Ciprofloxacin

PD Dialyzability: Likely

Pharmacokinetic Parameters [1] [2]

  Ciprofloxacin
Molecular Weight (Da) 331.35
Plasma Protein Binding (%) 20 - 40
Volume of Distribution (L/Kg) 2.5
Hepatic Metabolism Partial hepatic metabolism. Metabolites have antimicrobial activity.
Excreted Unchanged (%) 40 - 70
Half-Life; Normal Renal Function (hours) 3 - 6
Half-Life; ESRD (hours) 6 - 9

CAPD Dosing: [3] [4] [5]

  • Ciprofloxacin 500mg PO daily or 250mg PO BID
  • Ciprofloxacin 200mg IV Q12H
  • Ciprofloxacin 50mg/L exchange (LD), 25mg/L (MD)

CCPD Dosing:

  • Extrapolate dosing from CAPD dosing recommendations.
  • Consider ciprofloxacin 400mg IV BID [6]
  • Consider ciprofloxacin 750mg PO BID [7]

Indication Specific PD Dosing:

  • Peritonitis: Ciprofloxacin 250mg PO BID [8]
  • Exit-Site Infections: Ciprofloxacin 500mg PO BID [9]
  • Catheter-related infections: Ciprofloxacin 250mg PO BID or 500mg PO Daily [10]

Literature Summary:

  • PO Dosing
Title Patient Intervention Outcome Note
Peritoneal dialysis-related peritonitis due to Mycobacterium smegmatis. [11]
  • CAPD
  • 61 year old male
  • 3 day history consistent with peritonitis
  • Diagnosied with peritonitis due to Mycobacterium smegmatis
  • Ciprofloxacin 500mg PO daily x 6 months + SMX/TMP 1600/320mg PO twice weekly x 6 months
  • Symptoms of peritonitis
  • No ADR reported
Simultaneous peritoneal dialysis-associated peritonitis and bacteremia due to ceftriaxone-resistant Campylobacter fetus [12]
  • CAPD
  • 51 year old male
  • Presenting with fever, chills, abdominal pain, nausea and vomiting x 3 days
  • Diagnosed with peritonitis due to Campylobacter fetus
  • Initially treated with Ciprofloxacin 250mg IV TID + Gentamicin 36mg daily x 14 days
  • IV-to-PO stepped down to Ciprofloxacin 500mg PO daily to complete 21 days of therapy
  • Improvement of abdominal pain
  • Follow up blood and peritoneal dialysate cultures
  • No ADR reported
First reported case of Alcaligenes faecalis peritonitis. [13]
  • CAPD
  • 83 year old female
  • Presenting with fever, abdominal pain, nausea, vomiting, and cloudy dialysate
  • Diagnosed with peritonitis due to Alcaligenes faecalis
  • Ciprofloxacin 100mg IV BID x 5 days
  • IV-to-PO stepped down to Ciprofloxacin 250mg PO BID
  • Clinical improvement
  • Dialysate WBC
  • No ADR reported
Successful treatment of Alcaligenes xylosoxidans in automated peritoneal dialysis-related peritonitis. [14]
  • CAPD
  • 72 year old female presenting with cloudy dialysate and tender exit site with brown purulent discharge
  • Diagnosed with peritonitis due to Alcaligenes xylosoxidans
  • Ciprofloxacin 500mg PO BID x 10 days + imipenem IP
  • Follow up cultures
  • No ADR reported
Peritonitis by Rhizobium radiobacter. [15]
  • CAPD
  • 63 year old male
  • Presenting with cloudy dialysate fluid
  • Diagnosed with peritonitis due to Rhizobium radiobacter
  • Ciprofloxacin 500mg PO Q12H + Cefotaxime 1g/ exchange IP x 21 days
  • Clinical response
  • No ADR reported
Ciprofloxacin treatment of bacterial peritonitis associated with chronic ambulatory peritoneal dialysis caused by Neisseria cinerea. [16]
  • CAPD
  • 38 year old male
  • Presenting with diarrhea, severe abdominal pain, and cloudy dialysate fluid
  • Diagnosed with peritonitis due to Neisseria cinerea
  • Ciprofloxacin 500mg PO BID + Gentamicin 40mg IP x 10 days
  • Clinical symptoms
  • CRP
  • Dialysate fluid cell count
  • No ADR reported
Yersinia pseudotuberculosis bacteraemia in a kidney transplant patient. [17]
  • CAPD
  • 54 year old male
  • On long term immunosuppression with mycophenolate and prednisone after kidney transplant
  • Presenting with lower back pain, fever and chills
  • Diagnosed with bacteremia due to Yersinia pseudotuberculosis
  • Ciprofloxacin 500mg PO BID
  • Resolution of fever, osteolytic lesion on spinal MRI
  • No ADR reported
Mycobacterium abscessus: A cutaneous infection in a patient on renal replacement therapy. [18]
  • CAPD
  • 72 year old male
  • Presenting with multiple non-tender fluctuant swelling on both lower legs
  • Diagnosed with cutaneous infection due to Mycobacterium abscessus
  • Ciprofloxacin 250mg PO BID + Clarithromycin 250mg PO BID
  • Clinical improvement
  • No ADR reported
Successful use of recombinant tissue plasminogen activator in a patient with relapsing peritonitis. [19]
  • CAPD
  • 31 year old male
  • Presenting with symptoms history of 3 episodes of peritonitis
  • Diagnosed with peritonitis due to Enterobacter cloacae
  • Ciprofloxacin 500mg PO BID + Cefepime IP + tPA IP
  • Clinical improvement
  • No ADR reported
Peritoneal catheter exit-site infections caused by rapidly-growing atypical mycobacteria [20]
  • CAPD
  • 5 cases of exit-site infection due to Mycobacterium SPP
  • Ciprofloxacin 500mg PO Q12H
  • Infection resolution
  • No ADR reported
Treatment of acute peritonitis by temporary discontinuation of dialysis and low doses of oral ciprofloxacin in patients on CAPD. [21]
  • CAPD
  • 13 patients with peritonitis
  • Ciprofloxacin 500mg PO BID
  • Infection resolution
  • No ADR reported
  • CAPD was interrupted for 72 hours after initiation of antibiotic
Pharmacokinetics of oral ciprofloxacin in continuous cycling peritoneal dialysis. [7]
  • CCPD
  • 8 healthy patients
  • Ciprofloxacin 750mg PO Q12H
  • Serum concentration
  • MIC for E. coli and Klebsiella SPP
  • No ADR reported
Linezolid disposition during peritonitis: A case report. [22]
  • CCPD
  • 78 year old male
  • Presenting with vomiting, abdominal pain and fever
  • Diagnosed with peritonitis due to Escherichia coli
  • Ciprofloxacin 500mg PO BID + Cefazolin 150mg/L IP
  • Treatment failure per infectious symptoms
  • Patient switched to IV linezolid and levofloxacin
  • No ADR reported
  • IV Dosing
Title Patient Intervention Outcome Note
Severe septicemia, necrotizing fasciitis, and peritonitis due to Vibrio vulnificus in a patient undergoing continuous ambulatory peritoneal dialysis: A case report. [23]
  • CAPD
  • 37 year old male presenting with weakness, fever, diarrhea and abdominal pain
  • History of ingestion of raw seafood prior to symptom onset
  • Diagnosed with septicemia, nacrotizing fascitis, and peritonitis due to Vibrio vulnifucus
  • Ciprofloxacin 200mg IV BID + Cefotaxime 1 g IV Q12H + Ceftazidime 1g IP QD x 4 weeks
  • Recovery after 4 weeks of therapy
  • No ADR reported
Morphological analysis of biofilm of peritoneal dialysis catheter in refractory peritonitis patient. [24]
  • CAPD
  • 66 year old male
  • Presenting with multi-organism peritonitis
  • Ciprofloxacin 200mg IV Q12H
  • Inflammatory reaction disappeared within 1 week of therapy
  • No ADR reported
Simultaneous peritoneal dialysis-associated peritonitis and bacteremia due to ceftriaxone-resistant Campylobacter fetus. [25]
  • CAPD
  • 51 year old male
  • Presenting with 5th peritonitis recurrence demonstrating ascites and abdominal distension
  • Diagnosed with peritonitis due to Alcaligenes xylosoxidans
  • Initially treated with Ciprofloxacin 250mg IV TID + Gentamicin 36mg daily x 14 days
  • Improvement of abdominal pain
  • No ADR reported
First reported case of Alcaligenes faecalis peritonitis. [13]
  • CAPD
  • 83 year old female
  • Presenting with fever, abdominal pain, nausea, vomiting, and cloudy dialysate
  • Diagnosed with peritonitis due to Alcaligenes faecalis
  • Ciprofloxacin 100mg IV BID x 5 days
  • IV-to-PO stepped down to Ciprofloxacin 250mg PO BID
  • Clinical improvement
  • Dialysate WBC
  • No ADR reported
Severe peritonitis due to Pantoea agglomerans in a CCPD patient. [6]
  • CCPD
  • 65 year old male
  • Presenting with abdominal pain
  • Diagnosed with peritonitis due to Pantoea agglomerans
  • Ciprofloxacin 400mg IV BID+ Ceftazidime 2g IP x 21 days
  • Clinical improvement
  • Reduction of CRP
  • No ADR reported
Simultaneous peritoneal dialysis-associated peritonitis and bacteremia due to ceftriaxone-resistant Campylobacter fetus. [12]
  • CAPD
  • 51 year old male
  • Presenting with fever, chills, abdominal pain, nausea and vomiting x 3 days
  • Diagnosed with peritonitis due to Campylobacter fetus
  • Initially treated with Ciprofloxacin 250mg IV TID + Gentamicin 36mg daily x 14 days
  • IV-to-PO stepped down to Ciprofloxacin 500mg PO daily to complete 21 days of therapy
  • Improvement of abdominal pain
  • Follow up blood and peritoneal dialysate cultures
  • No ADR reported

References

[1]Wishart DS, Knox C, Guo AC, Shrivastava S, Hassanali M, Stothard P, et al. DrugBank: a comprehensive resource for in silico drug discovery and exploration. Nucleic Acids Res. 2006 Jan 1;34(suppl_1):D668–72.
[2]American Pharmacist Association. Drug information handbook: a comprehensive resource for all clinicians and healthcare professionals [Internet]. Hudson, Ohio: American Pharmacist association; 2012 [cited 2018 Jan 24]. Available from: http://online.lexi.com.login.ezproxy.library.ualberta.ca/lco/action/home?siteid=1
[3]Gilbert B, Robbins P, Livornese LL. Use of Antibacterial Agents in Renal Failure. Med Clin North Am. 2011;95(2):677–702.
[4]Aronoff GR. Drug prescribing in renal failure: dosing guidelines for adults and children. 5th ed. Philadelphia, PA: American College of Physicians; 2007.
[5]Adjusting oral antibiotics to estimated creatinine clearance [Internet]. [cited 2018 Jan 24]. Available from: http://www.vhpharmsci.com/VHFormulary/Tools/ADJUSTING%20ORAL%20ANTIBIOTICS.pdf
[6](1, 2) Magnette C, Tintillier M, Horlait G, Cuvelier C, Pochet JM. Severe peritonitis due to Pantoea agglomerans in a CCPD patient. Perit Dial Int J Int Soc Perit Dial. 2008;28(2):207–208.
[7](1, 2) Yeung SM, Walker SE, Tailor S a N, Awdishu L, Tobe S, Yassa T. Pharmacokinetics of oral ciprofloxacin in continuous cycling peritoneal dialysis. Perit Dial Int J Int Soc Perit Dial. 2004;24(5):447–53.
[8]Li PK-T, Szeto CC, Piraino B, Arteaga J de, Fan S, Figueiredo AE, et al. ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment. Perit Dial Int. 2016 Sep 1;36(5):481–508.
[9]Krediet RT, European Best Practice Guideline working group on Peritoneal Dialysis. European Best Practice Guidelines for Peritoneal Dialysis: 3. Peritoneal Access. Nephrol Dial Transplant. 2005;20(suppl_9):ix8–ix12.
[10]Szeto C-C, Li PK-T, Johnson DW, Bernardini J, Dong J, Figueiredo AE, et al. ISPD Catheter-Related Infection Recommendations: 2017 Update. Perit Dial Int. 2017 Mar 1;37(2):141–54.
[11]Jiang SH, Senanayake S, Talaulikar GS. Peritoneal dialysis-related peritonitis due to Mycobacterium smegmatis. Perit Dial Int J Int Soc Perit Dial. 2011;31(2):215–6.
[12](1, 2) Lee YC, Huang YT, Sheng WH, Hsueh PR. Simultaneous peritoneal dialysis-associated peritonitis and bacteremia due to ceftriaxone-resistant Campylobacter fetus. Perit Dial Int J Int Soc Perit Dial. 2011;31(3):366–8.
[13](1, 2) Kavuncuoglu F, Unal A, Oguzhan N, Tokgoz B, Oymak O, Utas C. First reported case of Alcaligenes faecalis peritonitis. Perit Dial Int. 2010;30(1):118–119.
[14]Ledge SG, Cordy P. Successful treatment of Alcaligenes xylosoxidans automated peritoneal dialysis-related peritonitis. Perit Dial Int. 2007;27:596–599.
[15]Minguela J, De-Pablos M. Peritonitis by Rhizobium radiobacter. Perit Dial Ldots. 2006;26(2):8608.
[16]Taegtmeyer M, Saxena R, Corkill JE, Anijeet H, Parry CM. Ciprofloxacin treatment of bacterial peritonitis associated with chronic ambulatory peritoneal dialysis caused by Neisseria cinerea. J Clin Microbiol. 2006;44(8):3040–1.
[17]Van Zonneveld M, Droogh JM, Fieren MW, Gyssens IC, Van Gelder T, Weimar W. Yersinia pseudotuberculosis bacteraemia in a kidney transplant patient. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc. 2002;17(12):2252–2254.
[18]Fletcher C, Brown T, Hay R. Mycobacterium abscessus : a cutaneous infection in a patient on renal replacement therapy. Clin Exp Dermatol. 2001;26:415–418.
[19]Duch JM, Yee J. Successful Use of Recombinant Tissue Plasminogen Activator in a Patient With Relapsing Peritonitis. Am J Kidney Dis. 2001;37(1):149–153.
[20]Hevia C, Bajo M. Peritoneal catheter exit-site infections caused by rapidly-growing atypical mycobacteria. Nephrol Dial Ldots. 2000;(May 1997):1458–1460.
[21]Usberti M, Gazzotti RM, Mileti M, Brazzoli A, Zucca F, Depetri G, et al. Treatment of acute peritonitis by temporary discontinuation of dialysis and low doses of oral ciprofloxacin in patients on CAPD. Perit Dial Int. 1994 Jan 1;14(2):185–6.
[22]Allcok NM, Krueger TS, Kumar VK, Abdallah J. Linezolid disposition during peritonitis: a case report. Perit Dial Int. 2004;24:68–70.
[23]Kim CS, Bae EH, Ma SK, Kim SW. Severe septicemia, necrotizing fasciitis, and peritonitis due to Vibrio vulnificus in a patient undergoing continuous ambulatory peritoneal dialysis: a case report. BMC Infect Dis. 2015;15(1):422.
[24]Kusaba T, Kirita Y, Ishida R, Matsuoka E, Nakayama M, Uchiyama H, et al. Morphological analysis of biofilm of peritoneal dialysis catheter in refractory peritonitis patient. CEN Case Rep. 2012;1(1):50–54.
[25]Tsai S-F, Shu K-H. CAPD peritonitis caused by Alcaligenes xylosoxidans in a diabetic cirrhosis patient. Ren Fail. 2010;32(7):899–901.