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  • 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 recommended for perforation since non-sterile preparation
  • Ciprodex: 4 drops in affected ear BID x 7 days
    • Similar to Cipro HC but contains dexamethasone
    • Safe with perforation
    • More expensive and 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


  • 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



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

Antibiotic Sensitivities[3]

Group Organism Sensitivity
Gram Positive Strep. Group A, B, C, G I
Strep. Pneumoniae I
Viridans strep R
Strep. anginosus gp R
Enterococcus faecalis U
Enterococcus faecium R
Staph. Epidermidis S
C. jeikeium R
L. monocytogenes S
Gram Negatives N. gonorrhoeae I
N. meningitidis S
Moraxella catarrhalis S
H. influenzae S
E. coli S
Klebsiella sp S
E. coli/Klebsiella ESBL+ S
E coli/Klebsiella KPC+ R
Enterobacter sp, AmpC neg S
Enterobacter sp, AmpC pos S
Serratia sp S
Serratia marcescens X1
Salmonella sp S
Shigella sp S
Proteus mirabilis S
Proteus vulgaris S
Providencia sp. S
Morganella sp. S
Citrobacter freundii S
Citrobacter diversus S
Citrobacter sp. S
Aeromonas sp S
Acinetobacter sp. I
Pseudomonas aeruginosa S
Burkholderia cepacia R
Stenotrophomonas maltophilia R
Yersinia enterocolitica S
Francisella tularensis X1
Brucella sp. X1
Legionella sp. S
Pasteurella multocida S
Haemophilus ducreyi X1
Vibrio vulnificus X1
Misc Chlamydophila sp S
Mycoplasm pneumoniae S
Rickettsia sp X1
Mycobacterium avium X1
Anaerobes Actinomyces R
Bacteroides fragilis R
Prevotella melaninogenica R
Clostridium difficile R
Clostridium (not difficile) I
Fusobacterium necrophorum X1
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