Ciprofloxacin

FDA

• Systemic:
  • Use of ciprofloxacin for acute sinusitis, AECB and acute uncomplicated UTIs should be avoided due to the FDA warning (Boxed warning) regarding serious and potentially permanent side effects (tendonitis and tendon rupture, peripheral neuropathy, and CNS side effects). FDA Safety Warning on Fluoroquinolone Use.
  • Skin and skin structure infections
  • Bone and joint infections
  • Complicated intra-abdominal infections
    • Note: IDSA/SIS guidelines recommend ciprofloxacin combined with metronidazole for community-acquired intra-abdominal and biliary tract infections.
    • Due to high rates of E. coli resistance in many communities, empiric use for healthcare-associated complicated infections is not recommended unless hospital surveillance indicates >90% susceptibility of E. coli to ciprofloxacin.
  • Infectious diarrhea
  • Typhoid fever (enteric fever)
  • Uncomplicated cervical and urethral N. gonorrhoeae (note: high resistance rates removed fluoroquinolones from the preferred agents; no longer recommended as first-line therapy)
  • Lower respiratory tract infections
    • AECB (see the first bullet)
  • Acute sinusitis (see the first bullet)
  • Urinary tract infections (see the first bullet)
    • Acute uncomplicated cystitis (see the first bullet)
    • Complicated UTI and pyelonephritis in pediatric patients
  • Chronic bacterial prostatitis
  • Inhalational anthrax postexposure in adult and pediatric patients
  • Plague in adult and pediatric patients

• Ophthalmic
  • Bacterial conjunctivitis (ophthalmic ointment and solution) due to susceptible organisms [Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Streptococcus viridans Group, and Haemophilus influenzae]
• Otic
  • Acute otitis externa(Ciprodexotic suspension) with tympanostomy tubes: infants ≥6 months, children, and adolescents
  • Tympanostomy tube treatment (Otovel) prevention of excess fluid in the middle ear, and treatment of acute otitis media with tympanostomy tubes (AOMT) by certain bacteria
  • Treatment of acute otitis externa (Cetraxal) due to susceptible Pseudomonas aeruginosa or Staphylococcus aureus isolates.

NON-FDA APPROVED USES

Partial listing

• Cat scratch disease
• Chancroid
• Cholera
• Diabetic foot infections
• Endocarditis
  
  • Due to HACEK or other susceptible Gram-negative organisms
• Empiric therapy for neutropenic fever (in combination with amoxicillin/clavulanate) in low-risk patients.
• Meningitis
  • Caused by Gram-negative organisms in penicillin-allergic patients
  • Prophylaxis forN. meningitidis meningitis prophylaxis in contacts
• Crohn’s flare
• Spontaneous bacterial peritonitis (SBP) prophylaxis
• Neutropenic fevers
• Osteomyelitis
• Surgical prophylaxis
• Tularemia
• Ophthalmic
  • Corneal ulcer