Fluoroquinolone Antibiotic Pregnancy: As a precautionary measure it is preferable to avoid the use of ciprofloxacin during pregnancy. Ciprofloxacin is excreted in breast milk and, due to the potential risk of articular damage, should not be used during breast-feeding.

Ciprofloxacin (Orthopaedic — Gram-negative Osteomyelitis)

Brand names: Ciproxin

This page covers oral or intravenous ciprofloxacin used in orthopaedics specifically for Gram-negative osteomyelitis, where its excellent oral bioavailability and bone penetration make it valuable for prolonged treatment of susceptible Enterobacterales and Pseudomonas. It is typically directed by culture and microbiology advice.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 500 mg twice daily to 750 mg twice daily

Route: Oral — tablets swallowed unchewed with fluid, independent of mealtimes; not to be taken with dairy products (e.g. milk, yoghurt) or mineral-fortified fruit juice (e.g. calcium-fortified orange juice)

Frequency: Twice daily

Max: Bone and joint infections: maximum total duration of treatment 3 months. Highest adult dose stated anywhere in this SPC is 750 mg twice daily.

SPC §4.2 adult table, verbatim row: 'Bone and joint infections — 500 mg twice daily to 750 mg twice daily — max. of 3 months' (total duration potentially including initial parenteral treatment with ciprofloxacin). §4.2 also states that treatment of infections due to certain bacteria (e.g. Pseudomonas aeruginosa, Acinetobacter or Staphylococci) may require higher ciprofloxacin doses and co-administration with other appropriate antibacterial agents, and that infections of bones and joints may require co-administration with other appropriate antibacterial agents depending on the pathogens involved. §4.4: ciprofloxacin monotherapy is not suited to severe infections or infections that might be due to Gram-positive or anaerobic pathogens. In severe cases, or if the patient is unable to take tablets, it is recommended to commence therapy with intravenous ciprofloxacin until a switch to oral administration is possible. Elderly: dose selected according to severity of the infection and the patient's creatinine clearance. Hepatic impairment: no dose adjustment required. PAEDIATRIC (§4.2 table — there is NO bone and joint infection row): cystic fibrosis 20 mg/kg twice daily (max 750 mg per dose); complicated urinary tract infection and pyelonephritis 10 mg/kg to 20 mg/kg twice daily (max 750 mg per dose); inhalation anthrax post-exposure 10 mg/kg to 15 mg/kg twice daily (max 500 mg per dose); other severe infections 20 mg/kg twice daily (max 750 mg per dose). The SPC states no paediatric bone/joint infection dose, and dosing in children with impaired renal and/or hepatic function has not been studied — verify against a children's formulary before prescribing. PROVENANCE: fetched eMC product is Ciprofloxacin 250 mg film-coated tablets. The openFDA fallback held in this bundle is a ciprofloxacin OPHTHALMIC (eye-drop) label (corneal ulcers / bacterial conjunctivitis) and was deliberately not used. §4.5 (interactions) was not part of the fetched bundle — the interaction entries below come from §4.3 and §4.2. §4.4 and §4.8 were truncated at the source-fetch limit.

Dose adjustments

Renal

Recommended starting and maintenance oral doses by creatinine clearance (mL/min/1.73 m2): >60 (serum creatinine <124 micromol/L) — usual dosage; 30–60 (124–168 micromol/L) — 250–500 mg every 12 hours; <30 (>169 micromol/L) — 250–500 mg every 24 hours; haemodialysis — 250–500 mg every 24 hours (after dialysis); peritoneal dialysis — 250–500 mg every 24 hours. No dose adjustment is required in impaired liver function.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance, to other quinolones or to any of the excipients
Concomitant administration of ciprofloxacin and tizanidine

Side effects

Nausea and diarrhoea (the most commonly reported adverse drug reactions)
Vomiting, gastrointestinal and abdominal pain, dyspepsia
Headache, dizziness, sleep disorders, taste disorders
Prolonged (months to years), disabling and potentially irreversible serious adverse reactions affecting multiple body systems including musculoskeletal, nervous, psychiatric and senses (§4.4) — discontinue immediately at the first sign
Seizures (including status epilepticus), peripheral neuropathy and polyneuropathy, psychotic/depressive reactions potentially culminating in suicidal ideation
Ventricular arrhythmia and torsades de pointes with QT prolongation (predominantly in patients with risk factors); anaphylactic reaction/shock; antibiotic-associated colitis; tendon disorders were not present in the retrieved (truncated) §4.8 text

Interactions

Tizanidine — concomitant administration is contraindicated (§4.3, cross-referring to §4.5)
Dairy products (e.g. milk, yoghurt) and mineral-fortified fruit juice (e.g. calcium-fortified orange juice) — tablets should not be taken with these (§4.2, cross-referring to §4.5)
Full §4.5 interaction section was not retrieved in this bundle — check the SPC directly before relying on this list

Clinical monograph

How it works

Ciprofloxacin is a fluoroquinolone that inhibits bacterial DNA gyrase and topoisomerase IV, blocking DNA replication and producing bactericidal killing of many Gram-negative organisms.

Prescribing in practice

MHRA warns of rare but serious, sometimes irreversible, disabling musculoskeletal and neurological adverse effects including tendinitis and tendon rupture (especially Achilles, higher risk with corticosteroids and in older patients) — stop at the first sign of tendon pain and avoid in those with prior fluoroquinolone tendon injury.
It prolongs the QT interval and lowers the seizure threshold, so review concurrent QT-prolonging drugs and use caution in epilepsy; it also interacts strongly with theophylline and with divalent/trivalent cations that impair absorption.
Confirm susceptibility before relying on it for bone infection, separate doses from antacids, dairy and iron/calcium, and adjust frequency in renal impairment per the SPC.

Monitoring

Monitor clinical and biochemical response of the bone infection, and remain alert for tendon, neurological, QT and glycaemic adverse effects throughout the prolonged course.

Counselling the patient

Stop the drug and seek advice at once if you develop tendon, joint or muscle pain or swelling, or new numbness or tingling.
Do not take it at the same time as indigestion remedies, dairy products or iron/calcium supplements.
Avoid excessive sun exposure as the skin can become more sensitive to light.

Evidence & guidelines

MHRA Drug Safety Updates restrict systemic fluoroquinolones to situations where other antibiotics are unsuitable because of the risk of long-lasting and disabling adverse effects.

Reference: MHRA DSU 2019 and 2023 (Fluoroquinolone Restrictions); IDSA Osteomyelitis Guidelines 2012; NICE Antimicrobials; SPC Ciproxin; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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