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Ciprofloxacin (CIPRO) - Renal dosing

Usual Dosing (Adults)

(Oral): 250- 750mg q12h. 

(IV): 200-400 mg IV q12h. 
[Febrile neutropenia]: 400 mg IV q8h.


DOSAGE AND ADMINISTRATION – ADULTS
Ciprofloxacin injection should be administered to adults by intravenous infusion over a period of 60 minutes at dosages described in the Dosage Guidelines table. Slow infusion of a dilute solution into a larger vein will minimize patient discomfort and reduce the risk of venous irritation. (See Preparation of Ciprofloxacin Injection for Administration section.)

The determination of dosage for any particular patient must take into consideration the severity and nature of the infection, the susceptibility of the causative microorganism, the integrity of the patient’s host-defense mechanisms, and the status of renal and hepatic function.
ADULT DOSAGE GUIDELINES
Infection* Severity Dose Frequency Usual Duration
Urinary Tract Mild/Moderate 200 mg q12h 7-14 Days
  Severe/Complicated 400 mg q12h 7-14 Days
Lower Respiratory Mild/Moderate 400 mg q12h 7-14 Days
Tract Severe/Complicated 400 mg q8h 7-14 Days
Nosocomial Mild/Moderate/Severe 400 mg q8h 10-14 Days
Pneumonia        
Skin and Skin Mild/Moderate 400 mg q12h 7-14 Days
Structure Severe/Complicated 400 mg q8h 7-14 Days
Bone and Joint Mild/Moderate 400 mg q12h greater than or equal4-6 Weeks
  Severe/Complicated 400 mg q8h greater than or equal4-6 Weeks
Intra-Abdominal^ Complicated 400 mg q12h 7-14 Days
Acute Sinusitis Mild/Moderate 400 mg q12h 10 Days
Chronic Bacterial
Prostatitis
Mild/Moderate 400 mg q12h 28 Days
Empirical Therapy in
Febrile
Severe
Ciprofloxacin
400 mg q8h  
Neutropenic Patients         +
Piperacillin
50 mg/kg q4h 7-14 Days
    Not to exceed
24 g/day
   
Inhalational Anthrax
(Post-Exposure)^^
400 mg q12h 60 Days
*DUE TO THE DESIGNATED PATHOGENS
^used in conjunction with metronidazole. (See product labeling for prescribing information.)

^^Drug administration should begin as soon as possible after suspected or confirmed exposure. This indication is based on a surrogate endpoint, ciprofloxacin serum concentrations achieved in humans, reasonably likely to predict clinical benefit.4 For a discussion of ciprofloxacin serum concentrations in various human populations, see INHALATIONAL ANTHRAX — ADDITIONAL INFORMATION. Total duration of ciprofloxacin administration (IV or oral) for inhalational anthrax (post-exposure) is 60 days.


Ciprofloxacin injection should be administered by intravenous infusion over a period of 60 minutes.

Conversion of IV to Oral Dosing in Adults: Ciprofloxacin tablets and oral suspension for oral administration are available. Parenteral therapy may be switched to oral ciprofloxacin when the condition warrants, at the discretion of the physician.
Equivalent AUC Dosing Regimens
Ciprofloxacin Oral Dosage Equivalent Ciprofloxacin Injection Dosage
250 mg Tablet q 12 h 200 mg IV q 12 h
500 mg Tablet q 12 h 400 mg IV q 12 h
750 mg Tablet q 12 h 400 mg IV q 8 h

Renal Dosing

dialysis =================================
Manufacturer's recommendations
:
=================================
Oral, immediate release:
Clcr >50 mL/minute: No dosage adjustment necessary
Clcr 30-50 mL/minute: 250-500 mg every 12 hours
Clcr 5-29 mL/minute: 250-500 mg every 18 hours

ESRD on intermittent hemodialysis (IHD)/peritoneal dialysis (PD) (administer after dialysis on dialysis days): 250-500 mg every 24 hours
--------------------------------------
I.V.:
Clcr geq30 mL/minute: No dosage adjustment necessary
Clcr 5-29 mL/minute: 200-400 mg every 18-24 hours



=================================
Alternative strategy  (Drug Prescribing in Renal Failure):
=================================
Oral & IV:
Clcr >50 mL/minute: No dosage adjustment necessary

Clcr 10-50 mL/minute: Administer 50% to 75% of usual dose every 12 hours

Clcr <10 mL/minute: Administer 50% of usual dose every 12 hours.

Hemodialysis

dialysis See above:
(IV/): 200-400mg q24h or 200mg q12h. Schedule dose after dialysis on dialysis days. 

(Oral): 250mg q12h or 250-500mg q24h. Schedule dose after dialysis on dialysis days. 

Reference(s)

National Institutes of Health, U.S. National Library of Medicine, DailyMed Database.
Provides access to the latest drug monographs submitted to the Food and Drug Administration (FDA). Please review the latest applicable package insert for additional information and possible updates.  A local search option of this data can be found here.

Disclaimer

The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.   Read the disclaimer
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