What is the role of ciprofloxacin in intravenous-to-oral switch therapy?

Updated: Jul 30, 2018
  • Author: Shirin A Mazumder, MD, FIDSA; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Ciprofloxacin also has a role in IV-to-PO switch therapy. Giamarellou and colleagues demonstrated that high-dose ciprofloxacin administered intravenously for at least 3 days and then orally is therapeutically equivalent to the routine regimen of intravenous ceftazidime plus amikacin, even in febrile patients with severe neutropenia (ie, polymorphonuclear leukocyte count, < 100/µL). [28]

Solomkin and colleagues studied patients with complicated intra-abdominal infections, who were randomized to receive either (1) intravenous ciprofloxacin plus metronidazole or intravenous imipenem throughout their treatment course or (2) intravenous ciprofloxacin plus metronidazole and treatment with oral ciprofloxacin plus metronidazole when oral feeding was resumed. The study demonstrated statistical equivalence between intravenous ciprofloxacin plus metronidazole and intravenous imipenem in both the intent-to-treat and valid populations. Conversion to oral therapy with intravenous ciprofloxacin plus metronidazole appeared as effective as continued intravenous therapy in patients able to tolerate oral feedings. [29]

Ciprofloxacin (Cipro) is a fluoroquinolone with activity against pseudomonads and most gram-negative organisms but no activity against anaerobes. It inhibits bacterial DNA synthesis and, consequently, growth. Continue treatment for at least 2 d (7-14 d typical) after signs and symptoms have disappeared. The adult dose is 250-500 mg PO bid for 7-14 d. It is not indicated in children. Ciprofloxacin is a pregnancy category C medication.

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