Susceptible infections, including lower respiratory tract, skin and skin structures, bone and joint, acute sinusitis, complicated intraabdominal (w. metronidazole), UTIs, chronic bacterial prostatitis. Postexposure prophylaxis and treatment of anthrax. Infectious diarrhea, typhoid fever, uncomplicated cervical and urethral gonorrhea: oral form only. Nosocomial pneumonia, empiric therapy in febrile neutropenia: IV form only.
See full labeling. Swallow tabs whole, do not chew microcapsules for susp. ≥18yrs: Sinusitis, typhoid fever: 500mg every 12 hrs for 10 days. Lower respiratory tract, skin and skin structure: 500–750mg every 12 hrs for 7–14 days. Intraabdominal (w. metronidazole): 500mg every 12 hrs for 7–14 days. Bone and joint: 500–750mg every 12 hrs for at least 4–6 weeks. Infectious diarrhea: 500mg every 12 hrs for 5–7 days. Acute uncomplicated cystitis due to E. coli, S. saprophyticus in females: 250mg every 12 hrs for 3 days (oral forms only). Other UTIs: 250–500mg every 12 hrs for 7–14 days. Prostatitis: 500mg every 12 hrs for 28 days. Gonorrhea: 250mg once. Postexposure prophylaxis of inhalational anthrax: 500mg every 12 hrs for 60 days (start as soon as possible after exposure). Treatment of inhalational, cutaneous, GI, or oropharyngeal anthrax: see CDC recommendations. Renal dysfunction (CrCl 30–50mL/min): 250–500mg every 12 hrs; (CrCl 5–29mL/min): 250–500mg every 18 hrs; hemo- or peritoneal dialysis: 250–500mg every 24 hrs (after dialysis).
<18yrs: usually not recommended. Swallow tabs whole, do not chew microcapsules for susp. 1–17yrs: Complicated UTIs or pyelonephritis: 10–20mg/kg (max 750mg) every 12 hrs for 10–21 days (see full labeling). Postexposure prophylaxis of inhalational anthrax: 15mg/kg (max 500mg/dose) every 12 hrs for 60 days (start as soon as possible after exposure). Treatment of inhalational, cutaneous, GI, or oropharyngeal anthrax: see CDC recommendations.
XR not interchangeable with other forms. Renal (except XR tabs for uncomplicated UTIs) or hepatic dysfunction: reduce dose. Increased risk of tendinitis or tendon rupture esp. in patients >60yrs, or those with kidney, heart or lung transplants. Discontinue if tendon pain, inflammation, or rupture occurs; if rash, phototoxicity, or other sign of hypersensitivity occurs; or if CNS disorders or neuropathy occurs. History of myasthenia gravis; avoid. Conditions that increase seizure risk. History of prolonged QT interval. Hypokalemia. History of joint-related disorders (esp. children). Maintain adequate hydration, avoid alkaline urine to avoid crystalluria. Avoid excessive sun and UV light. May mask symptoms of syphilis; test for syphilis before treating gonorrhea, then follow-up after 3 months. Monitor blood, renal, hepatic function in prolonged use. Elderly. Pregnancy (Cat.C), nursing mothers: usually not recommended.
Avoid theophylline (increases theophylline levels; may potentiate other CYP1A2 substrates), urinary alkalinizers; oral forms with antacids, calcium, iron, zinc, sucralfate, buffered forms of didanosine, other highly buffered drugs (may give ciprofloxacin 2 hrs before or 6 hrs after); high ciprofloxacin doses with NSAIDs (increases seizure risk). Potentiates caffeine. Potentiated by probenecid. Severe hypoglycemia with glyburide (rare). Increased serum creatinine with cyclosporine. Monitor methotrexate, oral anticoagulants (potentiation), phenytoin (variable effects). Increased risk of tendinitis and tendon rupture with corticosteroids. Caution with other drugs that lower seizure threshold. Increased risk of QT prolongation with Class IA or III antiarrhythmics. Reduced absorption with omeprazole (XR).
GI upset, headache, CNS disturbances (eg, convulsions, dizziness, nervousness, insomnia, nightmares, paranoia), rash, eosinophilia, elevated liver enzymes, photosensitivity, Stevens-Johnson syndrome, myalgia, tendinitis/rupture, joint-related disorders (children), local reactions (inj); rare: increased intracranial pressure, toxic psychosis; peripheral neuropathy, C. difficile-associated diarrhea.
See MMWR Vol 50, No.42 (Oct. 26, 2001) for more information on anthrax.
Tabs 250mg, 500mg—100; Oral Susp—100mL; Inj Conc (20mL, 40mL)—1; Infusion (100mL, 200mL)—1; XR Tabs—50, 100