Ciprofloxacin
Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.
| ID | DRUG-CIPROFLOXACIN |
|---|---|
| Type | Drug |
| Aliases | CiproCiprobayCiproletЦипрофлоксацин |
| Status | reviewed 2026-04-27 | pending_clinical_signoff |
| Diseases | None declared |
| Sources | SRC-NCCN-BCELL-2025 SRC-NCCN-MM-2025 |
Drug Facts
| Class | Second-generation fluoroquinolone antibiotic (Gram-negative + atypicals + Pseudomonas) |
|---|---|
| Mechanism | Synthetic broad-spectrum fluoroquinolone that inhibits two essential bacterial type-II topoisomerases: DNA gyrase (topoisomerase II) — primary target in Gram-negative bacteria — and topoisomerase IV — primary target in Gram-positive bacteria. Inhibition prevents DNA supercoiling/uncoiling required for replication, transcription, and repair, producing bactericidal effect with concentration-dependent killing (AUC/MIC > 100 for Gram-negative). Excellent activity vs Pseudomonas aeruginosa (best of the older fluoroquinolones), Enterobacterales (including ESBLs in some regions), Haemophilus, intracellular pathogens (Legionella, Chlamydia), atypical mycobacteria, Bacillus anthracis. Modest Gram-positive activity (lower than later fluoroquinolones). Approximately 70% oral bioavailability — IV-to-PO step-down convenient. FDA-approved 1987. |
| Typical dosing | Severe Gram-negative infection (adult IV): 400 mg IV every 8-12 hours via 60-min infusion. Oral step-down or moderate infection: 500-750 mg PO every 12 hours. Outpatient febrile neutropenia (low-risk, IDSA): 750 mg PO q12h + amoxicillin-clavulanate 875 mg PO q12h. Pediatric (typically avoided due to arthropathy concern but used for plague, anthrax, complicated UTI): 10 mg/kg IV q12h, max 400 mg/dose. Renal adjustment: CrCl 30-50 → 250-500 mg PO q12h or 200-400 mg IV q12h; CrCl <30 → 250-500 mg PO q18-24h or 200-400 mg IV q18-24h; hemodialysis → dose post-dialysis. Hepatic: no adjustment. CRITICAL: separate from polyvalent cation chelators (antacids, iron, calcium, sucralfate, dairy) by ≥2 h... |
| Ukraine registered | True |
| NSZU reimbursed | True |
| Ukraine last verified | 2026-04-27 |
Warnings
- Tendinitis and tendon rupture (Achilles tendon most common; risk increased by age >60, corticosteroid use, organ transplantation; can occur weeks-months post-treatment)
- Peripheral neuropathy (can be permanent)
- CNS effects (toxic psychosis, seizures, anxiety, depression, suicidal ideation, confusion)
- Exacerbation of myasthenia gravis (life-threatening respiratory weakness)
- Aortic aneurysm and dissection (especially in elderly)
- Class warning: avoid in uncomplicated infections (sinusitis, bronchitis, uncomplicated UTI) where alternatives exist (FDA, EMA 2018)
Notes
Workhorse fluoroquinolone for Gram-negative + Pseudomonas. In oncology, the principal use is IV-to-PO step-down therapy after documented Gram-negative bacteremia / UTI / intra-abdominal infection responding to initial broad-spectrum, allowing earlier discharge. ALSO used for outpatient management of low-risk febrile neutropenia (MASCC score ≥21, no comorbidities, expected ANC recovery <7 days) with the IDSA-recommended ciprofloxacin + amoxicillin-clavulanate oral regimen. NOT used for FN prophylaxis — that role belongs to levofloxacin, which has better Gram-positive coverage (esp. viridans streptococci, a major mucositis-related bacteremia source). Class-wide FDA / EMA 2018 warning restricts fluoroquinolones to serious infections without alternatives — applies to ciprofloxacin. Polyvalent cation chelation is the most common cause of treatment failure with oral therapy — patient counselling critical. CYP1A2 inhibition causes major DDIs (tizanidine contraindicated; theophylline doubles). Ukraine: cheap, ubiquitous, NSZU-covered.
Used By
No reverse references found in the YAML corpus.