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Overview of the tip topic

Ciprofloxacin, often shortened to Cipro, is an antibiotic from the fluoroquinolone group. Its main action is to stop susceptible bacteria from reproducing and to kill some strains directly.

This medicine treats specific bacterial infections and is not effective for viral illnesses such as the common cold or seasonal influenza. Clinical judgement and, when available, microbiology tests guide the decision to use ciprofloxacin.

Uses and key points

In routine practice in Great Britain ciprofloxacin may be selected for infections including:

• UTIs in adults, including selected complicated cases
• Certain infections of the lower respiratory tract
• Skin and soft tissue infections
• Some gastrointestinal infections caused by susceptible bacteria
• Bone and joint infections in certain circumstances

Prescribers in the UK pay attention to antimicrobial stewardship and local resistance trends before choosing ciprofloxacin. For guidance on legal requirements and supply see the section UK statutory status and rules.

Presentations and strengths

Common oral tablet strengths available in the UK are 250 mg, 500 mg and 750 mg. Injectable formulations and ophthalmic or otic preparations also exist but are not covered in depth here.

The correct dose and duration vary according to the infection type, how severe it is, the patient weight, coupled with the function of the kidneys and liver. Always adhere to the dose written on your prescription.

Before using ciprofloxacin

Tell your doctor or pharmacist about any of the following before you begin the task ciprofloxacin:

• Previous tendon problems or a diagnosis of myasthenia gravis
• Any history of heart rhythm abnormalities, especially prolonged QT interval, or electrolyte disturbances
• Kidney or liver function decline
• A seizure disorder or other conditions that increase seizure risk
• An allergy to ciprofloxacin, other quinolones or any component of the product
• Pregnancy, planning to become pregnant, or breastfeeding
• Patient is a child or adolescent, as use is generally limited and needs specialist input
• G6PD deficiency or existing peripheral neuropathy

If you are unsure about any item above, consult the prescriber prior to taking the medicine.

How to take with care and administer

Swallow tablets with a full glass of water and space doses evenly through the day. Complete the whole course prescribed even if you feel better before it ends. Do not increase the frequency of dosing above what is recommended.

Ciprofloxacin may be taken with or without food. Consuming dairy as part of a meal is acceptable, but avoid taking the tablet at the same time as a plain glass of milk, yogurt or a calcium-fortified beverage.

Mineral-containing products interfere with absorption. Do not take antacids or products that contain aluminium, magnesium, calcium, iron or zinc for 6 hours before or for 2 hours after a dose of ciprofloxacin. For more the description of the the back and forth of communication refer to Cross the act of interactions create opportunities for collaboration. among prescription medications with other medicines.

Minors should be under specialist care for dosing and formulation choices.

Missing dose with overdosed

If a dose is neglected, take it when you remember unless the next scheduled dose is imminent. Do not take two doses at once to make up for a missed one.

If an experienced an overdose is suspected or severe symptoms occur after taking ciprofloxacin, seek urgent help. In the UK contact NHS 111 for advice or call 999 / attend A and E for life-threatening signs.

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Some medicines should not be used with ciprofloxacin unless under specialist supervision. Refrain from combining ciprofloxacin with:

• A medication called Tizanidine
• As a prokinetic drug, cisapride helps coordinate GI motility.
• Terfenadine, an antihistamine
• Droperidol in drug therapy

Other agents that commonly interact include:

• Antacids and mineral supplements containing aluminium, magnesium, calcium, iron or zinc
• Multivitamin products
• Sucralfate and some formulations of didanosine
• Warfarin with other oral anticoagulant agents
• Theophylline, sometimes referred to as dimethylxanthine, methotrexate and phenytoin
• NSAIDs such as ibuprofen or naproxen
• Certain diabetes medicines that can cause low blood glucose
• Some proton pump inhibitors and drugs affecting cytochrome P450 enzymes
• Caffeine-containing medicines or beverages (may amplify stimulant effects)
• Cyclosporine and probenecid combination therapy

Not all items are shown in this list. Provide your healthcare team with a full list of prescribed medicines, over-the-counter products, herbal remedies and supplements before starting ciprofloxacin.

Heads up together with metric monitoring

• If your infection does not improve or symptoms worsen, contact your prescriber promptly.
• Do not use anti-diarrhoeal medicines without advice. Severe or persistent diarrhoea may indicate Clostridioides difficile infection and needs urgent assessment.
• Ciprofloxacin can cause dizziness, drowsiness or changes in vision. Do not drive vehicles or operate heavy machinery until you know how the drug affects you.
• Avoid excessive sun exposure and use sun protection since photosensitivity reactions can occur.
• Keep ciprofloxacin separate from mineral-containing products as explained under How to take control and administer.
• Stop taking the drug and seek urgent medical advice if you develop tendon pain or swelling, new sensory symptoms like persistent tingling or numbness, or marked mood or behavior changes.

Possible treatment-related effects

If you experience serious reactions seek immediate medical attention. Serious signs include:

• Allergic reactions: widespread rash, hives, swelling of face or throat
• Breathing is difficult
• Severe psychiatric effects such as hallucinations, confusion or extreme mood changes
• Marked lightheadedness, fainting or repeated falls
• Heart rhythm changes or palpitations
• Tendon, muscle or joint pain and swelling
• Difficulty passing urine or blood in the urine
• Severe skin reactions like blistering or peeling
• Seizure crises
• New numbness, persistent tingling or weakness

More frequent but usually milder effects that often resolve include:

• Bowel looseness or soft, loose stools
• Nausea, stomach discomfort or abdominal pain
• Oral thrush presenting with white patches in the mouth

To report suspected adverse reactions in the UK use the MHRA Yellow Card scheme; see Help, advice and reporting additional details can be found here.

Safekeeping and disposal

• Put medicines in a place where children cannot see or touch them.
• Store tablets at room temperature, below 30 degrees C, in a tightly closed container away from direct sunlight.
• Do not use the product after the expiry date printed on the pack.
• Return any unused or out of date antibiotics to a pharmacy for safe disposal. Do not retain leftover antibiotics for another episode or share them with others.

Substitute drugs and related medications

Other fluoroquinolones related to ciprofloxacin include levofloxacin, ofloxacin and moxifloxacin; norfloxacin is used less commonly in the UK. While they share some properties, each agent has distinct licensed uses and safety considerations.

Non-fluoroquinolone options frequently considered depending on the infection and likely organism include:

• For many lower urinary infections: nitrofurantoin, trimethoprim, pivmecillinam or fosfomycin
• For common respiratory infections: amoxicillin, doxycycline or clarithromycin
• For skin infections: flucloxacillin, doxycycline or clindamycin

Therapy choice should follow culture results when available and local or national guidelines to reduce resistance and minimize avoidable harms. Discuss options and risks in conjunction with your prescriber.

Price levels in the UK

Below are general notes about NHS prescription charges and indicative private costs in Great Britain, shown in GBP.

• NHS prescriptions: in Engltogether with the standard per-item charge applies (check current rate; historically around 9.worth 90 pounds sterling Scotland, Wales and Northern Ireland have free prescription services.
• Private purchase: retail prices differ by pharmacy, supplier and pack size; consultation and dispensing fees may be added.

Approximate private narrow price ranges for generic products (indicative only):

• Ciprofloxacin 250 mg tablets, pack of 10: about 5 to 15 GBP
• Ciprofloxacin 500 mg tablets, pack of 10: about 8 to 25 GBP
• Ciprofloxacin 750 mg tablets, pack of 10: about 12 to 30 GBP
• Nitrofurantoin 100 mg capsules, pack of 14: about 8 to 20 GBP
• Trimethoprim 200 mg tablets, pack of 14: about 5 to 12 GBP
• Doxycycline 100 mg capsules, pack of 14: about 5 to 15 GBP

Prices shift with supply and pharmacy policy. Always confirm the final price and ask whether a consultation fee applies before purchasing.

UK the current legal status and rules

• Classification: ciprofloxacin is a Prescription Only Medicine (POM) in the UK and requires a valid prescription for supply.
• Prescription validity: you must be prescribed by a clinician registered to practice in the UK to obtain ciprofloxacin from UK dispensing chemists.
• Online supply: order only from pharmacies registered with the General Pharmaceutical Council (GPhC). Legitimate online sellers will display their GPhC registration.
• Antimicrobial stewardship: British government guidance restricts routine use of fluoroquinolones because of resistance and immense potential serious adverse health effects; prescribers will usually consider optional choices when suitable.
• Special populations: use in children is limited and pregnancy or breastfeeding is generally avoided unless the expected benefit outweighs the risk.
• Transport and import: when travelling keep medicines in original packaging with the prescription; importing POMs is subject to rules and restrictions for personal use.

For advice on safe online purchase and legitimate supply see Help, advice and reporting and consult your pharmacist.

Help, advice and reporting

• In emergencies call 999 for life-threatening situations. For urgent non-life-threatening advice call NHS 111.
• To report suspected adverse reactions in the UK use the MHRA Yellow Card scheme online and include as much clinical detail as possible.
• Your GP, community pharmacist or NHS websites are reliable sources for patient information leaflets and personalised steady direction.

Educational note: this page provides general information and does not replace professional medical assessment, diagnosis or treatment. Follow instructions on your prescription merged with the patient information leaflet that comes with the medicine.