Cipro Dosage

Generic name: CIPROFLOXACIN HYDROCHLORIDE 250mg
Dosage form: tablet, film coated
Drug class: Quinolones and fluoroquinolones

Medically reviewed by Drugs.com. Last updated on Sep 20, 2024.

CIPRO Tablets and Oral Suspension should be administered orally as described in the appropriate Dosage Guidelines tables.

Dosage in Adults

The determination of dosage and duration for any particular patient must take into consideration the severity and nature of the infection, the susceptibility of the causative microorganism, the integrity of the patient’s host-defense mechanisms, and the status of renal and hepatic function. CIPRO Tablets or CIPRO for Oral Suspension may be administered to adult patients when clinically indicated at the discretion of the physician. Administer CIPRO for Oral Suspension using the co-packaged graduated spoon.

Table 1: Adult Dosage Guidelines
* Generally ciprofloxacin should be continued for at least 2 days after the signs and symptoms of infection have disappeared, except for inhalational anthrax (post-exposure). † Used in conjunction with metronidazole. ‡ Begin drug administration as soon as possible after suspected or confirmed exposure.
Infection	Dose	Frequency	Usual Durations*
Skin and Skin Structure	500–750 mg	every 12 hours	7 to 14 days
Bone and Joint	500–750 mg	every 12 hours	4 to 8 weeks
Complicated Intra–Abdominal†	500 mg	every 12 hours	7 to 14 days
Infectious Diarrhea	500 mg	every 12 hours	5 to 7 days
Typhoid Fever	500 mg	every 12 hours	10 days
Uncomplicated Urethral and Cervical Gonococcal Infections	250 mg	single dose	single dose
Inhalational anthrax (post-exposure)‡	500 mg	every 12 hours	60 days
Plague‡	500–750 mg	every 12 hours	14 days
Chronic Bacterial Prostatitis	500 mg	every 12 hours	28 days
Lower Respiratory Tract Infections	500–750 mg	every 12 hours	7 to 14 days
Urinary Tract Infections	250–500 mg	every 12 hours	7 to 14 days
Acute Uncomplicated Cystitis	250 mg	every 12 hours	3 days
Acute Sinusitis	500 mg	every 12 hours	10 days

Conversion of IV to Oral Dosing in Adults

Patients whose therapy is started with CIPRO IV may be switched to CIPRO Tablets or Oral Suspension when clinically indicated at the discretion of the physician (Table 2).

Table 2: Equivalent AUC Dosing Regimens
CIPRO Oral Dosage	Equivalent CIPRO IV Dosage
250 mg Tablet every 12 hours	200 mg intravenous every 12 hours
500 mg Tablet every 12 hours	400 mg intravenous every 12 hours
750 mg Tablet every 12 hours	400 mg intravenous every 8 hours

Dosage in Pediatric Patients

Dosing and initial route of therapy (that is, IV or oral) for cUTI or pyelonephritis should be determined by the severity of the infection. CIPRO should be administered as described in Table 3. Administer CIPRO for Oral Suspension using the co-packaged graduated spoon.

Table 3: Pediatric Dosage Guidelines
Infection	Dose	Frequency	Total Duration
Complicated Urinary Tract or Pyelonephritis (patients from 1 to 17 years of age)	10 mg/kg to 20 mg/kg (maximum 750 mg per dose; not to be exceeded even in patients weighing more than 51 kg)	Every 12 hours	10–21 days1
Inhalational Anthrax (Post-Exposure)2	15 mg/kg (maximum 500 mg per dose)	Every 12 hours	60 days
Plague2,3	15 mg/kg (maximum 500 mg per dose)	Every 8 to 12 hours	14 days

1 The total duration of therapy for cUTI and pyelonephritis in the clinical trial was determined by the physician. The mean duration of treatment was 11 days (range 10 to 21 days).

2Begin drug administration as soon as possible after suspected or confirmed exposure.

3Begin drug administration as soon as possible after suspected or confirmed exposure to Y. pestis.

Dosage Modifications in Patients with Renal Impairment

Ciprofloxacin is eliminated primarily by renal excretion; however, the drug is also metabolized and partially cleared through the biliary system of the liver and through the intestine. These alternative pathways of drug elimination appear to compensate for the reduced renal excretion in patients with renal impairment. Nonetheless, some modification of dosage is recommended, particularly for patients with severe renal dysfunction. Dosage guidelines for use in patients with renal impairment are shown in Table 4.

Table 4: Recommended Starting and Maintenance Doses for Adult Patients with Impaired Renal Function
Creatinine Clearance (mL/min)	Dose
> 50	See Usual Dosage.
30–50	250–500 mg every 12 hours
5–29	250–500 mg every 18 hours
Patients on hemodialysis or Peritoneal dialysis	250–500 mg every 24 hours (after dialysis)

When only the serum creatinine concentration is known, the following formulas may be used to estimate creatinine clearance:

Men - Creatinine clearance (mL/min) = Weight (kg) x (140–age)
	72 x serum creatinine (mg/dL)
Women - 0.85 x the value calculated for men.

The serum creatinine should represent a steady state of renal function.

In patients with severe infections and severe renal impairment, a unit dose of 750 mg may be administered at the intervals noted above. Patients should be carefully monitored.

Pediatric patients with moderate to severe renal insufficiency were excluded from the clinical trial of cUTI and pyelonephritis. No information is available on dosing adjustments necessary for pediatric patients with moderate to severe renal insufficiency (that is, creatinine clearance of < 50 mL/min/1.73m2).

Important Administration Instructions

With Multivalent Cations

Administer CIPRO at least 2 hours before or 6 hours after magnesium/aluminum antacids; polymeric phosphate binders (for example, sevelamer, lanthanum carbonate) or sucralfate; Videx® (didanosine) chewable/buffered tablets or pediatric powder for oral solution; other highly buffered drugs; or other products containing calcium, iron or zinc.

With Dairy Products

Concomitant administration of CIPRO with dairy products (like milk or yogurt) or calcium-fortified juices alone should be avoided since decreased absorption is possible; however, CIPRO may be taken with a meal that contains these products.

Hydration of Patients Receiving CIPRO

Assure adequate hydration of patients receiving CIPRO to prevent the formation of highly concentrated urine. Crystalluria has been reported with quinolones.

Instruct the patient of the appropriate CIPRO administration.

Missed Doses

If a dose is missed, it should be taken anytime but not later than 6 hours prior to the next scheduled dose. If less than 6 hours remain before the next dose, the missed dose should not be taken and treatment should be continued as prescribed with the next scheduled dose. Double doses should not be taken to compensate for a missed dose.

Splitting CIPRO Tablets

CIPRO Tablets, 250 mg and 500 mg are functionally scored tablets which can be split into one-half at the scored line to provide a 125 mg and 250 mg strength, respectively.

Directions for Reconstitution of the CIPRO Microcapsules for Oral Suspension

CIPRO Oral Suspension is supplied in 5% (5 g ciprofloxacin in 100 mL) and 10% (10 g ciprofloxacin in 100 mL) strengths. CIPRO oral suspension is composed of two components (microcapsules and diluent) that must be combined prior to dispensing.

Table 5: Appropriate Dosing Volumes of the Reconstituted Oral Suspensions
Dose	5% (250 mg/5 mL)	10% (500 mg/5 mL)
250 mg	5 mL	2.5 mL
500 mg	10 mL	5 mL
750 mg	15 mL	7.5 mL

Preparation of the suspension:

Step1	The small bottle contains the microcapsules, the large bottle contains the diluent.	Step 2	Open both bottles. Child-proof cap: Press down according to instructions on the cap while turning to the left.
Step 3	Pour the microcapsules completely into the larger bottle of diluent. Do not add water to the suspension.	Step 4	Remove the top layer of the diluent bottle label (to reveal the CIPRO Oral Suspension label). Close the large bottle completely according to the directions on the cap and shake vigorously for about 15 seconds. The suspension is ready for use.

Step 5: Write the expiration date of the re-constituted oral suspension on the bottle label.

Reconstituted product may be stored below 30°C (86°F) for 14 days. Protect from freezing.

No additions should be made to the mixed final ciprofloxacin suspension. CIPRO Oral Suspension should not be administered through feeding or NG (nasogastric) tubes due to its physical characteristics.

Administration Instructions for CIPRO for Oral Suspension After Reconstitution

•: Shake CIPRO Oral Suspension vigorously each time before use for approximately 15 seconds.
•: Administer CIPRO Oral Suspension using the co-packaged graduated teaspoon provided for the patient (see Figure 1)

Figure 1: Co-packaged 5 mL graduated teaspoon

The Co-packaged graduated teaspoon (5mL) is provided, with markings for 1/2 (2.5 mL) and 1/1 (5 mL)

•: After use, clean the graduated teaspoon under running water with dish detergent and dry thoroughly.
•: Do Not chew the microcapsules in the CIPRO Oral Suspension, instead swallow them whole.
•: Water may be taken afterwards.
•: Reclose the bottle properly after each use according to instructions on the cap.
•: After treatment has been completed, CIPRO Oral Suspension should not be reused.

Dosing of CIPRO for Oral Suspension using the Co-Packaged Spoon in Adults and Pediatric Patients

Table 6: 5% Cipro for Oral Suspension: 250 mg ciprofloxacin per 5 mL after reconstitution

Infection	Body weight (kg)	Dose by Measuring Spoonful(s) using Co-Packed Spoon* (teaspoonful (s) (volume (mL))	Dose Strength (mg)
Complicated Urinary Tract or Pyelonephritis (patients from 1 to 17 years of age)1 and Plague2	9 kg to 12 kg	½ teaspoonful (2.5 mL)	125 mg
	13 kg to 18 kg	1 teaspoonful (5 mL)	250 mg
	19 kg to 24 kg	1 to 1 ½ teaspoonful(s) (5 mL to 7.5 mL)	250 mg to 375 mg
	25 kg to 31 kg	1 ½ to 2 teaspoonfuls (7.5 mL to 10 mL)	375 mg to 500 mg
	32 kg to 37 kg	1 ½ to 2 ½ teaspoonfuls (7.5 mL to 12.5 mL)	375 mg to 625 mg
	38 kg or more	2 to 3 teaspoonfuls (10 mL to 15 mL)	500 mg to 750 mg
Inhalational Anthrax (Post-Exposure)3	9 kg to 12 kg	½ teaspoonful (2.5 mL)	125 mg
	13 kg to 18 kg	1 teaspoonful (5 mL)	250 mg
	19 kg to 24 kg	1 to 1 ½ teaspoonful(s) (5 mL to 7.5 mL)	250 mg to 375 mg
	25 kg or more	2 teaspoonfuls (10 mL)	500 mg

* A graduated teaspoon (5mL) with markings 1/2 (2.5) mL and 1/1 (5 mL) is provided for the patient.

1Administer every 12 hours for 10-21 days

2Administer every 8-12 hours for 10-21 days for Pediatric patients; for adults administer every 12 hours for 14 days

3Administer every 12 hours for 60 days

Table 7: 10% Oral Suspension: 500 mg ciprofloxacin per 5 mL after reconstitution (not appropriate for children weighing less than 13 kg)
Infection	Body weight (kg)	Dose by Measuring Spoonful(s) using Co-Packed Spoon* (teaspoonful (s) (volume (mL))	Dose Strength (mg)
Complicated Urinary Tract or Pyelonephritis (patients from 1 to 17 years of age)1 and Plague2	13 kg to 24 kg	½ teaspoonful (2.5 mL)	250 mg
	25 kg	½ to 1 teaspoonful (2.5 mL to 5 mL)	250 mg to 500 mg
	26 kg to 37 kg	1 teaspoonful (5 mL)	500 mg
	38 kg or more	1 to 1½ teaspoonful(s) (5 mL to 7.5 mL)	500 mg to maximum dose of 750 mg
Inhalational Anthrax (Post-Exposure)3	13 kg to 24 kg	½ teaspoonful (2.5 mL)	250 mg
	25 kg or more	1 teaspoonful (5 mL)	500 mg