Name /bks_53161_deglins_md_disk/ciprofloxacin
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Cipro, Cipro XR
Classification
Therapeutic: anti-infectives
Pharmacologic: fluoroquinolones
Pregnancy Category C
Indications
PO, IV: Treatment of the following bacterial infections: Urinary tract and gynecologic
infections, including cystitis, and prostatitis, Respiratory tract infections including
acute sinusitis, acute exacerbations of chronic bronchitis, and pneumonia, Skin and
skin structure infections , Bone and joint infections , Infectious diarrhea , Complicated intra-abdominal infections (with metronidazole), Typhoid fever. Post-exposure prophylaxis of inhalational anthrax. Cutaneous anthrax. Unlabeled Use: Febrile neutropenia. Acute pulmonary exacerbations in cystic fibrosis.
Action
Inhibits bacterial DNA synthesis by inhibiting DNA gyrase enzyme. Therapeutic Effects: Death of susceptible bacteria. Spectrum: Active against gram-positive pathogens, including: Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus, Streptococcus pyogenes, Streptococcus pneumoniae,
Enterococcus faecalis, Bacillus anthracis (anthrax). Gram-negative spectrum notable for activity against: Escherichia coli, Klebsiella pneumoniae, Enterobacter
cloacae, Salmonella typhi, Shigella spp, Proteus mirabilis, Proteus vulgaris, Providencia stuartii, Providencia rettgeri, Morganella morganii, Pseudomonas aeruginosa, Serratia marcescens, Haemophilus influenzae, Moraxella catarrhalis,
Campylobacter jejuni.
Pharmacokinetics
Absorption: 70% absorbed after oral administration; IV administration results in
complete bioavailability.
Distribution: Widely distributed. High tissue and urinary levels are achieved.
Crosses the placenta; enters breast milk.
Protein Binding: 20– 40%.
⫽ Genetic Implication.
pg 1 # 1
Metabolism and Excretion: — 15% metabolized by the liver, 40– 50% excreted unchanged by the kidneys.
Half-life: 4 hr.
TIME/ACTION PROFILE (blood levels)
ciprofloxacin (sip-roe-flox-a-sin)
⫽ Canadian drug name.
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ROUTE
ONSET
PEAK
DURATION
PO
PO-ER
IV
rapid
rapid
rapid
1–2 hr
1–4 hr
end of infusion
12 hr
24 hr
12 hr
Contraindications/Precautions
Contraindicated in: Hypersensitivity (cross-sensitivity within class may exist);
History of myasthenia gravis (may worsen symptoms including muscle weakness and
breathing problems); Use with tizanidine; OB: Do not use unless potential benefit
outweighs potential fetal risk; Pedi: Use only if no alternatives in children 1– 17
years due to possible arthropathy.
Use Cautiously in: Known or suspected CNS disorder; Renal impairment (dosep
if CCr ⱕ50 mL/min); Concurrent use of corticosteroids (qrisk of tendinitis/tendon
rupture); Kidney, heart, or lung transplant patients (qrisk of tendinitis/tendon rupture); Patients with history of or at risk for QTc prolongation, may prolong QTc interval; Lactation: Safety not established except for treatment of anthrax; Geri:qrisk of
adverse reactions.
Adverse Reactions/Side Effects
CNS: ELEVATED INTRACRANIAL PRESSURE (including pseudotumor cerebri), SEIZURES,
agitation, confusion, depression, dizziness, drowsiness, hallucinations, headache,
insomnia, nightmares, paranoia, tremor. GI: HEPATOTOXICITY, PSEUDOMEMBRANOUS
COLITIS, abdominal pain, diarrhea, nausea,qliver enzymes. GU: vaginitis. Derm:
photosensitivity, rash. Endo: hyperglycemia, hypoglycemia. Hemat: eosinophilia.
Local: phlebitis at IV site. MS: tendinitis, tendon rupture. Neuro: peripheral neuropathy. Misc: hypersensitivity reactions including — ANAPHYLAXIS.
Interactions
Drug-Drug: Concurrent use with theophylline may result inqtheophylline
concentrations and therefore serious and potentially fatal reactions due to theophylline toxicity; if concurrent use cannot be avoided serum theophylline levels should be
monitored. Administration with antacids, iron salts, bismuth subsalicylate, su-
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
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Name /bks_53161_deglins_md_disk/ciprofloxacin
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cralfate, and zinc saltspabsorption. May alter the effects of warfarin. Mayplevels
and effectiveness of phenytoin. Serum levels may bepby antineoplastics . Cimetidine may interfere with elimination . Beneficial effects may be antagonized by nitrofurantoin. Probenecidprenal elimination. Mayqrisk of nephrotoxicity from cyclosporine. Concurrent use with foscarnet mayqrisk of seizures. Concurrent
therapy with corticosteroids mayqrisk of tendon rupture. Maypmetabolism of tizanidine, use contraindicated.
Drug-Natural Products: Fennelpbioavailability.
Drug-Food: Absorption is impaired by concurrent enteral feeding (because of
metal cations). Absorption ispby food and/or dairy products (take 1 hr before or
2 hr after).
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pg 2 # 2
PO, IV (Children): 10 mg/kg q 12 hr IV (maximum: 400 mg/dose), change to 15
mg/kg PO q 12 hr (maximum: 500 mg/dose) when clinically appropriate for a total of
60 days; one or two other anti-infectives may be added initially, depending on clinical
situation.
Cutaneous anthrax
PO (Adults): 500 mg twice daily for 60 days; some patients may require intravenous
therapy initially depending on clinical situation (for IV dose see inhalational anthrax
above).
PO (Children): 10– 15 mg/kg q 12 hr for 60 days (maximum: 1 g/day); some patients may require intravenous therapy initially depending on clinical situation (for IV
dose see inhalational anthrax above).
Cystic Fibrosis
Route/Dosage
Most infections
PO (Children 5– 17 yrs): 20 mg/kg q 12 hr.
IV (Children 5– 17 yrs): 15 mg/kg q 8 hr for 1 week followed by oral therapy.
PO (Adults): 500– 750 mg q 12 hr.
IV (Adults): 400 mg q 12 hr.
NURSING IMPLICATIONS
Assessment
Renal Impairment
PO (Adults): CCr 30– 50 mL/min— 250– 500 mg q 12 hr; CCr 5– 29 mL/min—
250– 500 mg q 18 hr; Hemodialysis or peritoneal dialysis— 250– 500 mg q 24 hr.
Renal Impairment
IV (Adults): CCr 5– 29 mL/min— 200– 400 mg q 18– 24 hr.
● Assess for infection (vital signs; appearance of wound, sputum, urine, and stool;
●
Urinary tract infections
●
PO (Adults): 250– 500 mg q 12 hr; or 1000 mg q 24 hr for 10– 14 days as extended-release tablets. Uncomplicated urinary tract infections— 100 mg q 12 hr
for 3 days or 500 mg q 24 hr for 3 days as extended-release tablets.
PO (Children 1– 17 yr): Complicated urinary tract infections— 10– 15 mg/kg
every 12 hr (not to exceed 750 mg/dose)for 10– 21 days.
IV (Adults): 200 mg q 12 hr .
IV (Children 1– 17 yr): Complicated urinary tract infections— 6– 10 mg/kg
every 8 hr (not to exceed 400 mg/dose)for 10– 21 days.
●
Inhalational Anthrax
PO, IV (Adults): 400 mg q 12 hr IV, change to 500 mg PO twice daily when clinically
appropriate for a total of 60 days; one or two other anti-infectives may be added initially, depending on clinical situation.
●
WBC; urinalysis; frequency and urgency of urination; cloudy or foul-smelling
urine) at beginning of and throughout therapy.
Obtain specimens for culture and sensitivity before initiating therapy. First dose
may be given before receiving results.
Observe for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue drug and notify health care professional immediately if these problems occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in case of an
anaphylactic reaction.
Monitor bowel function. Diarrhea, abdominal cramping, fever, and
bloody stools should be reported to health care professional promptly
as a sign of pseudomembranous colitis. May begin up to several weeks
following cessation of therapy.
Lab Test Considerations: May causeqserum AST, ALT, LDH, bilirubin, and alkaline phosphatase. May also causeqorpserum glucose.
Potential Nursing Diagnoses
Risk for infection (Patient/Family Teaching)
䉷 2015 F.A. Davis Company
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CONTINUED
ciprofloxacin
Implementation
● PO: Administer on an empty stomach 1 hr before or 2 hr after meals, with a full
glass of water. Products or foods containing calcium, magnesium, aluminum,
iron, or zinc should not be ingested for 4 hr before and 2 hr after administration. If
gastric irritation occurs, ciprofloxacin may be administered with meals. Food
slows and may slightly decrease absorption. Regular tablets can be crushed for patients unable to swallow. Extended-release (XR) tablets should be swallowed
whole; do not split, crush, or chew. Do not administer 5% or 10% oral solution
through an enteral feeding tube or with enteral feedings; may decrease absorption.
days at refrigerated or room temperature. Concentration: 1– 2 mg/mL. Rate:
Administer over 60 min into a large vein to minimize venous irritation.
● Y-Site Compatibility: alemtuzumab, amifostine, amiodarone, anakinra, anidulafungin, argatroban, aztreonam, bivalirudin, bleomycin, calcium gluconate, carboplatin, carmustine, caspofungin, ceftaroline, ceftazidime, cisatracurium, cisplatin, cyclophosphamide, cytarabine, dactinomycin, daptomycin,
dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydramine, dobutamine, docetaxel, dolasetron, dopamine, doripenem, doxacurium, doxorubicin,
doxorubicin liposome, epirubicin, eptifibatide, ertapenem, etoposide, etoposide
phosphate, fenoldopam, fludarabine, gemcitabine, gentamicin, granisetron, hetastarch, hydromorphone, idarubicin, ifosfamide, irinotecan, leucovorin calcium,
lidocaine, linezolid, lorazepam, mechlorethamine, meperidine, methotrexate,
metoclopramide, metronidazole, midazolam, midodrine, milrinone, mitoxantrone, mycophentolate, nesiritide, octreotide, ondansetron, oxaliplatin, oxytocin,
paclitaxel, palonosetron, pamidronate, pancuronium, potassium acetate, potassium chloride, promethazine, quinupristin-dalfopristin, ranitidine, remifentanil,
rocuronium, sodium acetate, tacrolimus, telavancin, teniposide, thiotepa, tigecy⫽ Canadian drug name.
⫽ Genetic Implication.
pg 3 # 3
cline, tirofiban, tobramycin, trastuzumab, vancomycin, vasopressin, vecuronium,
verapamil, vinblastine, vincristine, vinorelbine, voriconazole, zoledronic acid.
● Y-Site Incompatibility: Manufacturer recommends temporarily discontinuing
other solutions when administering ciprofloxacin. acyclovir, aminocaproic acid,
aminophylline, amphotericin B lipid complex, amphotericin B liposome, ampicillin/sulbactam, cefepime, dexamethasone, fluorouracil, foscarnet, furosemide,
heparin, hydrocortisone, magnesium sulfate, methylprednisolone, pantoprazole,
pemetrexed, phenytoin, piperacillin/tazobactam, potassium phosphates, propofol, rituxumab, sodium phosphates, warfarin.
Patient/Family Teaching
● Instruct patient to take medication as directed at evenly spaced times and to finish
●
●
IV Administration
● pH: 3.3– 4.6.
● Intermittent Infusion: Diluent: Dilute with 0.9% NaCl or D5W. Stable for 14
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drug completely, even if feeling better. Take missed doses as soon as possible, unless almost time for next dose. Do not double doses. Advise patient that sharing of
this medication may be dangerous.
Advise patients to notify health care professional immediately if they are taking theophylline.
Encourage patient to maintain a fluid intake of at least 1500– 2000 mL/day to prevent crystalluria.
Advise patient that antacids or medications containing calcium, magnesium, aluminum, iron, or zinc will decrease absorption and should not be taken within 4 hr
before and 2 hr after taking this medication.
May cause dizziness and drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
Caution patient to use sunscreen and protective clothing to prevent phototoxicity
reactions during and for 5 days after therapy. Notify health care professional if a
sunburn-like reaction or skin eruption occurs.
Instruct patients being treated for gonorrhea that partners also must be treated.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking any other Rx, OTC, or herbal products.
Advise patient to report signs of superinfection (furry overgrowth on the tongue,
vaginal itching or discharge, loose or foul-smelling stools).
Instruct patient to notify health care professional if fever and diarrhea
develop, especially if stool contains blood, pus, or mucus. Advise patient
not to treat diarrhea without consulting health care professional.
Instruct patient to notify health care professional immediately if signs
and symptoms of hepatotoxicity (anorexia, jaundice, dark urine, pruri-
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
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tus, or tender abdomen), rash, signs of hypersensitivity, or tendon
(shoulder, hand, Achilles, and other) pain, swelling, or inflammation
occur. If tendon symptoms occur, avoid exercise and use of the affected
area. Increased risk in ⬎65 yrs old, kidney, heart and lung transplant recipients, and patients taking corticosteroids concurrently. Therapy
should be discontinued.
Evaluation/Desired Outcomes
● Resolution of the signs and symptoms of bacterial infection. Time for complete
resolution depends on organism and site of infection.
● Post-exposure treatment of inhalational anthrax or cutaneous anthrax.
Why was this drug prescribed for your patient?
䉷 2015 F.A. Davis Company