

  • a personal or family history of Long QT syndrome;

  • coronary artery disease (hardened arteries);

  • liver disease;

  • kidney disease;

  • seizures or epilepsy;

  • a history of head injury or brain tumor;

  • diabetes (especially if you take oral diabetes medication); or

  • low levels of potassium in your blood (hypokalemia).

Ciprofloxacin may cause swelling or tearing of a tendon (the fiber that connects bones to muscles in the body), especially in the Achilles' tendon of the heel. This can happen during treatment or up to several months after you stop using ciprofloxacin. Tendon problems may be more likely to occur if you are over 60, if you use steroid medication, or if you have had a kidney, heart, or lung transplant.

FDA pregnancy category C. It is not known whether ciprofloxacin will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medicine.

Ciprofloxacin can pass into breast milk and may harm a nursing baby. You should not breast-feed while using this medicine.

Do not give this medicine to anyone under 18 years old without medical advice.

How is ciprofloxacin given?

Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Ciprofloxacin is injected into a vein through an IV. You may be shown how to use an IV at home. Do not self-inject this medicine if you do not understand how to give the injection and properly dispose of used needles, IV tubing, and other items used to inject the medicine.

Ciprofloxacin must be injected slowly, over at least 60 minutes.

Drink plenty of liquids while you are using ciprofloxacin.

Ciprofloxacin is usually given every 8 to 12 hours for up to 14 days. Some infections may need to be treated for 4 to 6 weeks. Anthrax exposure is usually treated for 60 days.

Follow your doctor's dosing instructions very carefully.

Use this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Ciprofloxacin will not treat a viral infection such as the flu or a common cold.

If you use this medicine long-term, you may need frequent medical tests at your doctor's office.

Store at room temperature away from moisture, heat, and light. Do not freeze.

Do not use ciprofloxacin if it has changed colors or has particles in it. Call your pharmacist for new medication.

What happens if I miss a dose?

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while using ciprofloxacin?

Avoid caffeine while you are using ciprofloxacin, because the medicine can make the effects of caffeine stronger.

Avoid exposure to sunlight or tanning beds. Ciprofloxacin can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors. Call your doctor if you have severe burning, redness, itching, rash, or swelling after being in the sun.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, stop using ciprofloxacin and call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.

Ciprofloxacin may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Ciprofloxacin side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives, tingling; fast or slow heartbeats, weak pulse, feeling like you might pass out; difficult breathing; swelling of your face, lips, tongue, or throat.

Ciprofloxacin may cause swelling or tearing of (rupture) a tendon. Ciprofloxacin can also have serious effects on your nerves, and may cause permanent nerve damage. Stop using this medicine and call your doctor at once if you have:

  • signs of tendon rupture--sudden pain, swelling, bruising, tenderness, stiffness, movement problems, or a snapping or popping sound in any of your joints (rest the joint until you receive medical care or instructions); or

  • nerve symptoms--numbness, tingling, burning pain, or being more sensitive to temperature, light touch, or the sense of your body position.

Also, stop using ciprofloxacin and call your doctor at once if you have:

  • muscle weakness or trouble breathing;

  • headache with chest pain and severe dizziness, fainting, fast or pounding heartbeats;

  • the first sign of any skin rash, no matter how mild;

  • diarrhea that is watery or bloody;

  • confusion, hallucinations, nightmares, paranoia, depression, thoughts about hurting yourself;

  • pale skin, easy bruising or bleeding (nosebleeds, bleeding gums);

  • seizure (convulsions);

  • sudden weakness or ill feeling, fever, chills, swollen glands, sore throat, mouth sores, red or swollen gums, trouble swallowing;

  • liver problems--nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);

  • increased pressure inside the skull-- severe headaches, ringing in your ears, dizziness, vision problems, pain behind your eyes;

  • signs of a kidney problem--little or no urinating, pink or red urine, swelling, rapid weight gain, feeling drowsy or short of breath;

  • swelling of your blood vessels--fever, loss of appetite, numbness, weakness, tired feeling, weight loss; or

  • severe skin reaction--fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Common side effects may include:

  • nausea, vomiting, diarrhea, stomach pain;

  • dizziness, agitation, feeling anxious or nervous;

  • tremors, sleep problems (insomnia);

  • vaginal itching or discharge;

  • skin rash; or

  • abnormal liver function tests.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Ciprofloxacin dosing information

Usual Adult Dose for Inhalation Bacillus anthracis:

IV: 400 mg IV every 12 hours
Oral: 500 mg orally every 12 hours

Duration of therapy: 60 days

Comments:
-Therapy should be started as soon as possible after suspected/confirmed exposure.
-Indication based on efficacy studies in animals.

Use: For treatment of inhalational anthrax (postexposure) to reduce incidence/progression of disease after exposure to aerosolized Bacillus anthracis

US CDC recommendations:
-IV: 400 mg IV every 8 hours
-Oral: 500 mg orally every 12 hours

Duration of Therapy:
Postexposure prophylaxis for B anthracis infection: 60 days

Systemic anthrax:
-With possible/confirmed meningitis: At least 2 to 3 weeks or until patient is clinically stable (whichever is longer)
-When meningitis has been excluded: At least 2 weeks or until patient is clinically stable (whichever is longer)
-Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial regimen of 60 days from onset of illness.

Cutaneous anthrax without systemic involvement:
-Bioterrorism-related cases: 60 days
-Naturally acquired cases: 7 to 10 days

Comments:
-The preferred drug for pregnant women
-Recommended as a preferred oral drug for postexposure prophylaxis and for the treatment of cutaneous anthrax without systemic involvement
-Recommended as the preferred IV drug for the treatment of systemic anthrax
-Recommended for all strains (regardless of penicillin susceptibility or if susceptibility unknown) when used for postexposure prophylaxis, systemic anthrax when meningitis has been excluded, or cutaneous anthrax without systemic involvement
-Recommended for use with a protein synthesis inhibitor when used for systemic anthrax; the addition of a bactericidal beta-lactam is recommended with possible/confirmed meningitis.
-Systemic anthrax includes anthrax meningitis, inhalation anthrax, injection anthrax, gastrointestinal anthrax, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Cutaneous Bacillus anthracis:

IV: 400 mg IV every 12 hours
Oral: 500 mg orally every 12 hours

Duration of therapy: 60 days

Comments:
-Therapy should be started as soon as possible after suspected/confirmed exposure.
-Indication based on efficacy studies in animals.

Use: For treatment of inhalational anthrax (postexposure) to reduce incidence/progression of disease after exposure to aerosolized Bacillus anthracis

US CDC recommendations:
-IV: 400 mg IV every 8 hours
-Oral: 500 mg orally every 12 hours

Duration of Therapy:
Postexposure prophylaxis for B anthracis infection: 60 days

Systemic anthrax:
-With possible/confirmed meningitis: At least 2 to 3 weeks or until patient is clinically stable (whichever is longer)
-When meningitis has been excluded: At least 2 weeks or until patient is clinically stable (whichever is longer)
-Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial regimen of 60 days from onset of illness.

Cutaneous anthrax without systemic involvement:
-Bioterrorism-related cases: 60 days
-Naturally acquired cases: 7 to 10 days

Comments:
-The preferred drug for pregnant women
-Recommended as a preferred oral drug for postexposure prophylaxis and for the treatment of cutaneous anthrax without systemic involvement
-Recommended as the preferred IV drug for the treatment of systemic anthrax
-Recommended for all strains (regardless of penicillin susceptibility or if susceptibility unknown) when used for postexposure prophylaxis, systemic anthrax when meningitis has been excluded, or cutaneous anthrax without systemic involvement
-Recommended for use with a protein synthesis inhibitor when used for systemic anthrax; the addition of a bactericidal beta-lactam is recommended with possible/confirmed meningitis.
-Systemic anthrax includes anthrax meningitis, inhalation anthrax, injection anthrax, gastrointestinal anthrax, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Anthrax Prophylaxis:

IV: 400 mg IV every 12 hours
Oral: 500 mg orally every 12 hours

Duration of therapy: 60 days

Comments:
-Therapy should be started as soon as possible after suspected/confirmed exposure.
-Indication based on efficacy studies in animals.

Use: For treatment of inhalational anthrax (postexposure) to reduce incidence/progression of disease after exposure to aerosolized Bacillus anthracis

US CDC recommendations:
-IV: 400 mg IV every 8 hours
-Oral: 500 mg orally every 12 hours

Duration of Therapy:
Postexposure prophylaxis for B anthracis infection: 60 days

Systemic anthrax:
-With possible/confirmed meningitis: At least 2 to 3 weeks or until patient is clinically stable (whichever is longer)
-When meningitis has been excluded: At least 2 weeks or until patient is clinically stable (whichever is longer)
-Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial regimen of 60 days from onset of illness.

Cutaneous anthrax without systemic involvement:
-Bioterrorism-related cases: 60 days
-Naturally acquired cases: 7 to 10 days

Comments:
-The preferred drug for pregnant women
-Recommended as a preferred oral drug for postexposure prophylaxis and for the treatment of cutaneous anthrax without systemic involvement
-Recommended as the preferred IV drug for the treatment of systemic anthrax
-Recommended for all strains (regardless of penicillin susceptibility or if susceptibility unknown) when used for postexposure prophylaxis, systemic anthrax when meningitis has been excluded, or cutaneous anthrax without systemic involvement
-Recommended for use with a protein synthesis inhibitor when used for systemic anthrax; the addition of a bactericidal beta-lactam is recommended with possible/confirmed meningitis.
-Systemic anthrax includes anthrax meningitis, inhalation anthrax, injection anthrax, gastrointestinal anthrax, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Febrile Neutropenia:

Empirical therapy: 400 mg IV every 8 hours for 7 to 14 days

Comments:
-Recommended for use with piperacillin (50 mg/kg IV every 4 hours)

Use: In combination with piperacillin, for the treatment of febrile neutropenia

Usual Adult Dose for Intraabdominal Infection:

IV: 400 mg IV every 12 hours
Oral: 500 mg orally every 12 hours

Duration of therapy: 7 to 14 days

Use: In combination with metronidazole, for treatment of complicated intraabdominal infections due to Escherichia coli, Pseudomonas aeruginosa, Proteus mirabilis, Klebsiella pneumoniae, or Bacteroides fragilis

Usual Adult Dose for Joint Infection:

IV: 400 mg IV every 8 to 12 hours
Oral: 500 to 750 mg orally every 12 hours

Duration of therapy: 4 to 8 weeks

Uses: For treatment of bone and joint infections due to Enterobacter cloacae, Serratia marcescens, or P aeruginosa

Usual Adult Dose for Osteomyelitis:

IV: 400 mg IV every 8 to 12 hours
Oral: 500 to 750 mg orally every 12 hours

Duration of therapy: 4 to 8 weeks

Uses: For treatment of bone and joint infections due to Enterobacter cloacae, Serratia marcescens, or P aeruginosa

Usual Adult Dose for Plague:

IV: 400 mg IV every 8 to 12 hours
Oral: 500 to 750 mg orally every 12 hours

Duration of therapy: 14 days

Comments:
-Therapy should be started as soon as possible after suspected/confirmed exposure.
-Indication based on efficacy study in animals only.

Uses: For treatment of plague (including pneumonic and septicemic plague) due to Yersinia pestis; for prophylaxis of plague

Working Group on Civilian Biodefense recommendations for management of plague used as a biological weapon:
-IV: 400 mg IV twice a day
-Oral: 500 mg orally twice a day

Duration of therapy:
-Treatment, contained or mass casualty setting: 10 days
-Postexposure prophylaxis: 7 days

Comments:
-May switch to oral therapy when clinically indicated
-Recommended as an alternative IV drug for treatment of pneumonic plague in a contained casualty setting
-Recommended as a preferred oral drug for treatment of pneumonic plague in a mass casualty setting and for postexposure prophylaxis
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Plague Prophylaxis:

IV: 400 mg IV every 8 to 12 hours
Oral: 500 to 750 mg orally every 12 hours

Duration of therapy: 14 days

Comments:
-Therapy should be started as soon as possible after suspected/confirmed exposure.
-Indication based on efficacy study in animals only.

Uses: For treatment of plague (including pneumonic and septicemic plague) due to Yersinia pestis; for prophylaxis of plague

Working Group on Civilian Biodefense recommendations for management of plague used as a biological weapon:
-IV: 400 mg IV twice a day
-Oral: 500 mg orally twice a day

Duration of therapy:
-Treatment, contained or mass casualty setting: 10 days
-Postexposure prophylaxis: 7 days

Comments:
-May switch to oral therapy when clinically indicated
-Recommended as an alternative IV drug for treatment of pneumonic plague in a contained casualty setting
-Recommended as a preferred oral drug for treatment of pneumonic plague in a mass casualty setting and for postexposure prophylaxis
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Nosocomial Pneumonia:

400 mg IV every 8 hours for 10 to 14 days

Comments:
-Initial empiric treatment with broad-spectrum coverage according to the hospital's and/or ICU's antibiogram is recommended if multidrug-resistant organisms are suspected.

Use: For treatment of nosocomial pneumonia due to Haemophilus influenzae or K pneumoniae

Usual Adult Dose for Pneumonia:

IV: 400 mg IV every 8 to 12 hours
Oral: 500 to 750 mg orally every 12 hours

Duration of therapy: 7 to 14 days

Comments:
-This drug is not considered the drug of first choice for the treatment of presumed or confirmed pneumonia secondary to Streptococcus pneumoniae.
-Since fluoroquinolones (including this drug) have been associated with serious side effects and acute exacerbations of chronic bronchitis (AECB) is self-limiting for some patients, this drug should be saved for treatment of AECB in patients with no alternative treatment options.

Uses: For treatment of lower respiratory tract infections due to E coli, K pneumoniae, E cloacae, P mirabilis, P aeruginosa, H influenzae, H parainfluenzae, or S pneumoniae; for the treatment of AECB due to Moraxella catarrhalis

Usual Adult Dose for Bronchitis:

IV: 400 mg IV every 8 to 12 hours
Oral: 500 to 750 mg orally every 12 hours

Duration of therapy: 7 to 14 days

Comments:
-This drug is not considered the drug of first choice for the treatment of presumed or confirmed pneumonia secondary to Streptococcus pneumoniae.
-Since fluoroquinolones (including this drug) have been associated with serious side effects and acute exacerbations of chronic bronchitis (AECB) is self-limiting for some patients, this drug should be saved for treatment of AECB in patients with no alternative treatment options.

Uses: For treatment of lower respiratory tract infections due to E coli, K pneumoniae, E cloacae, P mirabilis, P aeruginosa, H influenzae, H parainfluenzae, or S pneumoniae; for the treatment of AECB due to Moraxella catarrhalis

Usual Adult Dose for Shigellosis:

500 mg orally every 12 hours for 5 to 7 days

Use: When antibacterial therapy is indicated, for treatment of infectious diarrhea due to E coli (enterotoxigenic isolates), Campylobacter jejuni, Shigella boydii, S dysenteriae, S flexneri, or S sonnei

Infectious Diseases Society of America (IDSA) recommendations: 500 mg orally twice a day

Duration of therapy:
-Immunocompetent patients: 3 days
-Immunocompromised patients: 7 to 10 days

Comments:
-Recommended for Shigella species, E coli species (enterotoxigenic, enteropathogenic, enteroinvasive), Aeromonas, Plesiomonas
-According to some experts, a single 1 g dose may be effective for non-dysentery shigellosis.

US CDC, National Institutes of Health (NIH), and HIV Medicine Association of the Infectious Diseases Society of America (HIVMA/IDSA) recommendations for HIV-infected patients:
Shigellosis therapy:
-IV: 400 mg IV every 12 hours
-Oral: 500 to 750 mg orally every 12 hours

Duration of therapy:
-Bacteremia: At least 14 days
-Gastroenteritis: 7 to 10 days
-Recurrent infections: 2 to 6 weeks

Comments:
-Recommended as preferred therapy to shorten duration of illness and to possibly prevent spread to others
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Infectious Diarrhea:

500 mg orally every 12 hours for 5 to 7 days

Use: When antibacterial therapy is indicated, for treatment of infectious diarrhea due to E coli (enterotoxigenic isolates), Campylobacter jejuni, Shigella boydii, S dysenteriae, S flexneri, or S sonnei

Infectious Diseases Society of America (IDSA) recommendations: 500 mg orally twice a day

Duration of therapy:
-Immunocompetent patients: 3 days
-Immunocompromised patients: 7 to 10 days

Comments:
-Recommended for Shigella species, E coli species (enterotoxigenic, enteropathogenic, enteroinvasive), Aeromonas, Plesiomonas
-According to some experts, a single 1 g dose may be effective for non-dysentery shigellosis.

US CDC, National Institutes of Health (NIH), and HIV Medicine Association of the Infectious Diseases Society of America (HIVMA/IDSA) recommendations for HIV-infected patients:
Shigellosis therapy:
-IV: 400 mg IV every 12 hours
-Oral: 500 to 750 mg orally every 12 hours

Duration of therapy:
-Bacteremia: At least 14 days
-Gastroenteritis: 7 to 10 days
-Recurrent infections: 2 to 6 weeks

Comments:
-Recommended as preferred therapy to shorten duration of illness and to possibly prevent spread to others
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Sinusitis:

IV: 400 mg IV every 12 hours
Oral: 500 mg orally every 12 hours

Duration of therapy: 10 days

Comments:
-Since fluoroquinolones (including this drug) have been associated with serious side effects and acute sinusitis is self-limiting for some patients, this drug should be saved for treatment of acute sinusitis in patients with no alternative treatment options.

Use: For treatment of acute sinusitis due to H influenzae, S pneumoniae, or M catarrhalis

Usual Adult Dose for Skin or Soft Tissue Infection:

IV: 400 mg IV every 8 to 12 hours
Oral: 500 to 750 mg orally every 12 hours

Duration of therapy: 7 to 14 days

Use: For treatment of skin and skin structure infections due to E coli, K pneumoniae, E cloacae, P mirabilis, P vulgaris, Providencia stuartii, Morganella morganii, Citrobacter freundii, P aeruginosa, Staphylococcus aureus (methicillin-susceptible), S epidermidis (methicillin-susceptible), or S pyogenes

IDSA Recommendations:
Incisional surgical site infection:
-IV: 400 mg IV every 12 hour
-Oral: 750 mg orally every 12 hours

Aeromonas hydrophila necrotizing infection: 400 mg IV every 12 hours

Infection after animal bite:
-IV: 400 mg IV every 12 hour
-Oral: 500 to 750 mg orally every 12 hours

Comments:
-Recommended for use with metronidazole as a combination regimen for treatment of incisional surgical site infections after intestinal or genitourinary tract surgery.
-Recommended for use with metronidazole for treatment of incisional surgical site infections after surgery of axilla or perineum; coverage for methicillin-resistant S aureus (MRSA) may be needed.
-In combination with doxycycline, recommended as a preferred IV drug for the treatment of A hydrophila necrotizing infections of the skin, fascia, and muscle
-For animal bites, fluoroquinolones have good activity against Pasteurella multocida but do not provide coverage for MRSA and some anaerobes.
-Current guidelines should be consulted for additional information.

Some Experts Recommend:
-Vibrio vulnificus: 400 mg IV every 12 hours

Comments:
-Recommended for use with ceftazidime (1 to 2 g IV every 8 hours) or cefotaxime (2 g IV every 8 hours)

Usual Adult Dose for Skin and Structure Infection:

IV: 400 mg IV every 8 to 12 hours
Oral: 500 to 750 mg orally every 12 hours

Duration of therapy: 7 to 14 days

Use: For treatment of skin and skin structure infections due to E coli, K pneumoniae, E cloacae, P mirabilis, P vulgaris, Providencia stuartii, Morganella morganii, Citrobacter freundii, P aeruginosa, Staphylococcus aureus (methicillin-susceptible), S epidermidis (methicillin-susceptible), or S pyogenes

IDSA Recommendations:
Incisional surgical site infection:
-IV: 400 mg IV every 12 hour
-Oral: 750 mg orally every 12 hours

Aeromonas hydrophila necrotizing infection: 400 mg IV every 12 hours

Infection after animal bite:
-IV: 400 mg IV every 12 hour
-Oral: 500 to 750 mg orally every 12 hours

Comments:
-Recommended for use with metronidazole as a combination regimen for treatment of incisional surgical site infections after intestinal or genitourinary tract surgery.
-Recommended for use with metronidazole for treatment of incisional surgical site infections after surgery of axilla or perineum; coverage for methicillin-resistant S aureus (MRSA) may be needed.
-In combination with doxycycline, recommended as a preferred IV drug for the treatment of A hydrophila necrotizing infections of the skin, fascia, and muscle
-For animal bites, fluoroquinolones have good activity against Pasteurella multocida but do not provide coverage for MRSA and some anaerobes.
-Current guidelines should be consulted for additional information.

Some Experts Recommend:
-Vibrio vulnificus: 400 mg IV every 12 hours

Comments:
-Recommended for use with ceftazidime (1 to 2 g IV every 8 hours) or cefotaxime (2 g IV every 8 hours)

Usual Adult Dose for Salmonella Enteric Fever:

500 mg orally every 12 hours for 10 days

Comments:
-Efficacy in eradicating the chronic typhoid carrier state has not been established.

Use: For treatment of typhoid fever (enteric fever) due to Salmonella typhi

IDSA Recommendations:
-Non-typhi species of Salmonella: 500 mg orally twice a day

Duration of Therapy:
-Immunocompetent patients: 5 to 7 days
-Immunocompromised patients: Up to 14 days (or longer if relapsing) may be required

US CDC, NIH, and HIVMA/IDSA Recommendations for HIV-infected Patients:
-IV: 400 mg IV every 12 hours
-Oral: 500 to 750 mg orally every 12 hours

Duration of Salmonellosis Therapy:
For gastroenteritis without bacteremia:
-If CD4 count at least 200 cells/mm3: 7 to 14 days
-If CD4 count less than 200 cells/mm3: 2 to 6 weeks

For gastroenteritis with bacteremia:
-If CD4 count at least 200 cells/mm3: 14 days; longer if persistent bacteremia or complicated infection (e.g., metastatic foci of infection present)
-If CD4 count less than 200 cells/mm3: 2 to 6 weeks

Comments:
-Recommended as preferred empiric therapy for bacterial enteric infections (pending diagnostic studies) and as preferred therapy for salmonella gastroenteritis with or without bacteremia
-Empiric therapy for bacterial enteric infections recommended for patients with advanced HIV (CD4 count less than 200 cells/mm3 or concomitant AIDS-defining illnesses) and clinically severe diarrhea (at least 6 stools/day or bloody stool) and/or associated fever/chills. Fecal samples should be obtained for diagnostic testing before starting therapy; therapy should be adjusted based on those results.
-All HIV-infected patients with salmonellosis should receive antibiotic therapy; increased risk of bacteremia (by 20- to 100-fold) and mortality (by up to 7-fold) compared to HIV-negative subjects.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Salmonella Gastroenteritis:

500 mg orally every 12 hours for 10 days

Comments:
-Efficacy in eradicating the chronic typhoid carrier state has not been established.

Use: For treatment of typhoid fever (enteric fever) due to Salmonella typhi

IDSA Recommendations:
-Non-typhi species of Salmonella: 500 mg orally twice a day

Duration of Therapy:
-Immunocompetent patients: 5 to 7 days
-Immunocompromised patients: Up to 14 days (or longer if relapsing) may be required

US CDC, NIH, and HIVMA/IDSA Recommendations for HIV-infected Patients:
-IV: 400 mg IV every 12 hours
-Oral: 500 to 750 mg orally every 12 hours

Duration of Salmonellosis Therapy:
For gastroenteritis without bacteremia:
-If CD4 count at least 200 cells/mm3: 7 to 14 days
-If CD4 count less than 200 cells/mm3: 2 to 6 weeks

For gastroenteritis with bacteremia:
-If CD4 count at least 200 cells/mm3: 14 days; longer if persistent bacteremia or complicated infection (e.g., metastatic foci of infection present)
-If CD4 count less than 200 cells/mm3: 2 to 6 weeks

Comments:
-Recommended as preferred empiric therapy for bacterial enteric infections (pending diagnostic studies) and as preferred therapy for salmonella gastroenteritis with or without bacteremia
-Empiric therapy for bacterial enteric infections recommended for patients with advanced HIV (CD4 count less than 200 cells/mm3 or concomitant AIDS-defining illnesses) and clinically severe diarrhea (at least 6 stools/day or bloody stool) and/or associated fever/chills. Fecal samples should be obtained for diagnostic testing before starting therapy; therapy should be adjusted based on those results.
-All HIV-infected patients with salmonellosis should receive antibiotic therapy; increased risk of bacteremia (by 20- to 100-fold) and mortality (by up to 7-fold) compared to HIV-negative subjects.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Typhoid Fever:

500 mg orally every 12 hours for 10 days

Comments:
-Efficacy in eradicating the chronic typhoid carrier state has not been established.

Use: For treatment of typhoid fever (enteric fever) due to Salmonella typhi

IDSA Recommendations:
-Non-typhi species of Salmonella: 500 mg orally twice a day

Duration of Therapy:
-Immunocompetent patients: 5 to 7 days
-Immunocompromised patients: Up to 14 days (or longer if relapsing) may be required

US CDC, NIH, and HIVMA/IDSA Recommendations for HIV-infected Patients:
-IV: 400 mg IV every 12 hours
-Oral: 500 to 750 mg orally every 12 hours

Duration of Salmonellosis Therapy:
For gastroenteritis without bacteremia:
-If CD4 count at least 200 cells/mm3: 7 to 14 days
-If CD4 count less than 200 cells/mm3: 2 to 6 weeks

For gastroenteritis with bacteremia:
-If CD4 count at least 200 cells/mm3: 14 days; longer if persistent bacteremia or complicated infection (e.g., metastatic foci of infection present)
-If CD4 count less than 200 cells/mm3: 2 to 6 weeks

Comments:
-Recommended as preferred empiric therapy for bacterial enteric infections (pending diagnostic studies) and as preferred therapy for salmonella gastroenteritis with or without bacteremia
-Empiric therapy for bacterial enteric infections recommended for patients with advanced HIV (CD4 count less than 200 cells/mm3 or concomitant AIDS-defining illnesses) and clinically severe diarrhea (at least 6 stools/day or bloody stool) and/or associated fever/chills. Fecal samples should be obtained for diagnostic testing before starting therapy; therapy should be adjusted based on those results.
-All HIV-infected patients with salmonellosis should receive antibiotic therapy; increased risk of bacteremia (by 20- to 100-fold) and mortality (by up to 7-fold) compared to HIV-negative subjects.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Urinary Tract Infection:

IV: 200 to 400 mg IV every 8 to 12 hours for 7 to 14 days

Oral:
Immediate-release: 250 to 500 mg orally every 12 hours for 7 to 14 days

Extended-release:
-Uncomplicated infection (Cipro[R] XR, Proquin[R] XR): 500 mg orally every 24 hours for 3 days
-Complicated infection (Cipro[R] XR): 1000 mg orally every 24 hours for 7 to 14 days

Uses:
-IV, Immediate-release: For treatment of urinary tract infections (UTIs) due to E coli, K pneumoniae, E cloacae, S marcescens, P mirabilis, P rettgeri, M morganii, C koseri, C freundii, P aeruginosa, S epidermidis (methicillin-susceptible), S saprophyticus, or Enterococcus faecalis
-Cipro(R) XR: For the treatment of uncomplicated UTIs due to E coli, P mirabilis, E faecalis, or S saprophyticus; for the treatment of complicated UTIs due to E coli, K pneumoniae, E faecalis, P mirabilis, or P aeruginosa
-Proquin(R) XR: For the treatment of uncomplicated UTIs due to E coli or K pneumoniae

Usual Adult Dose for Pyelonephritis:

Cipro(R) XR: 1000 mg orally every 24 hours for 7 to 14 days

Use: For the treatment of acute uncomplicated pyelonephritis due to E coli

Usual Adult Dose for Cystitis:

Immediate-release: 250 mg orally every 12 hours
Extended-release: 500 mg orally every 24 hours

Duration of therapy: 3 days

Comments:
-Since fluoroquinolones (including this drug) have been associated with serious side effects and acute uncomplicated cystitis/uncomplicated UTI (acute cystitis) is self-limiting for some patients, this drug should be saved for treatment of acute uncomplicated cystitis/uncomplicated UTI (acute cystitis) in patients with no alternative treatment options.

Uses:
-Immediate-release: In female patients, for treatment of acute uncomplicated cystitis due to E coli or S saprophyticus
-Cipro(R) XR: For the treatment of uncomplicated UTI (acute cystitis) due to E coli, P mirabilis, E faecalis, or S saprophyticus
-Proquin(R) XR: For the treatment of uncomplicated UTI (acute cystitis) due to E coli or K pneumoniae

Usual Adult Dose for Prostatitis:

IV: 400 mg IV every 12 hours
Oral: 500 mg orally every 12 hours

Duration of therapy: 28 days

Use: For treatment of chronic bacterial prostatitis due to E coli or P mirabilis

Usual Adult Dose for Gonococcal Infection -- Uncomplicated:

250 mg orally once

Uses: For treatment of uncomplicated urethral and cervical gonorrhea due to Neisseria gonorrhoeae

US CDC recommendations:
-Due to high rates of resistance, fluoroquinolones are not recommended for treatment of gonococcal infections in the US; dual therapy with ceftriaxone and azithromycin is the recommended regimen for treatment of gonorrhea in the US.
-Antimicrobial susceptibility patterns should be monitored.
-The patient's sexual partner(s) should also be evaluated/treated.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Meningococcal Meningitis Prophylaxis:

US CDC recommendations: 500 mg orally once

Usual Adult Dose for Tularemia:

IDSA recommendations:
-Mild to moderate illness: 750 mg orally twice a day for at least 14 days

Working Group on Civilian Biodefense recommendations for management of tularemia used as a biological weapon:
-IV: 400 mg IV twice a day for 10 days
-Oral: 500 mg orally twice a day for 14 days

Comments:
-May switch to oral therapy when clinically indicated
-Recommended as an alternative IV drug for treatment of tularemia in a contained casualty setting
-Recommended as a preferred oral drug for treatment of tularemia in a mass casualty setting and for postexposure prophylaxis
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Cholera:

IDSA recommendations: 1 g orally once

Comments:
-For use as an adjunct to fluid and electrolyte replacement
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Traveler's Diarrhea:

IDSA recommendations:
Prophylaxis: 500 mg orally once a day for up to 2 to 3 weeks
Treatment: 500 mg orally twice a day for up to 3 days

Comments:
-Routine use of antibiotic prophylaxis for traveler's diarrhea is not recommended but may be considered in certain circumstances.
-Most cases are self-limited, and prudent withholding of antibiotics in mild cases does not appear to slow recovery in most patients; important to replace fluids and maintain hydration.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Chancroid:

US CDC recommendations: 500 mg orally twice a day for 3 days

Comments:
-Alternative therapy recommended during pregnancy and lactation.
-The patient's sexual partner(s) should also be evaluated/treated.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Granuloma Inguinale:

US CDC recommendations: 750 mg orally twice a day
Duration of therapy: At least 3 weeks and until all lesions have completely healed

Comments:
-Recommended as an alternative regimen
-The patient's sexual partner(s) should also be evaluated/treated.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Surgical Prophylaxis:

American Society of Health-System Pharmacists (ASHP), IDSA, Surgical Infection Society (SIS), and Society for Healthcare Epidemiology of America (SHEA) recommendations:
-Preoperative dose: 400 mg IV once, starting within 120 minutes before surgical incision

Comments:
-A single prophylactic dose is usually sufficient; if prophylaxis is continued postoperatively, duration should be less than 24 hours.
-Readministration may be needed for unusually long procedures to ensure adequate serum and tissue drug levels.
-Redosing may be needed if drug half-life is shortened (e.g., extensive burns) or if prolonged/excessive bleeding during surgery; redosing may not be needed if drug half-life is prolonged (e.g., renal dysfunction).
-Before use, local susceptibility should be reviewed due to increasing resistance of E coli to fluoroquinolones.
-Coadministration with other agents may be recommended, depending on type of procedure.
-Current guidelines should be consulted for additional information.

Uses: For surgical prophylaxis for the following procedures:
-Gastroduodenal (as part of an alternative regimen): Procedures involving entry into lumen of gastrointestinal tract (bariatric, pancreaticoduodenectomy); Procedures without entry into gastrointestinal tract (antireflux, highly selective vagotomy) for high-risk patients
-Biliary tract (as part of an alternative regimen): Open procedure; elective, high-risk laparoscopic procedure
-Appendectomy (as part of an alternative regimen): Uncomplicated appendicitis
-Small intestine (as part of an alternative regimen): Nonobstructed; obstructed
-Colorectal (as part of an alternative regimen)
-Hysterectomy (as part of an alternative regimen): Vaginal or abdominal
-Urologic: Lower tract instrumentation with risk factors for infection, including transrectal prostate biopsy (recommended regimen); clean with entry into urinary tract or clean-contaminated (as part of an alternative regimen)
-Transplantation (as part of an alternative regimen): Liver; pancreas; pancreas-kidney

Usual Pediatric Dose for Inhalation Bacillus anthracis:

IV: 10 mg/kg IV every 12 hours
Maximum dose: 400 mg/dose

Oral: 15 mg/kg orally every 12 hours
Maximum dose: 500 mg/dose

Total duration of therapy: 60 days

Comments:
-Therapy should be started as soon as possible after suspected/confirmed exposure.
-Indication based on efficacy studies in animals.

Use: For treatment of inhalational anthrax (postexposure) to reduce incidence/progression of disease after exposure to aerosolized B anthracis

American Academy of Pediatrics recommendations:
Up to 4 weeks of age:
-Gestational age 32 to 37 weeks: 10 mg/kg orally or IV every 12 hours
-Term neonate: 15 mg/kg orally or IV every 12 hours

1 month or older:
IV: 10 mg/kg IV every 8 hours
Maximum dose: 400 mg/dose

Oral: 15 mg/kg orally every 12 hours
Maximum dose: 500 mg/dose

Duration of Therapy:
Postexposure prophylaxis for B anthracis infection (all ages): 60 days after exposure

Systemic anthrax:
-Severe anthrax (up to 4 weeks of age): At least 2 to 3 weeks or until patient is clinically stable (whichever is longer)
-With possible/confirmed meningitis (1 month or older): At least 2 to 3 weeks or until patient is clinically stable (whichever is longer)
-When meningitis has been excluded (1 month or older): At least 14 days or until patient is clinically stable (whichever is longer)
-Patients will require prophylaxis to complete an antimicrobial regimen of up to 60 days from onset of illness.

Cutaneous anthrax without systemic involvement:
-Bioterrorism-related cases: To complete an antimicrobial regimen of up to 60 days from onset of illness
-Naturally acquired cases: 7 to 10 days

Follow-up for severe anthrax: To complete a regimen of 10 to 14 days or longer (up to 4 weeks of age) or to complete a regimen of 14 days or longer (1 month or older)
-Patients may require prophylaxis to complete an antimicrobial regimen of up to 60 days from onset of illness.

Comments:
-Recommended as the preferred oral drug for postexposure prophylaxis and for the treatment of cutaneous anthrax without systemic involvement
-Recommended as the preferred IV drug for the treatment of systemic/severe anthrax (including follow-up)
-Recommended for all strains (regardless of penicillin susceptibility or if susceptibility unknown) when used for postexposure prophylaxis, systemic/severe anthrax when meningitis has been excluded, follow-up therapy for severe anthrax, or cutaneous anthrax without systemic involvement
-Recommended for use with a protein synthesis inhibitor when used for systemic anthrax (including follow-up); the addition of a bactericidal beta-lactam (all patients) or a bactericidal glycopeptide (patients 1 month or older) is recommended with possible/confirmed meningitis.
-Systemic/severe anthrax includes anthrax meningitis, inhalation anthrax, injection anthrax, gastrointestinal anthrax, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Cutaneous Bacillus anthracis:

IV: 10 mg/kg IV every 12 hours
Maximum dose: 400 mg/dose

Oral: 15 mg/kg orally every 12 hours
Maximum dose: 500 mg/dose

Total duration of therapy: 60 days

Comments:
-Therapy should be started as soon as possible after suspected/confirmed exposure.
-Indication based on efficacy studies in animals.

Use: For treatment of inhalational anthrax (postexposure) to reduce incidence/progression of disease after exposure to aerosolized B anthracis

American Academy of Pediatrics recommendations:
Up to 4 weeks of age:
-Gestational age 32 to 37 weeks: 10 mg/kg orally or IV every 12 hours
-Term neonate: 15 mg/kg orally or IV every 12 hours

1 month or older:
IV: 10 mg/kg IV every 8 hours
Maximum dose: 400 mg/dose

Oral: 15 mg/kg orally every 12 hours
Maximum dose: 500 mg/dose

Duration of Therapy:
Postexposure prophylaxis for B anthracis infection (all ages): 60 days after exposure

Systemic anthrax:
-Severe anthrax (up to 4 weeks of age): At least 2 to 3 weeks or until patient is clinically stable (whichever is longer)
-With possible/confirmed meningitis (1 month or older): At least 2 to 3 weeks or until patient is clinically stable (whichever is longer)
-When meningitis has been excluded (1 month or older): At least 14 days or until patient is clinically stable (whichever is longer)
-Patients will require prophylaxis to complete an antimicrobial regimen of up to 60 days from onset of illness.

Cutaneous anthrax without systemic involvement:
-Bioterrorism-related cases: To complete an antimicrobial regimen of up to 60 days from onset of illness
-Naturally acquired cases: 7 to 10 days

Follow-up for severe anthrax: To complete a regimen of 10 to 14 days or longer (up to 4 weeks of age) or to complete a regimen of 14 days or longer (1 month or older)
-Patients may require prophylaxis to complete an antimicrobial regimen of up to 60 days from onset of illness.

Comments:
-Recommended as the preferred oral drug for postexposure prophylaxis and for the treatment of cutaneous anthrax without systemic involvement
-Recommended as the preferred IV drug for the treatment of systemic/severe anthrax (including follow-up)
-Recommended for all strains (regardless of penicillin susceptibility or if susceptibility unknown) when used for postexposure prophylaxis, systemic/severe anthrax when meningitis has been excluded, follow-up therapy for severe anthrax, or cutaneous anthrax without systemic involvement
-Recommended for use with a protein synthesis inhibitor when used for systemic anthrax (including follow-up); the addition of a bactericidal beta-lactam (all patients) or a bactericidal glycopeptide (patients 1 month or older) is recommended with possible/confirmed meningitis.
-Systemic/severe anthrax includes anthrax meningitis, inhalation anthrax, injection anthrax, gastrointestinal anthrax, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Anthrax Prophylaxis:

IV: 10 mg/kg IV every 12 hours
Maximum dose: 400 mg/dose

Oral: 15 mg/kg orally every 12 hours
Maximum dose: 500 mg/dose

Total duration of therapy: 60 days

Comments:
-Therapy should be started as soon as possible after suspected/confirmed exposure.
-Indication based on efficacy studies in animals.

Use: For treatment of inhalational anthrax (postexposure) to reduce incidence/progression of disease after exposure to aerosolized B anthracis

American Academy of Pediatrics recommendations:
Up to 4 weeks of age:
-Gestational age 32 to 37 weeks: 10 mg/kg orally or IV every 12 hours
-Term neonate: 15 mg/kg orally or IV every 12 hours

1 month or older:
IV: 10 mg/kg IV every 8 hours
Maximum dose: 400 mg/dose

Oral: 15 mg/kg orally every 12 hours
Maximum dose: 500 mg/dose

Duration of Therapy:
Postexposure prophylaxis for B anthracis infection (all ages): 60 days after exposure

Systemic anthrax:
-Severe anthrax (up to 4 weeks of age): At least 2 to 3 weeks or until patient is clinically stable (whichever is longer)
-With possible/confirmed meningitis (1 month or older): At least 2 to 3 weeks or until patient is clinically stable (whichever is longer)
-When meningitis has been excluded (1 month or older): At least 14 days or until patient is clinically stable (whichever is longer)
-Patients will require prophylaxis to complete an antimicrobial regimen of up to 60 days from onset of illness.

Cutaneous anthrax without systemic involvement:
-Bioterrorism-related cases: To complete an antimicrobial regimen of up to 60 days from onset of illness
-Naturally acquired cases: 7 to 10 days

Follow-up for severe anthrax: To complete a regimen of 10 to 14 days or longer (up to 4 weeks of age) or to complete a regimen of 14 days or longer (1 month or older)
-Patients may require prophylaxis to complete an antimicrobial regimen of up to 60 days from onset of illness.

Comments:
-Recommended as the preferred oral drug for postexposure prophylaxis and for the treatment of cutaneous anthrax without systemic involvement
-Recommended as the preferred IV drug for the treatment of systemic/severe anthrax (including follow-up)
-Recommended for all strains (regardless of penicillin susceptibility or if susceptibility unknown) when used for postexposure prophylaxis, systemic/severe anthrax when meningitis has been excluded, follow-up therapy for severe anthrax, or cutaneous anthrax without systemic involvement
-Recommended for use with a protein synthesis inhibitor when used for systemic anthrax (including follow-up); the addition of a bactericidal beta-lactam (all patients) or a bactericidal glycopeptide (patients 1 month or older) is recommended with possible/confirmed meningitis.
-Systemic/severe anthrax includes anthrax meningitis, inhalation anthrax, injection anthrax, gastrointestinal anthrax, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Pyelonephritis:

1 year or older:
IV: 6 to 10 mg/kg IV every 8 hours
Maximum dose: 400 mg/dose

Oral: 10 to 20 mg/kg orally every 12 hours
Maximum dose: 750 mg/dose

Total duration of therapy: 10 to 21 days

Comments:
-Dose and initial route of therapy should be based on severity of infection.
-Due to an increased incidence of side effects compared to controls (including those related to joints and/or surrounding tissues), this drug is not a drug of first choice in pediatric patients.

Uses: For treatment of complicated UTIs and pyelonephritis due to E coli

Usual Pediatric Dose for Urinary Tract Infection:

1 year or older:
IV: 6 to 10 mg/kg IV every 8 hours
Maximum dose: 400 mg/dose

Oral: 10 to 20 mg/kg orally every 12 hours
Maximum dose: 750 mg/dose

Total duration of therapy: 10 to 21 days

Comments:
-Dose and initial route of therapy should be based on severity of infection.
-Due to an increased incidence of side effects compared to controls (including those related to joints and/or surrounding tissues), this drug is not a drug of first choice in pediatric patients.

Uses: For treatment of complicated UTIs and pyelonephritis due to E coli

Usual Pediatric Dose for Plague:

IV: 10 mg/kg IV every 8 to 12 hours
Maximum dose: 400 mg/dose

Oral: 15 mg/kg orally every 8 to 12 hours
Maximum dose: 500 mg/dose

Total duration of therapy: 10 to 21 days

Comments:
-Therapy should be started as soon as possible after suspected/confirmed exposure to Y pestis.
-Indication based on efficacy study in animals only.

Uses: For treatment of plague (including pneumonic and septicemic plague) due to Y pestis; for prophylaxis of plague

Working Group on Civilian Biodefense recommendations for management of plague used as a biological weapon:
IV: 15 mg/kg IV twice a day
Maximum dose: 400 mg/dose

Oral: 20 mg/kg orally twice a day
Maximum dose: 500 mg/dose

Duration of therapy:
-Treatment, contained or mass casualty setting: 10 days
-Postexposure prophylaxis: 7 days

Comments:
-May switch to oral therapy when clinically indicated
-Recommended as an alternative IV drug for treatment of pneumonic plague in a contained casualty setting
-Recommended as a preferred oral drug for treatment of pneumonic plague in a mass casualty setting and for postexposure prophylaxis

Usual Pediatric Dose for Plague Prophylaxis:

IV: 10 mg/kg IV every 8 to 12 hours
Maximum dose: 400 mg/dose

Oral: 15 mg/kg orally every 8 to 12 hours
Maximum dose: 500 mg/dose

Total duration of therapy: 10 to 21 days

Comments:
-Therapy should be started as soon as possible after suspected/confirmed exposure to Y pestis.
-Indication based on efficacy study in animals only.

Uses: For treatment of plague (including pneumonic and septicemic plague) due to Y pestis; for prophylaxis of plague

Working Group on Civilian Biodefense recommendations for management of plague used as a biological weapon:
IV: 15 mg/kg IV twice a day
Maximum dose: 400 mg/dose

Oral: 20 mg/kg orally twice a day
Maximum dose: 500 mg/dose

Duration of therapy:
-Treatment, contained or mass casualty setting: 10 days
-Postexposure prophylaxis: 7 days

Comments:
-May switch to oral therapy when clinically indicated
-Recommended as an alternative IV drug for treatment of pneumonic plague in a contained casualty setting
-Recommended as a preferred oral drug for treatment of pneumonic plague in a mass casualty setting and for postexposure prophylaxis

Usual Pediatric Dose for Tularemia:

Working Group on Civilian Biodefense recommendations for management of tularemia used as a biological weapon:
IV: 15 mg/kg IV twice a day for 10 days
Maximum dose: 400 mg/dose

Oral: 15 mg/kg orally twice a day for 14 days
Maximum dose: 500 mg/dose

Comments:
-May switch to oral therapy when clinically indicated
-Recommended as an alternative IV drug for treatment of tularemia in a contained casualty setting
-Recommended as a preferred oral drug for treatment of tularemia in a mass casualty setting and for postexposure prophylaxis
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Surgical Prophylaxis:

ASHP, IDSA, SIS, and SHEA recommendations:
1 year or older:
Preoperative dose: 10 mg/kg IV once, starting within 120 minutes before surgical incision
Maximum dose: 400 mg/dose

Comments:
-A single prophylactic dose is usually sufficient; if prophylaxis is continued postoperatively, duration should be less than 24 hours.
-Readministration may be needed for unusually long procedures to ensure adequate serum and tissue drug levels.
-Redosing may be needed if drug half-life is shortened (e.g., extensive burns) or if prolonged/excessive bleeding during surgery; redosing may not be needed if drug half-life is prolonged (e.g., renal dysfunction).
-Before use, local susceptibility should be reviewed due to increasing resistance of E coli to fluoroquinolones.
-Coadministration with other agents may be recommended, depending on type of procedure.
-Pediatric dose should not exceed adult dose.
-Current guidelines should be consulted for additional information.

Uses: For surgical prophylaxis for the following procedures:
-Gastroduodenal (as part of an alternative regimen): Procedures involving entry into lumen of gastrointestinal tract (bariatric, pancreaticoduodenectomy); Procedures without entry into gastrointestinal tract (antireflux, highly selective vagotomy) for high-risk patients
-Biliary tract (as part of an alternative regimen): Open procedure; elective, high-risk laparoscopic procedure
-Appendectomy (as part of an alternative regimen): Uncomplicated appendicitis
-Small intestine (as part of an alternative regimen): Nonobstructed; obstructed
-Colorectal (as part of an alternative regimen)
-Hysterectomy (as part of an alternative regimen): Vaginal or abdominal
-Urologic: Lower tract instrumentation with risk factors for infection, including transrectal prostate biopsy (recommended regimen); clean with entry into urinary tract or clean-contaminated (as part of an alternative regimen)
-Transplantation (as part of an alternative regimen): Liver; pancreas; pancreas-kidney

Usual Pediatric Dose for Shigellosis:

US CDC, NIH, and HIVMA/IDSA recommendations for HIV-infected adolescents:
Shigellosis therapy:
-IV: 400 mg IV every 12 hours
-Oral: 500 to 750 mg orally every 12 hours

Duration of therapy:
-Bacteremia: At least 14 days
-Gastroenteritis: 7 to 10 days
-Recurrent infections: 2 to 6 weeks

Comments:
-Recommended as preferred therapy to shorten duration of illness and to possibly prevent spread to others
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Salmonella Enteric Fever:

US CDC, NIH, and HIVMA/IDSA recommendations for HIV-infected adolescents:
-IV: 400 mg IV every 12 hours
-Oral: 500 to 750 mg orally every 12 hours

Duration of Salmonellosis Therapy:
For gastroenteritis without bacteremia:
-If CD4 count at least 200 cells/mm3: 7 to 14 days
-If CD4 count less than 200 cells/mm3: 2 to 6 weeks

For gastroenteritis with bacteremia:
-If CD4 count at least 200 cells/mm3: 14 days; longer if persistent bacteremia or complicated infection (e.g., metastatic foci of infection present)
-If CD4 count less than 200 cells/mm3: 2 to 6 weeks

Comments:
-Recommended as preferred empiric therapy for bacterial enteric infections (pending diagnostic studies) and as preferred therapy for salmonella gastroenteritis with or without bacteremia
-Empiric therapy for bacterial enteric infections recommended for patients with advanced HIV (CD4 count less than 200 cells/mm3 or concomitant AIDS-defining illnesses) and clinically severe diarrhea (at least 6 stools/day or bloody stool) and/or associated fever/chills. Fecal samples should be obtained for diagnostic testing before starting therapy; therapy should be adjusted based on those results.
-All HIV-infected patients with salmonellosis should receive antibiotic therapy; increased risk of bacteremia (by 20- to 100-fold) and mortality (by up to 7-fold) compared to HIV-negative subjects.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Salmonella Gastroenteritis:

US CDC, NIH, and HIVMA/IDSA recommendations for HIV-infected adolescents:
-IV: 400 mg IV every 12 hours
-Oral: 500 to 750 mg orally every 12 hours

Duration of Salmonellosis Therapy:
For gastroenteritis without bacteremia:
-If CD4 count at least 200 cells/mm3: 7 to 14 days
-If CD4 count less than 200 cells/mm3: 2 to 6 weeks

For gastroenteritis with bacteremia:
-If CD4 count at least 200 cells/mm3: 14 days; longer if persistent bacteremia or complicated infection (e.g., metastatic foci of infection present)
-If CD4 count less than 200 cells/mm3: 2 to 6 weeks

Comments:
-Recommended as preferred empiric therapy for bacterial enteric infections (pending diagnostic studies) and as preferred therapy for salmonella gastroenteritis with or without bacteremia
-Empiric therapy for bacterial enteric infections recommended for patients with advanced HIV (CD4 count less than 200 cells/mm3 or concomitant AIDS-defining illnesses) and clinically severe diarrhea (at least 6 stools/day or bloody stool) and/or associated fever/chills. Fecal samples should be obtained for diagnostic testing before starting therapy; therapy should be adjusted based on those results.
-All HIV-infected patients with salmonellosis should receive antibiotic therapy; increased risk of bacteremia (by 20- to 100-fold) and mortality (by up to 7-fold) compared to HIV-negative subjects.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Pneumonia with Cystic Fibrosis:

Study (n=67)
5 years or older: 10 mg/kg IV every 8 hours for 1 week followed by 20 mg/kg orally every 12 hours

Total duration of therapy: 10 to 21 days

What other drugs will affect ciprofloxacin?

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with ciprofloxacin, especially:

  • glyburide, methotrexate, metoclopramide, phenytoin, probenecid, theophylline;

  • a blood thinner (warfarin, Coumadin, Jantoven);

  • a diuretic or "water pill";

  • heart rhythm medication--amiodarone, disopyramide, dofetilide, dronedarone, procainamide, quinidine, sotalol, and others;

  • medicine to treat depression or mental illness--amitriptylline, clomipramine, desipramine, iloperidone, imipramine, nortriptyline, thioridazine, ziprasidone, and others; or

  • NSAIDs (nonsteroidal anti-inflammatory drugs)--aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others.

This list is not complete. Other drugs may interact with ciprofloxacin, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your pharmacist can provide more information about ciprofloxacin.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 1.01.

Date modified: November 30, 2016
Last reviewed: June 25, 2014

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