1
INDICATIONS AND
USAGE
Ciprofloxacin is a fluoroquinolone antibacterial indicated in adults (18 years of age and older) with the following infections caused by designated, susceptible bacteria and in pediatric patients where indicated:
Skin and Skin Structure Infections (
1.1)
Bone and Joint Infections (
1.2)
Complicated Intra-Abdominal Infections (
1.3)
Infectious Diarrhea (
1.4)
Typhoid Fever (Enteric Fever) (
1.5)
Uncomplicated Cervical and Urethral Gonorrhea (
1.6)
Inhalational Anthrax post-exposure in adult and pediatric patients (
1.7)
Plague in adult and pediatric patients (
1.8)
Chronic Bacterial Prostatitis (
1.9)
Lower Respiratory Tract Infections (
1.10)
Acute Exacerbation of Chronic Bronchitis
Urinary Tract Infections (
1.11)
Urinary Tract Infections (UTI)
Acute Uncomplicated Cystitis
Complicated UTI and Pyelonephritis in Pediatric Patients
Acute Sinusitis (
1.12)
Usage
To reduce the development of drug-resistant bacteria and maintain the effectiveness of ciprofloxacin and other antibacterial drugs, ciprofloxacin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria. (
1.13)
1.1
Skin and Skin Structure Infections
Ciprofloxacin tablets are indicated in adult patients for treatment of skin and skin structure infections caused by
Escherichia
coli,
Klebsiella
p
neumonia
e
,
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.
1.
2
Bone and Joint Infections
Ciprofloxacin tablets are indicated in adult patients for treatment of bone and joint infections caused by
Enterobacter
cloacae,
Serratia
marcescens,
or
Pseudomonas
aeruginosa.
1.
3
Complicated Intra-Abdominal Infections
Ciprofloxacin tablets are indicated in adult patients for treatment of complicated intra-abdominal infections (used in combination with metronidazole) caused by
Escherichia coli,
Pseudomonas
aeruginosa,
Proteus
mirabilis,
Klebsiella
p
neumonia
e
,
or
Bacteroides
fragilis.
1.
4
Infectious Diarrhea
Ciprofloxacin tablets are indicated in adult patients for treatment of infectious diarrhea caused by
Escherichia
coli
(enterotoxigenic isolates),
Campylobacter
jejuni,
Shigella
boyd
i
i
,
Shigella
dysenteriae,
Shigella
flexneri
or
Shigella
sonnei
when antibacterial therapy is indicated.
Although treatment of infections due to this organism in this organ system demonstrated a clinically significant outcome, efficacy was studied in fewer than 10 patients.
1.
5
Typhoid Fever (Enteric Fever)
Ciprofloxacin tablets are indicated in adult patients for treatment of typhoid fever (enteric fever
)
caused by
Salmonella
typhi.
The efficacy of ciprofloxacin in the eradication of the chronic typhoid carrier state has not been demonstrated.
1.
6
Uncomplicated Cervical and Urethral Gonorrhea
Ciprofloxacin tablets are indicated in adult patients for treatment of uncomplicated cervical and urethral gonorrhea due to
Neisseria
gonorrhoeae
[see
Warnings
and
Precautions
(
5.17
)].
1.
7
Inhalational Anthrax (
P
ost-
E
xposure)
Ciprofloxacin tablets are indicated in adults and pediatric patients from birth to 17 years of age for 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.
1
Supportive clinical information for ciprofloxacin for anthrax post-exposure prophylaxis was obtained during the anthrax bioterror attacks of October 2001
[s
ee
Clinical
Studies
(
14.2
)
]
.
1.
8
Plague
Ciprofloxacin tablets are indicated for treatment of plague, including pneumonic and septicemic plague, due to
Yersinia
pestis
(Y.
p
estis)
and prophylaxis for plague in adults and pediatric patients from birth to 17 years of age. Efficacy studies of ciprofloxacin could not be conducted in humans with plague for feasibility reasons. Therefore this indication is based on an efficacy study conducted in animals only
[see
Clinical
Studies
(
14.3
)].
1.
9
Chronic Bact
erial Prostatitis
Ciprofloxacin tablets are indicated in adult patients for treatment of chronic bacterial prostatitis caused by
Escherichia coli
or
Proteus mirabilis.
1.10
Low
er Respiratory Tract Infections
Ciprofloxacin tablets are indicated in adult patients for treatment of lower respiratory tract infections caused by Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Proteus mirabilis, Pseudomonas aeruginosa, Haemophilus influenzae, Haemophilus parainfluenzae, or Streptococcus pneumoniae.
Ciprofloxacin tablets are not a drug of first choice in the treatment of presumed or confirmed pneumonia secondary to Streptococcus pneumoniae.
Ciprofloxacin tablets are indicated for the treatment of acute exacerbations of chronic bronchitis (AECB) caused by Moraxella catarrhalis.
Because fluoroquinolones, including ciprofloxacin tablets, have been associated with serious adverse reactions [see Warnings and Precautions (
5.1
to
5.16)] and for some patients AECB is self-limiting, reserve ciprofloxacin tablets for treatment of AECB in patients who have no alternative treatment options.
1.11
Urinary Tract Infections
Urinary Tract Infections in Adults
Ciprofloxacin tablets are indicated in adult patients for treatment of urinary tract infections caused by
Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Serratia marcescens, Proteus mirabilis, Providencia rettgeri, Morganella morganii, Citrobacter koseri, Citrobacter freundii, Pseudomonas aeruginosa, methicillin-susceptible Staphylococcus epidermidis, Staphylococcus saprophyticus, or Enterococcus faecalis.
Acute Uncomplicated Cystitis
Ciprofloxacin tablets are indicated in adult female patients for treatment of acute uncomplicated cystitis caused by
Escherichia coli or
Staphylococcus saprophyticus.
Because fluoroquinolones, including ciprofloxacin tablets, have been associated with serious adverse reactions [see Warnings and Precautions (
5.1 to
5.16)] and for some patients acute uncomplicated cystitis is self-limiting, reserve ciprofloxacin tablets for treatment of acute uncomplicated cystitis in patients who have no alternative treatment options.
Complicated Urinary Tract Infection and Pyelonephritis
in
Pediatric
Patients
Ciprofloxacin tablets are indicated in pediatric patients aged one to 17 years of age for treatment of complicated urinary tract infections (cUTI) and pyelonephritis due to
Escherichia coli [see Use in Specific Populations (
8.4
)].
Although effective in clinical trials, ciprofloxacin tablets are not a drug of first choice in the pediatric population due to an increased incidence of adverse reactions compared to controls, including reactions related to joints and/or surrounding tissues
. Ciprofloxacin tablets, like other fluoroquinolones, is associated with arthropathy and histopathological changes in weight-bearing joints of juvenile animals
[see
Warnings
and
Precautions
(
5.13
),
Adverse
Reactions
(
6.1
),
Use
in
Specific
Populations
(
8.4
)
and
Nonclinical
Toxicology
(
13.2
)].
1
.1
2
Acute Sinusitis
Ciprofloxacin tablets are indicated in adult patients for treatment of acute sinusitis caused by
Haemophilus influenzae, Streptococcus pneumoniae,
or
Moraxella catarrhalis.
Because fluoroquinolones, including ciprofloxacin tablets, have been associated with serious adverse reactions
[see Warnings and Precautions (
5.1
to
5.16
)]
and for some patients acute sinusitis is self-limiting, reserve ciprofloxacin tablets for treatment of acute sinusitis in patients who have no alternative treatment options.
1.1
3
Usage
To reduce the development of drug-resistant bacteria and maintain the effectiveness of ciprofloxacin tablets and other antibacterial drugs, ciprofloxacin tablets 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.
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 tablets may be initiated before results of these tests are known; once results become available appropriate therapy should be continued.
As with other drugs, some isolates 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.