INDICATIONS AND USAGE
Ciprofloxacin Injection, USP is indicated for the treatment of infections caused by susceptible strains of the designated microorganisms in the conditions and patient populations listed below when the intravenous administration offers a route of administration advantageous to the patient. Please see
DOSAGE AND ADMINISTRATION
for specific recommendations.
Adult Patients:
Urinary Tract Infections
caused by
Escherichia coli
(including cases with secondary bacteremia),
Klebsiella pneumoniae
subspecies
pneumoniae
,
Enterobacter cloacae
,
Serratia marcescens
,
Proteus mirabilis
,
Providencia rettgeri
,
Morganella morganii
,
Citrobacter diversus
,
Citrobacter freundii
,
Pseudomonas aeruginosa
, methicillin-susceptible
Staphylococcus epidermidis
,
Staphylococcus saprophyticus
, or
Enterococcus faecalis
.
Lower Respiratory Infections
caused by
Escherichia coli
,
Klebsiella pneumoniae
subspecies
pneumoniae
,
Enterobacter cloacae
,
Proteus mirabilis
,
Pseudomonas aeruginosa
,
Haemophilus influenzae
,
Haemophilus parainfluenzae
, or penicillin-susceptible
Streptococcus pneumoniae
. Also,
Moraxella catarrhalis
for the treatment of acute exacerbations of chronic bronchitis.
NOTE: Although effective in clinical trials, ciprofloxacin is not a drug of first choice in the treatment of presumed or confirmed pneumonia secondary to
Streptococcus pneumoniae
.
Nosocomial Pneumonia
caused by
Haemophilus influenzae
or
Klebsiella pneumoniae
.
Skin and Skin Structure Infections
caused by
Escherichia coli
,
Klebsiella pneumoniae
subspecies
pneumoniae
,
Enterobacter cloacae
,
Proteus mirabilis
,
Proteus vulgaris
,
Providencia stuartii
,
Morganella morganii
,
Citrobacter freundii
,
Pseudomonas aeruginosa
, methicillin-susceptible
Staphylococcus aureus
, methicillin-susceptible
Staphylococcus epidermidis
, or
Streptococcus pyogenes
.
Bone and Joint Infections
caused by
Enterobacter cloacae
,
Serratia marcescens
, or
Pseudomonas aeruginosa
.
Complicated Intra-Abdominal Infections
(used in conjunction with metronidazole) caused by
Escherichia coli
,
Pseudomonas aeruginosa
,
Proteus mirabilis
,
Klebsiella pneumoniae
, or
Bacteroides fragilis
.
Acute Sinusitis
caused by
Haemophilus influenzae
, penicillin-susceptible
Streptococcus pneumoniae
, or
Moraxella catarrhalis
.
Chronic Bacterial Prostatitis
caused by
Escherichia coli
or
Proteus mirabilis
.
Empirical Therapy for Febrile Neutropenic Patients
in combination with piperacillin sodium. (See
CLINICAL STUDIES
.)
Pediatric Patients (1 to 17 years of age):
Complicated Urinary Tract Infections and Pyelonephritis
due to
Escherichia coli.
NOTE: Although effective in clinical trials, ciprofloxacin is not a drug of first choice in the pediatric population due to an increased incidence of adverse events compared to controls, including events related to joints and/or surrounding tissues. (See
WARNINGS
,
PRECAUTIONS:
Pediatric Use
,
ADVERSE REACTIONS
, and
CLINICAL STUDIES
.) Ciprofloxacin, like other fluoroquinolones, is associated with arthropathy and histopathological changes in weight-bearing joints of juvenile animals. (See
ANIMAL PHARMACOLOGY
.)
Adult and Pediatric Patients:
Inhalational anthrax
(post-exposure): To reduce the incidence or progression of disease following exposure to aerosolized
Bacillus anthracis
.
Ciprofloxacin serum concentrations achieved in humans served as a surrogate endpoint reasonably likely to predict clinical benefit and provided the initial basis for approval of this indication.4 Supportive clinical information for ciprofloxacin for anthrax post-exposure prophylaxis was obtained during the anthrax bioterror attacks of October 2001. (See also,
INHALATIONAL ANTHRAX
ADDITIONAL INFORMATION
.)
If anaerobic organisms are suspected of contributing to the infection, appropriate therapy should be administered.
Appropriate culture and susceptibility tests should be performed before treatment in order to isolate and identify organisms causing infection and to determine their susceptibility to ciprofloxacin. Therapy with Ciprofloxacin Injection, USP may be initiated before results of these tests are known; once results become available, appropriate therapy should be continued.
As with other drugs, some strains of
Pseudomonas aeruginosa
may develop resistance fairly rapidly during treatment with ciprofloxacin. Culture and susceptibility testing performed periodically during therapy will provide information not only on the therapeutic effect of the antimicrobial agent but also on the possible emergence of bacterial resistance.
To reduce the development of drug-resistant bacteria and maintain the effectiveness of Ciprofloxacin Injection, USP and other antibacterial drugs, Ciprofloxacin Injection, USP should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.