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Ciprofloxacin is an antibiotic agent in the fluoroquinolone class used to treat bacterial infections such as urinary tract infections and pneumonia. Ciprofloxacin has FDA approval to treat urinary tract infections, sexually transmitted infections (gonorrhea and chancroid), skin, bone, joint infections, prostatitis, typhoid fever, gastrointestinal infections, lower respiratory tract infections, anthrax, plague, and salmonellosis. In addition, ciprofloxacin is an appropriate treatment option in patients with mixed infections or patients with predisposing factors for Gram-negative infections. This activity covers ciprofloxacin, a broad-spectrum quinolone antibiotic that members of the interprofessional team need to review its indications, coverage, contraindications, and adverse event profile to optimally manage patients' infectious diseases. Objectives: Identify the mechanism of action of ciprofloxacin. Summarize the types of infections and bacterial coverage of ciprofloxacin and where it would be effective in a target population. Recognize the potential adverse events associated with ciprofloxacin therapy. Review the importance of improving care coordination amongst interprofessional team members to improve outcomes for patients with an infectious disease that would respond to ciprofloxacin therapy. Access free multiple choice questions on this topic.

The elimination half-life of ciprofloxacin ranges from 3.3 to 6.8 hours in the elderly compared with three to four hours in younger persons.[53] There is limited evidence suggesting ciprofloxacin excretion in breast milk.[54]. Clinical data indicate no significant evidence of osteoarticular toxicity in newborns and children. In these studies, the drug exposure of neonates and children was at much higher doses compared to children whose exposure was via breastfeeding.[14] Acute kidney injury following ciprofloxacin overdose has been reported. There is no specific antidote to ciprofloxacin overdose. Consider using magnesium and calcium-containing antacids to reduce the oral absorption of ciprofloxacin. Consider intermittent hemodialysis for ciprofloxacin-induced nephrotoxicity.[55][56]

Ciprofloxacin can be less costly and more cost-effective than traditional parenteral regimens in selected clinical settings with appropriate use. Additional well-designed studies would be helpful in further defining the most cost-efficient use of this antimicrobial agent. However, in E. coli-associated urinary tract infections, there has been an increase in ciprofloxacin resistance, more so in the hospital versus the community setting.[22] Evaluation of the use of ciprofloxacin as empiric therapy should be on a case-by-case basis. Ciprofloxacin is a common antibiotic prescribed and usually well-tolerated. Interprofessional health care team members must use antibiotics as targeted therapy, effectively managing infections and conferring a societal benefit in addressing drug-resistant microbes. Clinicians need to consider that the drug's pharmacokinetics can undergo alteration in patients with renal or hepatic dysfunction and order the tests to monitor patient status when used for a prolonged period. Pharmacists can review the antibiogram and verify the dosing and duration of ciprofloxacin. Nursing can counsel the patient on taking the medication, monitor patient compliance and therapeutic effectiveness, answer any questions, and report any concerns to the prescriber. Ciprofloxacin therapy requires the collaborative approach of an interprofessional healthcare team, including infectious disease specialists, clinicians (MD, DO, NP, PA), pharmacists, and specialty-trained nurses working together to achieve optimal patient outcomes. All team members must be vigilant for adverse events or therapeutic failure and immediately report any patient status changes to other team members. A study shows that hospital-based antimicrobial stewardship interventions are associated with fewer fluoroquinolone (including ciprofloxacin) prescriptions during hospitalization.[57] [Level 3]