Intravenous ciprofloxacin: a position statement by the Society of Infectious Diseases Pharmacists

Intravenous ciprofloxacin is approved for the treatment of urinary tract, bone and joint, skin and soft tissue, and lower respiratory tract infections. Few large, randomized studies comparing its effectiveness with that of other available agents exist; most of these have been published in non-peer-reviewed journal supplements. Intravenous ciprofloxacin is nearly ten times more expensive than the "equivalent" oral dose. Based on the limitations of currently available clinical data, iv ciprofloxacin does not appear to be superior, and is at best comparable in efficacy to other currently available antibiotics. Bacterial resistance, especially in serious infections secondary to P. aeruginosa and S. aureus, is becoming more prevalent. Intravenous ciprofloxacin should be considered an alternative for the treatment of infections of the urinary and lower respiratory tracts only when the following conditions exist: (1) documented bacterial resistance to less-costly regimens with proven efficacy for these indications (e.g., beta-lactams, aminoglycosides, trimethoprim/sulfamethoxazole) and known susceptibility to ciprofloxacin, (2) documented hypersensitivity to first-line agents, or (3) inability to ingest or absorb oral ciprofloxacin. Further clinical trials using higher doses are required before iv ciprofloxacin can be recommended routinely for treatment of serious systemic infections. Because of its poor activity against streptococci, marginal activity against some strains of P. aeruginosa, and the rapidly developing resistance of staphylococci, iv ciprofloxacin should not be used empirically for infections in settings (such as the intensive care unit) where these organisms are likely to be pathogenic.