Ciprofloxacin | Drugs | BNF content published by NICE (2023)

Indications and dose

For ciprofloxacin

Superficial bacterial eye infection for ciprofloxacin

To the eye using eye drop

Child: Apply 4 times a day for maximum duration of treatment 21 days.
Adult: Apply 4 times a day for maximum duration of treatment 21 days.

To the eye using eye ointment

Child 1–17 years: Apply 1.25centimetres 3 times a day for 2 days, then apply 1.25centimetres twice daily for 5 days.
Adult: Apply 1.25centimetres 3 times a day for 2 days, then apply 1.25centimetres twice daily for 5 days.

Superficial bacterial eye infection (severe infection) for ciprofloxacin

To the eye using eye drop

Child: Apply every 2hours during waking hours for 2 days, then apply 4 times a day for maximum duration of treatment 21 days.
Adult: Apply every 2hours during waking hours for 2 days, then apply 4 times a day for maximum duration of treatment 21 days.

Corneal ulcer for ciprofloxacin

To the eye using eye drop

Child: Apply every 15minutes for 6 hours, then apply every 30minutes for the remainder of day 1, then apply every 1hour on day 2, then apply every 4hours on days 3–14, maximum duration of treatment 21 days, to be administered throughout the day and night.
Adult: Apply every 15minutes for 6 hours, then apply every 30minutes for the remainder of day 1, then apply every 1hour on day 2, then apply every 4hours on days 3–14, maximum duration of treatment 21 days, to be administered throughout the day and night.

To the eye using eye ointment

Child 1–17 years: Apply 1.25centimetres every 1–2hours for 2 days, then apply 1.25centimetres every 4hours for the next 12 days, to be administered throughout the day and night.
Adult: Apply 1.25centimetres every 1–2hours for 2 days, then apply 1.25centimetres every 4hours for the next 12 days, to be administered throughout the day and night.

Acute otitis externa for ciprofloxacin

To the ear

Child 1–17 years: Apply 0.25mL twice daily for 7 days, each 0.25mL dose contains 0.5mg ciprofloxacin.
Adult: Apply 0.25mL twice daily for 7 days, each 0.25mL dose contains 0.5mg ciprofloxacin.

Moderate diabetic foot infection, Severe diabetic foot infection for ciprofloxacin

By mouth

Adult: 500mg twice daily.

By intravenous infusion

Adult: 400mg every 8–12hours, to be given over 60 minutes.

Fistulating Crohn's disease for ciprofloxacin

By mouth

Adult: 500mg twice daily.

Acute diverticulitis [in combination with metronidazole] (administered on expert advice) for ciprofloxacin

By mouth

Adult: 500mg twice daily for 5 days then review.

By intravenous infusion

Adult: 400mg every 8–12hours, to be given over 60 minutes.

Respiratory-tract infections for ciprofloxacin

By mouth

Adult: 500–750mg twice daily.

By intravenous infusion

Adult: 400mg every 8–12hours, to be given over 60 minutes.

Pseudomonal lower respiratory-tract infection in cystic fibrosis for ciprofloxacin

By mouth

Adult: 750mg twice daily.

Urinary-tract infections for ciprofloxacin

By mouth

Adult: 250–750mg twice daily.

By intravenous infusion

Adult: 400mg every 8–12hours, to be given over 60 minutes.

Acute prostatitis for ciprofloxacin

By mouth

Adult: 500mg twice daily for 14 days then carry out a clinical assessment to decide whether to continue for a further 14 days.

By intravenous infusion

Adult: 400mg every 8–12hours.

Uncomplicated gonorrhoea [anogenital and pharyngeal infection, when sensitivity confirmed] for ciprofloxacin

By mouth

Adult: 500mg for 1 dose.

Disseminated gonococcal infection [when sensitivity confirmed] for ciprofloxacin

By intravenous infusion

Adult: 500mg every 12hours for 7 days, may be switched 24–48 hours after symptoms improve to a suitable oral antibacterial.

By mouth

Adult: 500mg twice daily, following intravenous antibacterial treatment, starting 24–48 hours after symptoms improve, to give 7 days treatment in total.

Most other infections for ciprofloxacin

By mouth

Adult: Initially 500mg twice daily; increased to 750mg twice daily, in severe or deep-seated infection.

By intravenous infusion

Adult: 400mg every 8–12hours, to be given over 60 minutes.

Surgical prophylaxis for ciprofloxacin

By mouth

Adult: 750mg, to be taken 60 minutes before procedure.

Anthrax (treatment and post-exposure prophylaxis) for ciprofloxacin

By mouth

Adult: 500mg twice daily.

By intravenous infusion

Adult: 400mg every 12hours, to be given over 60 minutes.

Prevention of secondary case of meningococcal meningitis for ciprofloxacin

By mouth

Child 1 month–4 years: 30mg/kg (max. per dose 125mg) for 1 dose.
Child 5–11 years: 250mg for 1 dose.
Child 12–17 years: 500mg for 1 dose.
Adult: 500mg for 1 dose.

Acute pyelonephritis, Urinary tract infection (catheter-associated) for ciprofloxacin

By mouth

Adult: 500mg twice daily for 7 days.

By intravenous infusion

Adult: 400mg every 8–12hours.

Unlicensed use

Unlicensed use For ciprofloxacin

With intravenous use or oral use:

Ciprofloxacin is used for the treatment of disseminated gonococcal infection, A but is not licensed for this indication.

With oral use in children:

Ciprofloxacin is used for the treatment of uncomplicated gonorrhoea, A but is not licensed for this indication.

When used by eye in children:

Eye ointment not licensed for use in children under 1 year.

With intravenous use or oral use in children:

Not licensed for use in children under 1 year of age.

Licensed for use in children over 1 year for complicated urinary-tract infections, for pseudomonal lower respiratory-tract infections in cystic fibrosis, for prophylaxis and treatment of inhalational anthrax. Licensed for use in children over 1 year for other infections where the benefit is considered to outweigh the potential risks.

Not licensed for use in children for gastro-intestinal anthrax.

Not licensed for use in children for prophylaxis of meningococcal meningitis.

Important safety information

Important safety information For all quinolones

With intravenous use or oral use or when used by inhalation:

The CSM has warned that quinolones may induce convulsions in patients with or without a history of convulsions; taking NSAIDs at the same time may also induce them.

Tendon damage

With intravenous use or oral use or when used by inhalation in adults:

Tendon damage (including rupture) has been reported rarely in patients receiving quinolones. Tendon rupture may occur within 48 hours of starting treatment; cases have also been reported several months after stopping a quinolone. Healthcare professionals are reminded that:

quinolones are contra-indicated in patients with a history of tendon disorders related to quinolone use;
patients over 60 years of age are more prone to tendon damage;
the risk of tendon damage is increased by the concomitant use of corticosteroids;
if tendinitis is suspected, the quinolone should be discontinued immediately.

Tendon damage

With intravenous use or oral use in children:

quinolones are contra-indicated in patients with a history of tendon disorders related to quinolone use;
the risk of tendon damage is increased by the concomitant use of corticosteroids;
if tendinitis is suspected, the quinolone should be discontinued immediately.

MHRA/CHM advice: Systemic and inhaled fluoroquinolones: small increased risk of aortic aneurysm and dissection; advice for prescribing in high-risk patients (November 2018)

With intravenous use or oral use or when used by inhalation in adults:

The MHRA advises that benefit-risk should be assessed and other therapeutic options considered before using fluoroquinolones in patients at risk of aortic aneurysm and dissection.

Patients (particularly the elderly and those at risk) and their carers should be informed about rare events of aortic aneurysm and dissection, and advised to seek immediate medical attention if sudden-onset severe abdominal, chest, or back pain develops.

MHRA/CHM advice: Systemic and inhaled fluoroquinolones: small increased risk of aortic aneurysm and dissection; advice for prescribing in high-risk patients (November 2018)

With intravenous use or oral use in children:

The MHRA advises that benefit-risk should be assessed and other therapeutic options considered before using fluoroquinolones in patients at risk of aortic aneurysm and dissection.

Patients (particularly those at risk) and their carers should be informed about rare events of aortic aneurysm and dissection, and advised to seek immediate medical attention if sudden-onset severe abdominal, chest, or back pain develops.

MHRA/CHM advice: Fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects (March 2019)

With intravenous use or oral use or when used by inhalation in adults:

Disabling, long-lasting or potentially irreversible adverse reactions affecting musculoskeletal and nervous systems have been reported very rarely with fluoroquinolone antibiotics. Healthcare professionals are advised to inform patients to stop treatment at the first signs of a serious adverse reaction, such as tendinitis or tendon rupture, muscle pain, muscle weakness, joint pain, joint swelling, peripheral neuropathy, and CNS effects, and to contact their doctor immediately.

Fluoroquinolones should not be prescribed for non-severe or self-limiting infections, or non-bacterial conditions. Unless other commonly recommended antibiotics are inappropriate, fluoroquinolones should not be prescribed for some mild to moderate infections, such as acute exacerbation of chronic bronchitis and chronic obstructive pulmonary disease, and ciprofloxacin or levofloxacin should not be prescribed for uncomplicated cystitis.

Fluoroquinolones should be avoided in patients who have previously had serious adverse reactions. Use of fluoroquinolones with corticosteroids should also be avoided as it may exacerbate fluoroquinolone-induced tendinitis and tendon rupture. Fluoroquinolones should be prescribed with caution in patients older than 60 years and in patients with renal impairment or solid-organ transplants as they are at a higher risk of tendon injury.

MHRA/CHM advice: Fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects (March 2019)

With intravenous use or oral use in children:

Fluoroquinolones should be avoided in patients who have previously had serious adverse reactions. Use of fluoroquinolones with corticosteroids should also be avoided as it may exacerbate fluoroquinolone-induced tendinitis and tendon rupture. Fluoroquinolones should be prescribed with caution in patients with renal impairment or solid-organ transplants as they are at a higher risk of tendon injury.

MHRA/CHM advice: Systemic and inhaled fluoroquinolones: small risk of heart valve regurgitation; consider other therapeutic options first in patients at risk (December 2020)

With intravenous use or oral use or when used by inhalation in adults:

A European review of worldwide data found an increased risk of heart valve regurgitation associated with systemic and inhaled fluoroquinolones. A case-control study suggested a two-fold increased relative risk with current oral fluoroquinolone use compared with amoxicillin or azithromycin use.

Healthcare professionals are advised that fluoroquinolones are authorised for use in serious, life-threatening bacterial infections, and should only be used after careful benefit-risk assessment and consideration of other therapeutic options in patients with the following risk factors:

congenital or pre-existing heart valve disease;
connective tissue disorders (e.g. Marfan syndrome or Ehlers-Danlos syndrome);
other risk factors or conditions predisposing to heart valve regurgitation (e.g. hypertension, Turner’s syndrome, Behçet’s disease, rheumatoid arthritis, and infective endocarditis).

Patients should be advised to seek immediate medical attention if they experience a rapid onset of shortness of breath (especially when lying down flat in bed), swelling of the ankles, feet, or abdomen, or new-onset heart palpitations.

MHRA/CHM advice: Systemic and inhaled fluoroquinolones: small risk of heart valve regurgitation; consider other therapeutic options first in patients at risk (December 2020)

With intravenous use or oral use in children:

congenital or pre-existing heart valve disease;
connective tissue disorders (e.g. Marfan syndrome or Ehlers-Danlos syndrome);
other risk factors or conditions predisposing to heart valve regurgitation (e.g. hypertension, Turner’s syndrome, Behçet’s disease, rheumatoid arthritis, and infective endocarditis).

Contra-indications

Contra-indications For all quinolones

When used by inhalation

History of tendon disorders related to quinolone use

With intravenous use

History of tendon disorders related to quinolone use

With oral use

History of tendon disorders related to quinolone use

Cautions

Cautions For all quinolones

When used by inhalation

Can prolong the QT interval; conditions that predispose to seizures; diabetes (may affect blood glucose); exposure to excessive sunlight and UV radiation should be avoided during treatment and for 48 hours after stopping treatment; G6PD deficiency; history of epilepsy; myasthenia gravis (risk of exacerbation); psychiatric disorders

With intravenous use

Can prolong the QT interval; children or adolescents (arthropathy has developed in weight-bearing joints in young animals) (in children); conditions that predispose to seizures; diabetes (may affect blood glucose); exposure to excessive sunlight and UV radiation should be avoided during treatment and for 48 hours after stopping treatment; G6PD deficiency; history of epilepsy; myasthenia gravis (risk of exacerbation); psychiatric disorders

With oral use

Cautions, further information

Use in children

With intravenous use or oral use in children:

Quinolones cause arthropathy in the weight-bearing joints of immature animals and are therefore generally not recommended in children and growing adolescents. However, the significance of this effect in humans is uncertain and in some specific circumstances use of ciprofloxacin may be justified in children.

Cautions For ciprofloxacin

When used by ear

Known (or at risk of) perforated tympanic membrane

With intravenous use

Acute myocardial infarction (risk factor for QT interval prolongation); avoid excessive alkalinity of urine (risk of crystalluria); bradycardia (risk factor for QT interval prolongation); congenital long QT syndrome (risk factor for QT interval prolongation); electrolyte disturbances (risk factor for QT interval prolongation); ensure adequate fluid intake (risk of crystalluria); heart failure with reduced left ventricular ejection fraction (risk factor for QT interval prolongation); history of symptomatic arrhythmias (risk factor for QT interval prolongation)

With oral use

Interactions

View interactions for ciprofloxacin

Side-effects

Side-effects For all quinolones

Common or very common

Appetite decreased; arthralgia; asthenia; constipation; diarrhoea; dizziness; dyspnoea; eye discomfort; eye disorders; fever; fungal infection; gastrointestinal discomfort; headache; myalgia; nausea; QT interval prolongation; skin reactions; sleep disorders; taste altered; tinnitus; vision disorders; vomiting

Uncommon

Altered smell sensation; anaemia; anxiety; arrhythmias; chest pain; confusion; cough; depression; drowsiness; dry eye; eosinophilia; eye inflammation; flatulence; hallucination; hearing impairment; hepatic disorders; hyperglycaemia; hyperhidrosis; hypersensitivity; hypoglycaemia; hypotension; leucopenia; muscle weakness; neutropenia; pain; palpitations; peripheral neuropathy (sometimes irreversible); pseudomembranous enterocolitis (in adults); renal impairment; seizure; sensation abnormal; stomatitis; tendon disorders; thrombocytopenia; tremor; vertigo

Rare or very rare

Agranulocytosis; angioedema; arthritis; coordination abnormal; gait abnormal; haemolytic anaemia; idiopathic intracranial hypertension; myasthenia gravis aggravated; pancreatitis; photosensitivity reaction; polyneuropathy; psychotic disorder; severe cutaneous adverse reactions (SCARs); suicidal behaviours; syncope; vasculitis

Frequency not known

Heart valve incompetence; hypoglycaemic coma; increased risk of aortic aneurysm (more common in elderly); increased risk of aortic dissection (more common in elderly); rhabdomyolysis (in adults)

Side-effects, further information

The drug should be discontinued if neurological, psychiatric, tendon disorders or hypersensitivity reactions (including severe rash) occur. For more information regarding the safety of fluoroquinolones, please see Important Safety Information.

Side-effects For ciprofloxacin

Common or very common

When used by eye (topical)

Corneal deposits (reversible after completion of treatment)

With intravenous use

Arthropathy (in children)

With oral use

Arthropathy (in children)

Uncommon

When used by ear

Ear pruritus

With intravenous use

Akathisia; fungal superinfection; oedema; thrombocytosis; vasodilation

With oral use

Akathisia; fungal superinfection

Rare or very rare

When used by eye (topical)

Ear pain; increased risk of infection; paranasal sinus hypersecretion

With intravenous use

Antibiotic associated colitis; asthma; bone marrow disorders; crystalluria; erythema nodosum; haematuria; intracranial pressure increased; leucocytosis; migraine; muscle cramps; muscle tone increased; nephritis tubulointerstitial; olfactory nerve disorder; status epilepticus

With oral use

Frequency not known

With intravenous use

Mood altered; self-injurious behaviour

With oral use

Mood altered; self-injurious behaviour

Allergy and cross-sensitivity

Allergy and cross-sensitivity For all quinolones

Use of quinolones contraindicated in quinolone hypersensitivity. M

Pregnancy

Pregnancy For all quinolones

With intravenous use or oral use or when used by inhalation:

Avoid in pregnancy—shown to cause arthropathy in animal studies; safer alternatives are available.

Pregnancy For ciprofloxacin

With intravenous use or oral use:

A single dose of ciprofloxacin may be used for the prevention of a secondary case of meningococcal meningitis.

When used by eye:

Manufacturer advises use only if potential benefit outweighs risk.

Breast feeding

Breast feeding For ciprofloxacin

When used by eye:

Manufacturer advises caution.

With intravenous use or oral use:

Amount too small to be harmful but manufacturer advises avoid.

Renal impairment

Renal impairment For ciprofloxacin

Dose adjustments

With oral use in adults:

Give 250–500mg every 12 hours if eGFR 30–60mL/minute/1.73m² (every 24 hours if eGFR less than 30mL/minute/1.73m²).

With intravenous use in adults:

Give (200mg over 30 minutes), 200–400mg every 12 hours if eGFR 30–60mL/minute/ 1.73m² (every 24 hours if eGFR less than 30mL/ minute/1.73m²).

With intravenous use or oral use in children:

Reduce dose if estimated glomerular filtration rate less than 30mL/minute/1.73m²—consult product literature.

Prescribing and dispensing information

Prescribing and dispensing information For ciprofloxacin

For choice of antibacterial therapy, see Antibacterials, use for prophylaxis, Anthrax, Ear infections, antibacterial therapy, Gastro-intestinal system infections, antibacterial therapy, Genital system infections, antibacterial therapy, Respiratory system infections, antibacterial therapy, Urinary-tract infections.

In adults:

For choice of antibacterial therapy, see Diabetic foot infections, antibacterial therapy.

Handling and storage

Handling and storage For ciprofloxacin

When used by ear:

Manufacturer advises discard any ampoules remaining 8days after opening the pouch.

Patient and carer advice

Patient and carer advice For all quinolones

With intravenous use or oral use or when used by inhalation in adults:

The MHRA has produced an advice sheet on serious adverse reactions affecting musculoskeletal and nervous systems associated with fluoroquinolone use, which should be provided to patients and their carers.

With intravenous use or oral use in children:

Patient and carer advice For ciprofloxacin

Granules present in the oral suspension should not be chewed.

Medicines for Children leaflet: Ciprofloxacin drops for infection

When used by ear in children:

https://www.medicinesforchildren.org.uk/medicines/ciprofloxacin-drops-for-infection/

Medicines for Children leaflet: Ciprofloxacin for bacterial infection

With systemic use in children:

https://www.medicinesforchildren.org.uk/medicines/ciprofloxacin-for-bacterial-infection/

Driving and skilled tasks

With intravenous use or oral use:

May impair performance of skilled tasks (e.g. driving); effects enhanced by alcohol.

National funding/access decisions

National funding/access decisions For ciprofloxacin

For full details see funding body website.

Scottish Medicines Consortium (SMC) decisions For ciprofloxacin

SMC No. 1320/18
Ciprofloxacin (Cetraxal®) for the treatment of acute otitis externa in adults and children older than 1 year with an intact tympanic membrane, caused by ciprofloxacin susceptible microorganisms (April 2018)
Funding decision:
Recommended with restrictions

All Wales Medicines Strategy Group (AWMSG) decisions For ciprofloxacin

AWMSG No. 1343
Ciprofloxacin (Cetraxal®) for the treatment of acute otitis externa in adults and children older than 1 year with an intact tympanic membrane, caused by ciprofloxacin susceptible microorganisms (July 2018)
Funding decision:
Recommended

Medicinal forms

There can be variation in the licensing of different medicines containing the same drug.

Forms available from special-order manufacturers include: oral suspension, ear drops, eye drops, eye ointment.

View all medicinal forms and pricinginformation

Or jump straight to:

Tablet
Oral suspension
Infusion
Solution for infusion
Ear drops
Eye drops

Anthrax
Antibacterials, use for prophylaxis
Blood infections, antibacterial therapy
Crohn's disease
Diabetic foot infections, antibacterial therapy
Diarrhoea (acute)
Ear infections, antibacterial therapy
Gastro-intestinal system infections, antibacterial therapy
Genital system infections, antibacterial therapy
MRSA
Quinolones
Urinary-tract infections

Other drugs in class

Other drugs in classQuinolones

Delafloxacin
Levofloxacin
Moxifloxacin
Ofloxacin