• Type: Fluoroquinolones
  • Dosage Forms: IV; PO (Standard: 100, 250, 500; ER 500, 1000)
  • Common Trade Names: Cipro, Ciloxan (ophthalmic)

Given the multiple adverse effects listed below, there has been a recent move away from prescribing this and other fluoroquinolones as first line antibiotics for many indications (such as UTI or pneumonia).

Adult Dosing


  • PO
    • 250-750mg PO q12h
    • First Dose: 250-750mg PO x1
  • IV
    • 200-400mg IV q12
    • First Dose: 400mg IV x 1
    • Alt: 400mg IV q8h


  • Uncomplicated
    • 500mg ER PO q24h x 3 days
    • Alt: 250mg PO q12h x 3 days
  • Complicated
    • IV: 400mg IV q12h x 7-14 days
    • PO: 1000mg ER PO q24h x 7-14 days
      • Alt: 500mg PO q12h x 7-14 days


  • Inhalational, GI, Oropharyngeal
    • 400mg IV q12h OR 500mg PO q12 x 60 days
    • First dose: 400mg IV + 1-2 additional antibiotics
  • Cutaneous
    • 400mg IV q12h OR 500mg PO q12 x 7-10 days
    • Info: Give x 60 days if bioterrorism suspected
  • Post-Exposure Prophylaxis
    • 500mg PO q12h x 60 days (or exposure excluded)

Traveler's Diarrhea[1]

  • 750mg PO BID x 1-3 days

Typhoid Fever

  • 500mg PO q12h x 2 weeks


  • 500mg PO q12h x 3 days


  • Acute
    • 500-750mg PO q12h x 3-7 days
    • Extend treatment x 1 week if immunocompromised
  • Chronic Carrier
    • 750mg PO q12h x 1 month

Otitis externa

  • Cipro HC otic: 3 drops in affected ear BID x 7 days
    • Contains hydrocortisone
    • Not safe with perforation
  • Ciprodex: 4 drops in affected ear BID x 7 days
    • Similar to cipro HC but contains dexamethasone
    • Not safe with perforation
    • Not covered by many insurance companies

Pediatric Dosing


  • PO
    • 20-30mg/kg/day PO divided q12h
    • First Dose: 10-15mg/kg PO x 1
    • Max: 750mg/dose PO
  • IV
    • 15-30mg/kg/day IV divided q8-12h
    • First Dose: 5-15mg/kg IV x 1
    • Max: 400mg/dose IV


Max (All): 400mg/dose IV or 500mg/dose PO

  • Inhalational, GI, Oropharyngeal
    • 20-30mg/kg/day IV/PO divided q12h x 60 days
    • First Dose: 10-15mg/kg IV x 1 (give with 1-2 additional antibiotics)
  • Cutaneous
    • 20-30mg/kg/day IV/PO divided q12h x 7-10 days
    • First Dose: 10-15mg/kg IV/PO x 1
    • Info: Give x 60 days if bioterrorism suspected
  • Post-Exposure Prophylaxis
    • 20-30mg/kg/day PO divided q12h x 60 days (or exposure excluded)
    • First Dose: 10-15mg/kg PO x 1

UTI, Complicated (1-17 Years Old)

Not first line given adverse effects

  • IV
    • 6-10mg/kg IV q8h
    • First Dose:
    • Max: 400mg/dose IV
  • PO
    • 10-20mg/kg PO q12h
    • First Dose:
    • Max: 750mg/dose PO

Special Populations

  • Drug ratings in pregnancy: C (but indicated for anthrax)
  • Lactation risk categories: Probably safe
  • Renal Dosing
    • Adult: renal impairment less than creatinine clearance 30 mL/min, q24hrs instead of q12hrs
    • Pediatric
  • Hepatic Dosing - no dose adjustments needed


  • Allergy to class/drug
  • Administration with Tizanidine

Adverse Reactions


  • Prolonged QT interval and Syncope/Torsades de pointes
  • Photosensitivity
  • Stevens-Johnson syndrome/Toxic epidermal necrolysis
  • Clostridium difficile diarrhea, Pseudomembranous enterocolitis
  • Tendonitis or tendon rupture (black box warning) - increased risk in age >60, immunosuppressed, corticosteroid use
  • peripheral neuropathy
  • severe hypoglycemia [2]
  • mental health effects


  • Rash
  • Diarrhea/Nausea/Vomiting


  • Half-life: 4 hours
  • Metabolism: Liver
  • Excretion: Urine, Feces
  • Mechanism of Action: Bactericidal. Inhibits DNA gyrase

Antibiotic Sensitivities[3]

Group Organism Sensitivity
Gram PositiveStrep. Group A, B, C, GI
Strep. PneumoniaeI
Viridans strepR
Strep. anginosus gpR
Enterococcus faecalisU
Enterococcus faeciumR
Staph. EpidermidisS
C. jeikeiumR
L. monocytogenesS
Gram NegativesN. gonorrhoeaeI
N. meningitidisS
Moraxella catarrhalisS
H. influenzaeS
E. coliS
Klebsiella spS
E. coli/Klebsiella ESBL+S
E coli/Klebsiella KPC+R
Enterobacter sp, AmpC negS
Enterobacter sp, AmpC posS
Serratia spS
Serratia marcescensX1
Salmonella spS
Shigella spS
Proteus mirabilisS
Proteus vulgarisS
Providencia sp.S
Morganella sp.S
Citrobacter freundiiS
Citrobacter diversusS
Citrobacter sp.S
Aeromonas spS
Acinetobacter sp.I
Pseudomonas aeruginosaS
Burkholderia cepaciaR
Stenotrophomonas maltophiliaR
Yersinia enterocoliticaS
Francisella tularensisX1
Brucella sp.X1
Legionella sp.S
Pasteurella multocidaS
Haemophilus ducreyiX1
Vibrio vulnificusX1
MiscChlamydophila spS
Mycoplasm pneumoniaeS
Rickettsia spX1
Mycobacterium aviumX1
Bacteroides fragilisR
Prevotella melaninogenicaR
Clostridium difficileR
Clostridium (not difficile)I
Fusobacterium necrophorumX1
Peptostreptococcus sp.I


  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also


  1. Sanford 2014
  2. FDA updates warnings for fluoroquinolone antibiotics on risks of mental health and low blood sugar adverse reactions. US Food and Drug Administration. Updated July 10, 2018. Accessed Oct 22, 2018.
  3. Sanford Guide to Antimicrobial Therapy 2014
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