Mild/moderate: 500 mg PO q12hr or 400 mg IV q12hr for 10 daysLimitations-of-use: Reserve fluoroquinolones for patients who do not have other available treatment options for acute sinusitisMild/moderate: 500 mg PO q12hr or 400 mg IV q12hr for ≥4-6 weeksSevere/complicated: 750 mg PO q12hr or 400 mg IV q8hr for ≥4-6 weeksIndicated for chronic bacterial prostatitis caused by Escherichia coli or Proteus mirabilisMild/moderate: 500 mg PO q12hr or 400 mg IV q12hr for 28 daysComplicated: 500 mg PO q12hr or 400 mg IV q12hr for 7-14 daysMild/moderate: 500 mg PO q12hr or 400 mg IV q12hr for 7-14 daysSevere/complicated: 750 mg PO q12hr or 400 mg IV q8hr for 7-14 daysLimitations-of-use: Reserve fluoroquinolones for patients who do not have other available treatment options for acute bacterial exacerbation of chronic bronchitisMild/moderate/severe: 400 mg IV q8hr for 10-14 daysMild/moderate: 500 mg PO q12hr or 400 mg IV q12hr for 7-14 daysSevere/complicated: 750 mg PO q12hr or 400 mg IV q8hr for 7-14 daysAcute uncomplicated: Immediate-release, 250 mg PO q12hr for 3 days; extended-release, 500 mg PO q24hr for 3 daysMild/moderate: 250 mg PO q12hr or 200 mg IV q12hr for 7-14 daysSevere/complicated: 500 mg PO q12hr or 400 mg IV q12hr for 7-14 daysLimitations-of-use: Reserve fluoroquinolones for patients who do not have other available treatment options for uncomplicated urinary tract infectionsInhalation (prophylaxis/postexposure): 500 mg PO q12hr or 400 mg IV q12hr for 60 daysCutaneous: 500 mg PO q12hr or 400 mg IV q12hr for 60 daysIndication for treatment and prophylaxis of plague due to Yersinia pestisDry powder for inhalation: Orphan designation for patients with NCFB who suffer from frequent severe acute pulmonary bacterial exacerbations which lead to further inflammation, airway, and lung parenchyma damageProQuin XR should be taken with a main meal, preferably evening mealCipro XR may be taken with or without meal; drink fluids liberally≥1 year (IV): 6-10 mg/kg q8hr; individual dose not to exceed 400 mg for 10-21 days ≥1 year (PO): 10-20 mg/kg q12hr; individual dose not to exceed 750 mg q12hr for 10-21 daysMultiple doses: 30 mg/kg/day PO divided q12hr for 3 daysIndication for treatment and prophylaxis of plague due to Yersinia pestis in pediatric patients from birth to 17 years of age15 mg/kg PO q8-12hr x10-21 days; not to exceed 500 mg/dose, OR 10 mg/kg IV q8-12hr x 10-21 days; not to exceed 400 mg/doseIV: 10 mg/kg q12hr for 60 days; individual dose not to exceed 400 mg PO: 15 mg/kg q12hr for 60 days; individual dose not to exceed 500 mgChange antibiotic to amoxicillin as soon as penicillin susceptibility confirmedPO: 40 mg/kg/day divided q12hr; not to exceed 2 g/day IV: 20-30 mg/kg/day divided q8-12hr; not to exceed 1.2 g/dayAcute generalized exanthematous pustulosis (AGEP), erythema multiforme, exfoliative dermatitis, fixed eruption, photosensitivity/phototoxicity reactionAgranulocytosis, albuminuria, serum cholesterol and TG elevations, blood glucose disturbances, hemolytic anemia, marrow depression (life threatening), pancytopenia (life threatening or fatal outcome), potassium elevation (serum)Anaphylactic reactions (including life-threatening anaphylactic shock), serum sickness like reaction, Stevens-Johnson syndromeConstipation, dyspepsia, dysphagia, flatulence, hepatic failure (including fatal cases), hepatic necrosis, jaundice, pancreatitisHypertonia, hypotension (postural), increased INR (in patients treated with Vitamin K antagonists), QT prolongation, torsade de pointes, ventricular arrhythmiaMyasthenia, exacerbation of myasthenia gravis, myoclonus, nystagmus, peripheral neuropathy that may be irreversible, phenytoin alteration (serum), polyneuropathy, psychosisMyalgia, tendinitis, tendon rupture, toxic epidermal necrolysis (Lyell’s Syndrome), twitchingInfections: Candiduria, vaginal candidiasis, moniliasis (oral, gastrointestinal, vaginal), pseudomembranous colitisBecause the risk of these serious side effects generally outweighs the benefits for patients with acute bacterial sinusitis, acute exacerbation of chronic bronchitis, and uncomplicated UTIs, that fluoroquinolones should be reserved for use in patients with these conditions who have no alternative treatment optionsDocumented hypersensitivity; concurrent tizanidine administrationUse in pregnancy, though generally contraindicated for all quinolones, is allowed for life-threatening situations; limited data from use of ciprofloxacin in pregnancy show no higher rate of birth defects than backgroundDo not use oral suspension in nasogastric tube; to prepare, add microcapsules to diluentCommonly seen adverse reactions include tendinitis, tendon rupture, arthralgia, myalgia, peripheral neuropathy, and central nervous system effects (hallucinations, anxiety, depression, insomnia, severe headaches, and confusion); these reactions can occur within hours to weeks after starting therapy, including in patients of any age or without pre-existing risk factors; discontinue therapy immediately at first signs or symptoms of any serious adverse reaction; in addition, avoid use of fluoroquinolones, in patients who have experienced any serious adverse reactions associated with fluoroquinolones (see Black Box Warnings)Peripheral neuropathy: sensory or sensorimotor axonal polyneuropathy affecting small and/or large axons resulting in paresthesias, hypoesthesias, dysesthesias, and weakness reported; peripheral neuropathy may occur rapidly after initiating and may potentially become permanentIn prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); adjust dose in renal impairment; superinfections may occur with prolonged or repeated antibiotic therapy; discontinue use immediately if signs and symptoms of hepatitis occurNot first drug of choice in pediatrics (except in anthrax), because of increased incidence of adverse events in comparison with control subjects, including arthropathy; no data exist on dosing for pediatric patients with renal impairment (ie, CrCl <50 mL/min)Crystalluria may occur; urine alkalinity may increase risk; ensure adequate hydration during therapySerious and sometimes fatal hypoglycemia reported with fluoroquinolone use; hyperglycemia also reported; monitor patients closely for signs/symptoms of abnormal glucose levels; if hypoglycemic reaction occurs in a patient being treated discontinue therapy and initiate appropriate treatment immediatelyModerate-to-severe phototoxicity reactions reported; avoid excessive sunlight and take precautions to limit exposure; discontinue use if phototoxicity occursAcute onset of retinal detachment increased 4.5-fold with oral fluoroquinolones in a single case-controlled study - JAMA 2012;307(13):1414-1419; another study disputes these findings (relative risk, 1.29) - JAMA 2013;310(20):2184-2190Clostridium difficile-associated diarrhea (CDAD) reported; if CDAD suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued; appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be instituted as clinically indicatedPrescribing antibiotics in absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to patient and increases risk of development of drug-resistant bacteriaFluoroquinolones may exacerbate muscle weakness in patients with myasthenia gravis; postmarketing serious adverse reactions, including deaths and requirement for ventilatory support, have been associated with fluoroquinolone use in patients with myasthenia gravis; avoid in patients with known history of myasthenia gravisProlonged experience with ciprofloxacin in pregnant women over several decades, based on available published information from case reports, case control studies and observational studies during pregnancy, have not identified any drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomesOral administration during organogenesis at doses up to 100 mg/kg to pregnant mice and rats, and up to 30 mg/kg to pregnant rabbits did not cause fetal malformations; these doses were up to 0.3, 0.6, and 0.4 times the maximum recommended clinical oral dose in mice, rats, and rabbits, respectively, based on body surface areaPublished literature reports that ciprofloxacin is present in human milk following intravenous and oral administration; there is no information regarding effects on milk production or breastfed infant; because of potential risk of serious adverse reactions in breastfed infants, including arthropathy shown in juvenile animal studiesFor most indications a lactating woman may consider pumping and discarding breast milk during treatment and an additional two days (five half-lives) after last dose; alternatively, advise a woman that breastfeeding is not recommended during treatment and for an additional two days (five half-lives) after last doseHowever, for inhalation anthrax (post exposure), during an incident resulting in exposure to anthrax, the risk-benefit assessment of continuing breastfeeding while the mother (and potentially the infant) is (are) on CIPRO may be acceptableThe developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for therapy and any potential adverse effects on breastfed child from drug or from underlying maternal conditionCiprofloxacin may cause intestinal flora alteration of breastfeeding infant; advise a woman to monitor breastfed infant for loose or bloody stools and candidiasis (thrush, diaper rash)A: Generally acceptable.
Twenty-nine-year-old pregnant woman with history of reflux uropathy and ureteral reimplantation at age 21 months presents with right-side flank pain and proteinuria.
Patients with pyelonephritis can become dehydrated because of nausea and vomiting and need IV hydration. Mazor-Dray E, Levy A, Schlaeffer F, Sheiner E. Maternal urinary tract infection: is it independently associated with adverse pregnancy outcome?. Asymptomatic bacteriuria in pregestational diabetic pregnancies and the role of group B streptococcus. Often, therapy must be initiated on an empirical basis, before culture results are available.
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