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Mild/moderate: 500 mg PO q12hr or 400 mg IV q12hr for 7-14 days Severe/complicated: 750 mg PO q12hr or 400 mg IV q8hr for 7-14 days Limitations-of-use: Reserve fluoroquinolones for patients who do not have other available treatment options for acute bacterial exacerbation of chronic bronchitis Acute uncomplicated: Immediate-release, 250 mg PO q12hr for 3 days; extended-release, 500 mg PO q24hr for 3 days Mild/moderate: 250 mg PO q12hr or 200 mg IV q12hr for 7-14 days Severe/complicated: 500 mg PO q12hr or 400 mg IV q12hr for 7-14 days Limitations-of-use: Reserve fluoroquinolones for patients who do not have other available treatment options for uncomplicated urinary tract infections Dry powder for inhalation: Orphan desnation for patients with NCFB who suffer from frequent severe acute pulmonary bacterial exacerbations which lead to further inflammation, airway, and lung parenchyma damage Indication for treatment and prophylaxis of plague due to Yersinia pestis in pediatric patients from birth to 17 years of age 15 mg/kg PO q8-12hr x10-21 days; not to exceed 500 mg/dose, OR 10 mg/kg IV q8-12hr x 10-21 days; not to exceed 400 mg/dose Postexposure therapy IV: 10 mg/kg q12hr for 60 days; individual dose not to exceed 400 mg PO: 15 mg/kg q12hr for 60 days; individual dose not to exceed 500 mg Change antibiotic to amoxicillin as soon as penicillin susceptibility confirmed Nausea (3%) Abdominal pain (2%) Diarrhea (2% adults; 5% children) Increased aminotransferase levels (2%) Vomiting (1% adults; 5% children) Headache (1%) Increased serum creatinine (1%) Rash (2%) Restlessness (1%) Acidosis Allergic reaction Angina pectoris Anorexia Arthralgia Ataxia Back pain Bad taste Blurred vision Breast pain Bronchospasm Diplopia Dizziness Drowsiness Dysphagia Dyspnea Flushing Foot pain Hallucinations Hiccups Hypertension Hypotension Insomnia Irritability Joint stiffness Lethargy Mraine Nephritis Nhtmares Oral candidiasis Palpitation Photosensitivity Polyuria Syncope Tachycardia Tinnitus Tremor Urinary retention Vaginitis Acute generalized exanthematous pustulosis (AGEP), erythema multiforme, exfoliative dermatitis, fixed eruption, photosensitivity/phototoxicity reaction Agitation, confusion, delirium Agranulocytosis, albuminuria, serum cholesterol and TG elevations, blood glucose elevation, hemolytic anemia, marrow depression (life threatening), pancytopenia (life threatening or fatal outcome), potassium elevation (serum) Anaphylactic reactions (including life-threatening anaphylactic shock), serum sickness like reaction, Stevens-Johnson syndrome Anosmia, hypesthesia Constipation, dyspepsia, dysphagia, flatulence, hepatic failure (including fatal cases), hepatic necrosis, jaundice, pancreatitis Hypertonia, hypotension (postural), increased INR (in patients treated with Vitamin K antagonists), QT prolongation, torsade de pointes, ventricular arrhythmia Methemoglobinemia Myasthenia, exacerbation of myasthenia gravis, myoclonus, nystagmus, peripheral neuropathy that may be irreversible, phenytoin alteration (serum), polyneuropathy, psychosis Myalgia, tendinitis, tendon rupture, toxic epidermal necrolysis (Lyell’s Syndrome), twitching Infections: Candiduria, vaginal candidiasis, moniliasis (oral, gastrointestinal, vaginal), pseudomembranous colitis Renal calculi Vasculitis Fluoroquinolones have been associated with disabling and potentially irreversible serious adverse reactions that have occurred together including: tendinitis and tendon rupture, peripheral neuropathy, and CNS effects Discontinue the drug immediately and avoid use of systemic fluoroquinolones in patients who experience any of these serious adverse reactions May exacerbate muscle weakness in patients with myasthenia gravis; avoid fluoroquinolones with known history of myasthenia gravis Use in pregnancy, though generally contraindicated for all quinolones, is allowed for life-threatening situations; limited data from use of ciprofloxacin in pregnancy show no hher rate of birth defects than background Do not use oral suspension in nasogastric tube; to prepare, add microcapsules to diluent No longer recommended for gonorrhea in United States, because of widespread resistance Commonly seen adverse reactions include tendinitis, tendon rupture, arthralgia, myalgia, peripheral neuropathy, and central nervous system effects (hallucinations, anxiety, depression, insomnia, severe headaches, and confusion); these reactions can occur within hours to weeks after starting therapy, including in patients of any age or without pre-existing risk factors; discontinue therapy immediately at first sns or symptoms of any serious adverse reaction; in addition, avoid use of fluoroquinolones, in patients who have experienced any serious adverse reactions associated with fluoroquinolones Peripheral neuropathy: Sensory or sensorimotor axonal polyneuropathy affecting small and/or large axons resulting in paresthesias, hypoesthesias, dysesthesias, and weakness reported; peripheral neuropathy may occur rapidly after initiating and may potentially become permanent In prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); adjust dose in renal impairment; superinfections may occur with prolonged or repeated antibiotic therapy; discontinue use immediately if sns and symptoms of hepatitis occur Not drug of first choice in pediatrics (except in anthrax), because of increased incidence of adverse events in comparison with control subjects, including arthropathy; no data exist on dosing for pediatric patients with renal impairment (ie, Cr Cl 60 years); in patients taking corticosteroids; and in kidney, heart, or lung transplant recipients; discontinue therapy immediately at first sns or symptoms of any serious adverse reaction; in addition, avoid use of fluoroquinolones, in patients who have experienced any serious adverse reactions associated with fluoroquinolones Convulsions, increased intracranial pressure (including pseudotumor cerebri), and toxic psychosis are reported with fluoroquinolones; psychotic reactions have progressed to suicidal ideations or thoughts and self-injurious behavior Avoid IV administration in patients who have known QT prolongation, carry risk factors for prolonged QT, or are taking class 1A or class III antiarrhythmic drugs Crystalluria may occur; urine alkalinity may increase risk; ensure adequate hydration during therapy Serious and sometimes fatal hypoglycemia reported with fluoroquinolone use; hyperglycemia also reported; monitor patients closely for sns/symptoms of abnormal glucose levels Moderate-to-severe phototoxicity reactions reported; avoid excessive sunlht and take precautions to limit exposure; discontinue use if phototoxicity occurs Use with caution in patients with history of seizures taking concurrent therapy that lowers seizure threshold; risk increases rarely when administered concomitantly with NSAIDs Acute onset of retinal detachment increased 4.5-fold with oral fluoroquinolones in a single case-controlled study - JAMA 2012;307(13):1414-1419; another study disputes these findings (relative risk, 1.29) - JAMA 2013;310(20):2184-2190 Serious and fatal reactions have reported in patients receiving concurrent administration of ciprofloxacin and theophylline; if concomitant use cannot be avoided, monitor serum levels of theophylline and adjust dosage as appropriate Clostridium difficile-associated diarrhea (CDAD) has been reported; if CDAD suspected or confirmed, ongoing antibiotic use not directed against C.

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