Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

Pediatrics:** (not approved for children < 18 years) 20 - 30 mg/kg/day PO/IV in divided doses Q12H; PO dose not toexceed 1500 mg/day and IV dose not to exceed 800 mg/day.Indications1. Pyelonephritis or prostatitis, especially if the Gram-negative organisms are known or likely to be resistant to ampicillinand/or trimethoprim/sulfamethoxazole.2. Pseudomonas aeruginosa or other Gram-negative infections with presumed or documented susceptibility tociprofloxacin. In sites other than the urinary tract, higher doses are employed and usually used in combination with a betalactamantibiotic.3. Severe enteric infections with Salmonella, Shigella, Campylobacter or toxigenic Escherichia coli.4. Gram-negative osteomyelitis.5. Open, massively contaminated fractures, where Gram-negative contamination is likely.6. Mycobacterium avium complex infections as part of a multi-drug regimen.7. Legionella/atypical pneumonia organisms.8. Meningococcal prophylaxis (500 mg PO single dose). Drug of choice.9. Neutropenic fever – empiric therapy in the outpatient setting.10. Traveler’s diarrhea treatment.CommentsDose adjustment required for renal impairment. See renal dosing guideline on uconnect.Oral ciprofloxacin has excellent bioavailability and is much less expensive than the IV form. The intravenousformulation should be reserved for treating known or strongly suspected pseudomonal or severe Gram-negativeinfections. An IV-to-oral conversion policy exists at UW, and physicians and pharmacists are encouraged to steppatients down from IV to oral therapy when the infection seems contained and the patient is taking other medication andfood orally.IV DosePO Dose200 mg Q 12 hours 250 mg Q 12 hours400 mg Q 12 hours 500 mg Q 12 hours400 mg Q 8 hours 750 mg Q 12 hoursUse of quinolones is generally contraindicated in children 60, steroid use, and kidney, heart or lung transplantation. Doses of 750 mg PO BID or400 mg IV Q8H are needed only for Gram-negative bacillus osteomyelitis, serious Pseudomonas aeruginosa or otherGram-negative infections, or Mycobacterium avium complex. Not indicated for anaerobic or known streptococcalinfections. Ciprofloxacin should not be used for treatment of methicillin-resistant staphylococcal infections regardless ofspecies; reports of therapeutic failures and rapid development of Staphylococcus aureus resistance have been published.Ciprofloxacin may not be effective for S pneumoniae infections. Ciprofloxacin should not be used for uncomplicated UTIsunless due to Pseudomonas or organisms resistant to TMP/sulfa or ampicillin. Use of ciprofloxacin should be limited tothe listed indications because of concerns regarding emergence of resistant strains. See IV-to-PO conversion policy(Appendix F) or on uconnect. Dose adjustment required for renal impairment. See renal dosing guideline on uconnect.Drug InteractionsThe following drugs have serum levels that are increased by ciprofloxacin’s inhibition of CYP1A2 or 3A4-mediatedmetabolism:-Alosetron-Erlotinib-Bendamustine-Olanzapine-Caffeine-Rasagiline-Clozapine-Ropinirole-Cyclosporine-Ropivacaine-Duloxetine-Simvastatin