Drug reference

Ciprofloxacin

Fluoroquinolone · Antibiotic

Also known as Cipro, Ciproxin, Ciprofloxacin Hydrochloride, Cifran

START

500 mg PO BID

TYPICAL MAX

750 mg BID (complicated infection)

STOP IF

Tendon rupture history · aortic aneurysm risk · age <18 unless mandatory

WATCH

Tendons · QTc · CNS effects · C. difficile · glucose

CDSCO approvedJan AushadhiNPPA price-controlledATC J01MA02

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 1h · tissue distribution
PEAK: 1.5h · Cmax
t½: 4h · plasma t½
DURATION: 12h · BID dosing window

EXCRETION

50-70% renal unchanged · CYP1A2 inhibitor

route + CYP

INTERACTIONS

12 major

incl. contraindicated

PREGNANCY

Category C — avoid; arthropathy in juveniles

FDA category + note

Top interactionssee all 12 →

CilostazoleContraindicatedTextbookKDT 7e · p555
CelecoxibSevereTextbook-citedKDT 7e · p949
DiclofenacSevereTextbook-citedKDT 7e · p949
IbuprofenSevereTextbook-citedKDT 7e · p949

Available in India

1,259 branded formulations and 509 fixed-dose combinations. Look up specific brands in the Drugs workspace.

Jan Aushadhi — generic available at GoI pharmacies

Mechanism

Ciprofloxacin inhibits bacterial DNA gyrase (topoisomerase II) and topoisomerase IV, enzymes essential for bacterial DNA replication, transcription, repair, and recombination. By blocking these enzymes, it causes breaks in the bacterial DNA, leading to cell death and a bactericidal effect.

Indications

Urinary Tract Infections (UTIs)Respiratory Tract InfectionsSkin and Soft Tissue InfectionsBone and Joint InfectionsInfectious DiarrheaIntra-abdominal InfectionsTyphoid FeverAnthrax (post-exposure prophylaxis and treatment)PlagueGonorrhea (note: increasing resistance, not first-line)Cystic Fibrosis exacerbations (off-label)Acute diarrhea (first-line for traveler's diarrhea)Small intestinal bacterial overgrowth (SIBO)adjunctive treatment with other medications for active IBD in severe cases where there is concern about coexisting sepsistreatment for perforating or fistulizing complications of Crohn’s diseaseprophylaxis for recurrence in postoperative Crohn’s diseasepediatric Crohn’s disease (mild-to-moderate)Urinary tract infectionsProstatitisTraveler's diarrheaIntra-abdominal infections (with metronidazole)Pseudomonas infectionsAnthrax (prophylaxis)TularemiaPlague (due to Yersinia pestis)ChancroidconjunctivitiskeratitiskeratoconjunctivitisblepharitisblepharoconjunctivitismeibomianitisdacryocystitisPseudomonas infected orthopedic prosthesisPrevention of acute exacerbations in chronic obstructive lung disease (doubtful value)Prevention of acute exacerbations in chronic bronchitis (doubtful value)urinary tract infections (complicated cases, indwelling catheters, prostatitis)gonorrhoea (single 500 mg dose, if strain is sensitive, but no longer first line)chancroid (second line alternative, 500 mg BD for 3 days)bacterial gastroenteritis (empirical therapy of severe diarrhoea by EPEC, Shigella, Salmonella, Campy. jejuni, also reduces stool volume in cholera)typhoid fever (one of the first choice drugs, prevents carrier state)bone, soft tissue, gynaecological and wound infections (caused by resistant Staph. and gram-negative bacteria, e.g., osteomyelitis, joint infections, diabetic foot)respiratory infections (Mycoplasma, Legionella, H. influenzae, Branh. catarrhalis, some streptococcal and pneumococcal infections)inhalational anthrax (post-exposure treatment, US-FDA approved)tuberculosis (second line for multidrug resistant TB)gram-negative septicaemias (parenteral, may be combined with a third generation cephalosporin or an aminoglycoside)meningitis (gram-negative bacterial meningitis, especially in immunocompromised or with CSF shunts)prophylaxis of infections (in neutropenic/cancer and other susceptible patients)conjunctivitis (by gram-negative bacteria, topical therapy)uncomplicated acute UTIcomplicated cases of UTIUTI with prostatitisUTI with indwelling cathetersUTI with bacteria resistant to cotrimoxazole/ampicillinchronic UTIpenicillinase producing gonorrhoea (alternative)chancroid (alternative)Atypical mycobacteria infections (more active against atypical mycobacteria than Lfx)MAC infectionM. fortuitum infectionProsthetic-joint infections (in combination with rifampin)Nontypeable H. influenzae infections (general class effect)Exacerbations of COPD in adults (for H. influenzae)ShigellosisAdjunctive antibiotic for patients with moderate or severe dehydration due to cholera (in areas with confirmed susceptibility)Moderate or severe Vibrio parahaemolyticus–associated gastrointestinal illnessExtraintestinal non-O1/O139 V. cholerae infections (in vitro sensitive)Vibrio vulnificus primary sepsis (as a fluoroquinolone option, combined with a third-generation cephalosporin)Brucellosis (potential alternative, but controversial and not first-line)Brucella endocarditis (as an optional add-on)

Dosing

Adult: Dosing varies by indication. For uncomplicated UTI: 250 mg orally every 12 hours for 3 days. For complicated UTI/Pyelonephritis: 500 mg orally every 12 hours or 400 mg IV every 8-12 hours for 7-14 days. For Respiratory Tract Infections: 500-750 mg orally every 12 hours or 400 mg IV every 8-12 hours for 7-14 days.
Pediatric: Generally reserved for severe infections (e.g., complicated UTI, anthrax) where benefits outweigh risks of arthropathy. For complicated UTI/Pyelonephritis (1-17 years): 10-20 mg/kg orally every 12 hours (max 750 mg/dose) or 6-10 mg/kg IV every 8 hours (max 400 mg/dose).
Renal adjustment: CrCl 30-50 mL/min: Administer usual dose every 12 hours or reduce oral dose to 250-500 mg. CrCl <30 mL/min (including hemodialysis/peritoneal dialysis): Administer usual dose every 24 hours, or half the usual dose every 12 hours. Dosing should occur after dialysis on dialysis days.
Hepatic adjustment: No dosage adjustment is generally required for mild to moderate hepatic impairment. Use with caution and monitor in severe hepatic impairment.
Geriatric: Use with caution due to potential for decreased renal function and increased risk of tendon rupture and QTc prolongation. Monitor renal function and use lower end of dosing range.
Max dose: Oral: 1500 mg/day (in divided doses for specific severe infections); typically 1000 mg/day. IV: 1200 mg/day.

Pharmacokinetics

Onset

Oral: 0.5-2 hours; IV: Rapid

Peak effect

Oral: 1-2 hours; IV: 30-60 minutes after infusion

Duration

8-12 hours

Half-life

3-5 hours (increases with renal impairment)

Bioavailability

Oral: 70-80%

Protein binding

20-40%

Metabolism

Partially metabolized in the liver (approx. 15-30%) by CYP1A2 to several metabolites, some with minor activity.

Excretion

Primarily renal (50-70% as unchanged drug); 15-20% via feces.

Contraindications

Hypersensitivity to ciprofloxacin or other fluoroquinolones.
Concurrent use with Tizanidine.
History of tendinitis or tendon rupture associated with quinolone use.
Myasthenia Gravis (may exacerbate muscle weakness).
Known QTc prolongation or uncorrected hypokalemia/hypomagnesemia.
Uncontrolled epilepsy or other seizure disorders (relative).
Children (not routinely recommended)
patients with myasthenia gravis
Pregnancy (increased risk to foetus)
pregnancy
children (caution due to potential cartilage damage, though used in pressing situations like Pseudomonas pneumonia in cystic fibrosis and multi-resistant typhoid)
patients with predisposing factors for CNS toxicity at high doses
pregnant women
Children
Pregnant women (due to possible effects on articular cartilage)

Side effects

Common

NauseaDiarrheaVomitingAbdominal painHeadacheDizzinessRestlessnessRashAbnormal liver function testsGI disturbancesAbdominal discomfortHeadachesInsomniaAnxietyHypersensitivity reactionsbad tasteanorexiaimpairment of concentration and dexteritypruritusphotosensitivityurticariaswelling of lips

Serious

Tendinitis and tendon rupture (especially Achilles tendon)
Peripheral neuropathy (irreversible in some cases)
CNS effects (seizures, psychosis, suicidal ideation, confusion, tremors)
Clostridioides difficile-associated diarrhea (CDAD)
QTc prolongation and Torsades de Pointes
Aortic aneurysm rupture or dissection
Severe hypersensitivity reactions (anaphylaxis, Stevens-Johnson Syndrome)
Dysglycemia (hypoglycemia or hyperglycemia)
tendinopathy
tendon rupture
peripheral neuropathy
CNS effects
Optic neuritis
Tendinitis
QT interval prolongation (lowest risk among quinolones)
drug-related corneal deposits
Haemolysis (in G-6-PD deficient patients)
tremor
seizures (rare)
tendon rupture (risk higher in >60 years and with corticosteroids)
serious cutaneous reactions (rare)
CNS stimulatory effects (including seizures)
Glucose dysregulation
Tendinopathy (including Achilles tendon rupture, especially in older patients, organ transplant recipients, and those on glucocorticoids)
Increased risk of aortic aneurysm
Worsening of myasthenia gravis
QTc interval prolongation (moxifloxacin more likely)

Pregnancy & lactation

Pregnancy

Category C — avoid; arthropathy in juveniles

Lactation

Ciprofloxacin is excreted into breast milk. Due to the potential for serious adverse reactions (e.g., arthropathy) in the infant, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.