ciprofloxacin Nursing Considerations & Management

 Drug Name

Generic Name : ciprofloxacin

Brand Name: Ciloxan, Cipro, Cipro HC Otic, Cipro I.V., Cipro XR, Co Ciprofloxacin (CAN), Proquin XR

Classification: Antibacterial, Fluoroquinolone

Pregnancy Category C

Dosage & Route
Adults
  • Uncomplicated UTIs: 100–250 mg PO q 12 hr for 3 days or 500 mg PO daily (ER tablets) for 3 days. Proquin XR—500 mg PO as a single dose.
  • Mild to moderate UTIs: 250 mg PO q 12 hr for 7–14 days or 200 mg IV q 12 hr for 7–14 days.
  • Complicated UTIs: 500 mg PO q 12 hr for 7–14 days or 400 mg IV q 12 hr or 1,000 mg (ER tablets) PO daily for 7–14 days.
  • Chronic bacterial prostatitis: 500 mg PO q 12 hr for 28 days or 400 mg IV q 12 hr for 28 days.
  • Infectious diarrhea: 500 mg q 12 hr PO for 5–7 days.
  • Anthrax postexposure: 500 mg PO q 12 hr for 60 days or 400 mg IV q 12 hr for 60 days.
  • Respiratory infections 500–750 mg PO q 12 hr or 400 mg IV q 8–12 hr for 7–14 days.
  • Acute sinusitis: 500 mg PO q 12 hr or 400 mg IV q 12 hr for 10 days.
  • Acute uncomplicated pyelonephritis: 1,000 mg ER tablets PO daily for 7–14 days.
  • Bone, joint, skin infections: 500–750 mg PO q 12 hr or 400 mg IV q 8–12 hr for 4–6 wk.
  • Nosocomial pneumonia: 400 mg IV q 8 hr for 10–14 days.
  • Ophthalmic infections caused by susceptible organisms not responsive to other therapy: 1 or 2 drops per eye daily or bid or 1/2 inch ribbon of ointment into conjunctival sac tid on first 2 days, then apply 1/2 inch ribbon bid for next 5 days.
  • Acute otitis externa: 4 drops in infected ear, tid–qid.
Pediatric Patients
  • Not recommended; produced lesions of joint cartilage in immature experimental animals.
  • Inhalational anthrax: 15 mg/kg/dose PO q 12 hr for 60 days or 10 mg/kg/dose IV q 12 hr for 60 days; do not exceed 500 mg/dose PO or 400 mg/dose IV.
Geriatric Patients or Patients with Impaired Renal Function
  • For creatinine clearance of 30–50 mL/min, give 250–500 mg PO q 12 hr. For creatinine clearance of 5–29 mL/min, give 250–500 mg PO q 18 hr or 200–400 mg IV q 18–24 hr. For patients on hemodialysis, give 250–500 mg q 24 hr, after dialysis.
Therapeutic actions
  • Ciprofloxacin promotes breakage of double-stranded DNA in susceptible organisms and inhibits DNA gyrase, which is essential in reproduction of bacterial DNA.
Indications
  • For the treatment of infections caused by susceptible gram-negative bacteria, including Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, Enterobacter cloacae, Proteus vulgaris, Proteus rettgeri, Morganella morganii, Pseudomonas aeruginosa, Citrobacter freundii, Staphylococcus aureus, Staphylococcus epidermidis, group D streptococci
  • Treatment of uncomplicated UTIs caused by E. coli, K. pneumoniae as a one-time dose in patients at low risk of nausea, diarrhea (Proquin XR)
  • Otic: Treatment of acute otitis externa
  • Treatment of chronic bacterial prostatitis
  • IV: Treatment of nosocomial pneumonia caused by Haemophilus influenza, K. pneumoniae
  • Oral: Typhoid fever
  • Oral: STDs caused by Neisseria gonorrhea
  • Prevention of anthrax following exposure to anthrax bacilla (prophylactic use in regions suspected of using germ warfare)
  • Acute sinusitis caused by H. influenzae, Streptococcus pneumoniae, or Moraxella catarrhalis
  • Lower respiratory tract infections: Caused by E. Coli, Klebsiella, Enterobacter species, P. mirabilis, P. aeruginosa, H. influenzae, Haemophilia parainfluenza, S. pneumoniae
  • Unlabeled use: Effective in patients with cystic fibrosis who have pulmonary exacerbations
Adverse effects
  • GI disturbances; headache, tremor, confusion, convulsions; rashes; joint pain; phototoxicity. Transient increases in serum creatinine. Hematological, hepatic and renal disturbances. Vasculitis, pseudomembranous colitis and tachycardia. Phototoxicity.
  • Potentially Fatal: Anaphylactoid reaction; cardiopulmonary arrest.
Contraindications
  • Hypersensitivity. Not to be used concurrently with tizanidine. Avoid exposure to strong sunlight or sun lamps during treatment.
Nursing considerations
Assessment
  • History: Allergy to ciprofloxacin, norfloxacin or other quinolones; renal dysfunction; seizures; lactation
  • Physical: Skin color, lesions; T; orientation, reflexes, affect; mucous membranes, bowel sounds; LFTs, renal function tests
Interventions
  • Arrange for culture and sensitivity tests before beginning therapy.
  • Continue therapy for 2 days after signs and symptoms of infection are gone.
  • Be aware that Proquin XR is not interchangeable with other forms.
  • Ensure that the patient swallows ER tablets whole; do not cut, crush, or chew.
  • Ensure that patient is well hydrated.
  • Give antacids at least 2 hr after dosing.
  • Monitor clinical response; if no improvement is seen or a relapse occurs, repeat culture and sensitivity.
  • Encourage patient to complete full course of therapy.
Teaching points
  • If an antacid is needed, take it at least 2 hours before or after dose.
  • Take Proquin XR with the main meal of the day.
  • Do not touch tip of eye ointment or solution for this may contaminate the product.
  • Drink plenty of fluids while you are taking this drug.
  • You may experience these side effects: Nausea, vomiting, abdominal pain (eat frequent small meals); diarrhea or constipation; drowsiness, blurring of vision, dizziness (observe caution if driving or using dangerous equipment).
  • Report rash, visual changes, severe GI problems, weakness, tremors.