Ciprofloxacin: an oral quinolone for the treatment of infections with gram-negative pathogens. Committee on Antimicrobial Agents. Canadian Infectious Disease Society.

OBJECTIVE: To optimize the use of ciprofloxacin, a synthetic fluoroquinolone, in community and hospital practice, and to minimize overprescribing by providing an overview of the literature and recommendations for appropriate use. OPTIONS: First-line treatment for infections in which ciprofloxacin is shown to be effective, treatment with oral ciprofloxacin rather than parenteral therapy with another drug, and step-down therapy with oral ciprofloxacin after initial parenteral treatment. OUTCOMES: In order of importance: efficacy, side effects and cost. EVIDENCE: A MEDLINE search of articles concerning ciprofloxacin, including in-vitro and pharmacokinetic studies using recognized standard methods with appropriate controls and published in recognized peer-reviewed journals, and randomized, controlled, double-blind clinical trials. VALUES: The Committee on Antimicrobial Agents of the Canadian Infectious Disease Society (CIDS) and a recognized expert (T.J.L.) recommended use of ciprofloxacin to treat infections against which it has proved effective both in vitro and in randomized controlled trials. They took into account its value as an oral replacement for other drugs given parenterally and development of resistance. BENEFITS, HARMS AND COSTS: With more appropriate use of ciprofloxacin there will be less development of resistant pathogens. For certain infections patients who would otherwise require admission to hospital could be treated at home and patients initially admitted for parenteral therapy could be discharged sooner on oral therapy with ciprofloxacin. RECOMMENDATIONS: Ciprofloxacin may be considered as first-line treatment for a number of infections in which gram-negative pathogens are proven or strongly suspected, including complicated urinary tract infections, bacterial prostatitis, bacterial diarrhea, selected bone and joint infections, malignant otitis externa, bronchopulmonary infections in patients with cystic fibrosis and selected pneumonia cases. VALIDATION: The paper was prepared, reviewed and revised by the Committee on Antimicrobial Agents of the CIDS. It was then reviewed and revised further by the Council of the CIDS. SPONSOR: The CIDS is solely responsible for developing, funding and endorsing these guidelines.