Ciprofloxacin
Class
Quinolone
Dose
400mg (IV) q8h
500-750mg (po) bd (step-down)
Mechanism
Bacteristatic & Bactericidal
MoA
Inhibits DNA gyrase enzymes
Promotes breakage of DNA
Time v Concentration
Combination concentration and time dependent killing
Post dose effect
Spectrum
Covers
Doesn't Cover
Most G -ve including Pseudomonas
Atypicals including Legionella
Anaerobes
Indications
Intra-abdominal (with Metronidazole)
Expansion of G -ve cover in setting of renal impairment/allergy where other drugs cannot be used (ie Aminoglycosides)
PK
A
70% OBA. Delayed by food
D
20% PPB
M
4 metabolites, probably hepatic
E
Renal excretion of metabolites
A/E
CNS – headache, insomnia, dizziness, hallucinations
Renal – interstitial nephritis
CVS – QTC prolongation, TdP, arrhythmias
GI – C Diff
Skin – toxic epidermal necrolysis
Drug Interaction – with warfarin, increases PT
MSK – long term use assosciated with msk toxicity particularly to cartilage ie AAA, spontaneous tendon rupture
Resistance
Can evolve on therapy
Monitoring
ECG (QT)