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Uses

Bone and Joint Infections

Treatment of bone and joint infections (including osteomyelitis) caused by susceptible Pseudomonas aeruginosa, Enterobacter cloacae, or Serratia marcescens; also has been used in bone and joint infections caused by E. aerogenes†, Escherichia coli†, Klebsiella pneumoniae†, Morganella morganii†, or Proteus mirabilis†.

Has been used for treatment of bone and joint infections caused by susceptible gram-positive bacteria, including Staphylococcus aureus†, S. epidermidis†, other coagulase-negative staphylococci†, or Enterococcus faecalis†. Other anti-infectives generally preferred for these gram-positive infections, but ciprofloxacin may be a useful alternative for treatment of infections caused by susceptible oxacillin-resistant (methicillin-resistant) staphylococci.

Endocarditis

Alternative for treatment of native or prosthetic valve endocarditis† caused by fastidious gram-negative bacilli known as the HACEK group (Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Haemophilus aphrophilus, H. influenzae, H. parainfluenzae, H. paraphrophilus, Kingella denitrificans, K. kingae). AHA and IDSA recommend ceftriaxone or ampicillin-sulbactam as drugs of choice, but a fluoroquinolone (ciprofloxacin, levofloxacin, moxifloxacin) may be considered when β-lactam anti-infectives cannot be used. Consultation with an infectious disease specialist is recommended.

Alternative for treatment of uncomplicated right-sided S. aureus native valve endocarditis†. For native valve staphylococcal endocarditis, AHA and IDSA recommend IV nafcillin or oxacillin (with or without gentamicin) as regimen of choice and IV cefazolin (with or without gentamicin) as an alternative; IV vancomycin is recommended when staphylococci are oxacillin-resistant. An oral regimen of ciprofloxacin and rifampin can be considered in IV drug abusers who will not comply with a parenteral regimen.

Alternative to gentamicin in regimens used for treatment of coagulase-negative staphylococcal endocarditis in the presence of prosthetic valves or materials†. For prosthetic valve staphylococcal endocarditis, AHA and IDSA recommend IV nafcillin or oxacillin with oral or IV rifampin and parenteral gentamicin; IV vancomycin with oral or IV rifampin and parenteral gentamicin is recommended when staphylococci are oxacillin-resistant. If causative organism is resistant to aminoglycosides, AHA and IDSA suggest a fluoroquinolone replace gentamicin in these regimens, provided in vitro susceptibility tests indicate the organism is susceptible to the fluoroquinolone.

Empiric treatment of culture-negative endocarditis†. For empiric treatment of native valve culture-negative endocarditis, AHA and IDSA recommend a regimen of ampicillin-sulbactam with gentamicin or a regimen of vancomycin, gentamicin, and ciprofloxacin. Selection of the most appropriate anti-infective regimen is difficult and should be guided by epidemiologic features and clinical course of the infection. Consultation with an infectious diseases specialist is recommended.

GI Infections

Treatment of infectious diarrhea caused by susceptible enterotoxigenic E. coli, Campylobacter fetus subsp. jejuni, Salmonella (see Typhoid Fever and other Salmonella Infections under Uses), Shigella flexneri, S. boydii, S. sonnei, or S. dysenteriae. Active in vitro against most pathogens associated with infectious diarrhea; may be a drug of choice for empiric treatment. Consider increasing emergence of fluoroquinolone-resistant Campylobacter secondary to widespread use of the drugs; use judiciously for treatment and prevention of enteropathogenic diarrhea.

Alternative to co-trimoxazole for treatment of GI infections caused by Cyclospora† or Isospora†.

Treatment of GI infections caused by Yersinia enterocolitica† or Y. pseudotuberculosis†. These infections usually self-limited, but IDSA, AAP, and others recommend anti-infectives for severe infections or when septicemia or other invasive disease occurs. Some suggest that the role of anti-infectives in management of enterocolitis, pseudoappendicitis syndrome, or mesenteric adenitis caused by Yersinia needs further evaluation.

Treatment of travelers’ diarrhea†. Generally self-limited and may resolve within 3–4 days without anti-infective treatment; if diarrhea is moderate or severe, persists for >3 days, or is associated with fever or bloody stools, short-term (1–3 days) anti-infective treatment may be indicated. Fluoroquinolones (ciprofloxacin, levofloxacin, norfloxacin, ofloxacin) usually drugs of choice when treatment, including self-treatment, is indicated. Azithromycin is a treatment alternative for those who should not receive fluoroquinolones (e.g., children, pregnant women) and may be a drug of choice for travelers in areas with a high prevalence of fluoroquinolone-resistant Campylobacter (e.g., Thailand, India) or those who have not responded after 48 hours of fluoroquinolone treatment. Rifaximin is another alternative for treatment of travelers’ diarrhea caused by noninvasive E. coli.

Prevention of travelers’ diarrhea† in individuals traveling for relatively short periods to areas where enterotoxigenic E. coli and other causative bacterial pathogens (e.g., Shigella) are known to be susceptible to the drug. CDC and others do not recommend anti-infective prophylaxis in most individuals traveling to areas of risk; the principal preventive measures are prudent dietary practices. If anti-infective prophylaxis is used (e.g., in immunocompromised individuals such as those with HIV infection), a fluoroquinolone (ciprofloxacin, levofloxacin, ofloxacin, norfloxacin) is recommended for nonpregnant adults, although the increasing incidence of quinolone resistance in pathogens that cause travelers’ diarrhea (e.g., Campylobacter) should be considered.

Intra-abdominal Infections

Parenteral treatment of complicated intra-abdominal infections caused by E. coli, Ps. aeruginosa, P. mirabilis, K. pneumoniae, or Bacteroides fragilis; used in conjunction with oral metronidazole.

For immunosuppressed patients or those with severe intra-abdominal infections, IDSA recommends an initial empiric regimen with broad spectrum of activity such as meropenem or imipenem; a third or fourth generation cephalosporin (cefepime, cefotaxime, ceftazidime, ceftizoxime, ceftriaxone) in conjunction with metronidazole; ciprofloxacin in conjunction with metronidazole; piperacillin-tazobactam; or aztreonam in conjunction with metronidazole. For mild to moderate community-acquired intra-abdominal infections, IDSA recommends an initial empiric regimen with narrower spectrum of activity such as ampicillin-sulbactam; cefazolin or cefuroxime in conjunction with metronidazole; ticarcillin-clavulanate; ertapenem; or a fluoroquinolone (ciprofloxacin, levofloxacin, moxifloxacin) in conjunction with metronidazole.

Meningitis and CNS Infections

Has been used for treatment of meningitis and other CNS infections† caused by susceptible gram-negative bacteria (e.g., Ps. aeruginosa, Salmonella) either alone or in conjunction with other drugs (e.g., aminoglycoside, ceftriaxone or cefotaxime).

Safety and efficacy not established for CNS infections; only low ciprofloxacin concentrations attained in CSF. (See Distribution under Pharmacokinetics.) Fluoroquinolones (including ciprofloxacin) generally considered for treatment of meningitis only when the infection is caused by multidrug-resistant gram-negative bacilli or when the usually recommended anti-infectives cannot be used or have been ineffective.

Otic Infections

Treatment of malignant otitis externa† caused by Ps. aeruginosa. Treatment of choice usually is ciprofloxacin or an antipseudomonal β-lactam (e.g., ceftazidime, imipenem). Consider the possibility of ciprofloxacin-resistant strains if there is an inadequate response to treatment.

Respiratory Tract Infections

Treatment of respiratory tract infections (including bronchiectasis, bronchitis, lung abscess, pneumonia) caused by susceptible E. cloacae, E. coli, Haemophilus influenzae, H. parainfluenzae, K. pneumoniae, P. mirabilis, Ps. aeruginosa, or S. pneumoniae; also has been used for respiratory tract infections caused by susceptible E. aerogenes†, K. oxytoca†, or S. aureus†.

Treatment of acute sinusitis caused by susceptible H. influenzae, M. catarrhalis, or S. pneumoniae.

Treatment of acute exacerbations of chronic bronchitis caused by susceptible Moraxella catarrhalis.

Parenteral treatment of nosocomial pneumonia caused by susceptible H. influenzae or K. pneumoniae.

Most effective in treatment of respiratory tract infections caused by H. influenzae or M. catarrhalis; treatment failures have occurred when used in infections caused by S. pneumoniae or Ps. aeruginosa.

Not a drug of first choice for pneumonia caused by S. pneumoniae; generally should not be used for empiric treatment of community-acquired pneumonia (CAP) when S. pneumoniae is likely or suspected. IDSA and ATS state that other fluoroquinolones with enhanced activity against S. pneumoniae (gemifloxacin, levofloxacin, moxifloxacin) are drugs of choice for empiric treatment of CAP in outpatients at risk for infections caused by drug-resistant S. pneumoniae (DRSP) and also are drugs of choice for empiric treatment of CAP in inpatients.

Treatment of acute exacerbations of bronchopulmonary Ps. aeruginosa infections in cystic fibrosis patients. As with other anti-infectives, Ps. aeruginosa may be cleared temporarily from the sputum, but a bacteriologic cure rarely is obtained and should not be expected in these patients.

Probably should not be used for treatment of aspiration pneumonia since these infections generally involve anaerobic bacteria.

Skin and Skin Structure Infections

Treatment of skin and skin structure infections (e.g., cellulitis, abscesses, folliculitis, furunculosis, pyoderma, postoperative wound infections, infected ulcers, burns, or wounds) caused by susceptible C. freundii, E. cloacae, E. coli, K. oxytoca, K. pneumoniae, M. morganii, P. mirabilis, P. vulgaris, P. stuartii, Ps. aeruginosa, S. marcescens†, S. aureus (oxacillin-susceptible strains), S. epidermidis, or S. pyogenes (group A β-hemolytic streptococci).

Urinary Tract Infections (UTIs) and Prostatitis

Treatment of complicated UTIs and pyelonephritis caused by susceptible E. coli in pediatric patients 1–17 years of age. Not a drug of first choice in pediatric patients because of increased risk of adverse events (e.g., events related to joints and/or surrounding tissues) in this age group. (See Musculoskeletal Effects under Cautions.)

Treatment of acute uncomplicated cystitis in adults caused by susceptible E. coli, P. mirabilis, S. saprophyticus, or E. faecalis.

Treatment of complicated or uncomplicated UTIs in adults caused by susceptible gram-negative bacteria, including Citrobacter diversus, C. freundii, E. cloacae, E. coli, K. pneumoniae, M. morganii, P. mirabilis, Providencia rettgeri, Ps. aeruginosa, or S. marcescens; also has been used for UTIs caused by E. aerogenes†, Klebsiella oxytoca†, or P. stuartii†.

Treatment of UTIs in adults caused by susceptible gram-positive bacteria, including S. aureus†, S. epidermidis, S. saprophyticus, or E. faecalis.

Treatment of acute uncomplicated pyelonephritis in adults caused by E. coli.

Treatment of recurrent UTIs and chronic prostatitis in adults caused by E. coli or P. mirabilis in men. May be a drug of choice because high concentrations are attained in prostatic tissue.

Usually reserved for treatment of complicated UTIs, especially those caused by multidrug-resistant bacteria; generally not recommended for uncomplicated UTIs (e.g., acute cystitis) unless more commonly employed urinary anti-infectives are likely to be ineffective or other equally effective, less expensive anti-infectives are contraindicated or not tolerated.

Anthrax

Postexposure prophylaxis to reduce the incidence or progression of disease following suspected or confirmed exposure to aerosolized Bacillus anthracis spores (inhalational anthrax). Initial drug of choice for such prophylaxis is ciprofloxacin or doxycycline. Based on in vitro data, other fluoroquinolones (e.g., moxifloxacin, ofloxacin, levofloxacin) are considered alternatives to ciprofloxacin when needed.

Treatment of inhalational anthrax. Monotherapy may be effective for anthrax that occurs as the result of natural or endemic exposures, but a multiple-drug parenteral regimen (ciprofloxacin or doxycycline and 1 or 2 other anti-infectives predicted to be effective) is recommended for inhalational anthrax that occurs as the result of exposure to anthrax spores in the context of biologic warfare or bioterrorism. Other drugs suggested as possibilities to augment ciprofloxacin or doxycycline in such multiple-drug regimens include chloramphenicol, clindamycin, rifampin, vancomycin, macrolides (azithromycin, clarithromycin, erythromycin), imipenem, meropenem, penicillin, ampicillin, daptomycin, quinupristin and dalfopristin, linezolid, and aminoglycosides (gentamicin). If meningitis is established or suspected, some clinicians suggest a multiple-drug regimen that includes a fluoroquinolone (e.g., ciprofloxacin) and 1 or 2 additional agents with good CSF penetration (e.g., ampicillin or penicillin, meropenem, rifampin, vancomycin, chloramphenicol).

Treatment of cutaneous anthrax†, including that occurring following exposure to B. anthracis spores in the context of biologic warfare or bioterrorism. Parenteral multiple-drug regimen recommended for initial treatment when there are signs of systemic involvement, extensive edema, or lesions on the head and neck or when cutaneous anthrax occurs in children <2 years of age.

Treatment of GI and oropharyngeal anthrax. If occurring in the context of biologic warfare or bioterrorism, use parenteral regimens recommended for inhalational anthrax.

Prophylaxis following ingestion of B. anthracis spores† in contaminated meat.

Although ciprofloxacin not usually used in children <18 years of age or in pregnant women, CDC and others state ciprofloxacin can be used when necessary in these patients for postexposure prophylaxis or treatment of anthrax since the benefits of ciprofloxacin outweigh the risks.

Bartonella Infections

Treatment of infections caused by Bartonella henselae† (e.g., cat scratch disease, bacillary angiomatosis, peliosis hepatitis).

Cat scratch disease generally self-limited in immunocompetent individuals and may resolve spontaneously in 2–4 months; some clinicians suggest that anti-infectives be considered for acutely or severely ill patients with systemic symptoms, particularly those with hepatosplenomegaly or painful lymphadenopathy, and probably is indicated in immunocompromised patients. Anti-infectives also indicated in patients with B. henselae infections who develop bacillary angiomatosis, neuroretinitis, or Parinaud’s oculoglandular syndrome. Optimum regimens have not been identified; some clinicians recommend azithromycin, ciprofloxacin, erythromycin, doxycycline, rifampin, co-trimoxazole, gentamicin, or third generation cephalosporins.

Brucellosis

Treatment of brucellosis† caused by Brucella melitensis. Ciprofloxacin used in conjunction with rifampin is an alternative to a regimen of a tetracycline and rifampin.

Capnocytophaga Infections

Alternative to penicillin G for treatment of infections caused by Capnocytophaga canimorsus†.

Chancroid

Treatment of chancroid† (genital ulcers caused by Haemophilus ducreyi).

CDC and others recommend azithromycin, ceftriaxone, ciprofloxacin, or erythromycin as drugs of choice for treatment of chancroid. HIV-infected patients and uncircumcised patients may not respond to treatment as well as those who are HIV-negative or circumcised.

Crohn’s Disease

Management of Crohn’s disease† as an adjunct to conventional therapies.

Has been used (with or without metronidazole) for induction of remission of mildly to moderately active Crohn’s disease. May be more effective in patients with ileitis than in those with colitis.

Has been used in the management of refractory perianal Crohn’s disease†. Relapse usually occurs when the drug is discontinued.

Gonorrhea and Associated Infections

Has been used for treatment of uncomplicated urethral, endocervical, rectal†, or pharyngeal† gonorrhea caused by susceptible Neisseria gonorrhoeae.

Has been used for treatment of disseminated gonococcal infections† caused by susceptible N. gonorrhoeae.

Although fluoroquinolones (ciprofloxacin, levofloxacin, ofloxacin) were previously considered drugs of choice for treatment of uncomplicated gonorrhea, CDC currently states fluoroquinolones should not be used for treatment of gonorrhea or any associated infections involving N. gonorrhoeae (e.g., pelvic inflammatory disease [PID], epididymitis).

Quinolone-resistant N. gonorrhoeae (QRNG) has been reported with increasing frequency worldwide and is widespread in the US. (See Resistance in Neisseria gonorrhoeae under Cautions.)

For treatment of uncomplicated cervical, urethral, or rectal gonorrhea, CDC and others recommend IM ceftriaxone or oral cefixime; IM ceftriaxone is drug of choice for pharyngeal infections.

For initial treatment of disseminated gonococcal infections, CDC recommends IM or IV ceftriaxone as drug of choice and IV cefotaxime, IV ceftizoxime (no longer commercially available in the US), or IM spectinomycin (not currently commercially available in the US) as alternatives. Initial parenteral regimen should be continued for 24–48 hours after improvement begins; therapy can be switched to oral cefixime or oral cefpodoxime and continued to complete ≥1 week of treatment. CDC states that fluoroquinolones (ciprofloxacin, ofloxacin, levofloxacin) may be alternative treatment option for disseminated infections only if in vitro susceptibility can be documented by culture.

Granuloma Inguinale (Donovanosis)

Alternative for treatment of granuloma inguinale† (donovanosis) caused by Klebsiella granulomatis (formerly Calymmatobacterium granulomatis). CDC recommends doxycycline or co-trimoxazole as drugs of choice; ciprofloxacin, erythromycin, and azithromycin are alternatives.

Legionnaires’ Disease

Treatment of Legionnaires’ disease† caused by Legionella pneumophila. A drug of choice, especially in immunocompromised patients (e.g., transplant recipients).

Malaria

Although ciprofloxacin reportedly has in vitro activity against Plasmodium falciparum, it has been ineffective when used alone in the treatment of uncomplicated malaria caused by chloroquine-resistant P. falciparum†.

Mycobacterial Infections

Alternative for use in multiple-drug regimens for treatment of active tuberculosis†.

CDC, ATS, and IDSA state that use of fluoroquinolones can be considered in patients with relapse, treatment failure, or Mycobacterium tuberculosis resistant to isoniazid and/or rifampin or when first-line drugs cannot be tolerated. There have been recent reports of extensively drug-resistant tuberculosis (XDR tuberculosis). XDR tuberculosis is caused by M. tuberculosis resistant to rifampin and isoniazid (multiple-drug resistant strains) that also are resistant to a fluoroquinolone and at least one parenteral second-line antimycobacterial (capreomycin, kanamycin, amikacin).

Although there is clinical experience with several fluoroquinolones in the treatment of tuberculosis (e.g., ciprofloxacin, levofloxacin, moxifloxacin, ofloxacin), levofloxacin and moxifloxacin are the fluoroquinolones recommended by CDC, ATS, and IDSA and levofloxacin may be preferred on the basis of cumulative experience. Consult the most recent CDC, ATS, and IDSA recommendations for treatment of tuberculosis for more specific information.

Treatment of cutaneous infections caused by M. fortuitum†; used alone or in conjunction with amikacin. ATS and IDSA recommend that M. fortuitum pulmonary infections be treated with a regimen consisting of at least 2 anti-infectives selected based on results of in vitro susceptibility testing and tolerability (e.g., amikacin, ciprofloxacin or ofloxacin, a sulfonamide, cefoxitin, imipenem, doxycycline).

Has been used in multiple-drug regimens for treatment of pulmonary and extrapulmonary (localized or disseminated) M. avium complex† (MAC) infections. Role of fluoroquinolones in treatment of MAC infections has not been established. Moxifloxacin may be preferred if a fluoroquinolone is used in conjunction with other antimycobacterial anti-infectives for the treatment of MAC infections, but many strains are resistant in vitro. Treatment of MAC infections is complicated and should be directed by clinicians familiar with mycobacterial diseases; consultation with a specialist is particularly important when the patient cannot tolerate first-line drugs or when the infection has not responded to prior therapy or is caused by macrolide-resistant MAC.

Based on results of in vitro susceptibility testing, ciprofloxacin may be considered for use in combination antimycobacterial regimens used for treatment of infections caused by M. chelonae†, M. haemophilum†, or M. terrae†. Because of considerations related to resistance, not recommended for treatment of M. marinum infections.

Nasal Carriage of Staphylococcus aureus

Has been used for temporary elimination of oxacillin-resistant (methicillin-resistant) S. aureus colonization† in patients with serious diseases at risk for infection. Consider that management of oxacillin-resistant S. aureus colonization is controversial, permanent eradication of nasal carriage of staphylococci following topical or systemic anti-infectives is unlikely, ciprofloxacin resistance has been reported in some oxacillin-resistant S. aureus, and there is some evidence that ciprofloxacin may be an independent risk factor for colonization with oxacillin-resistant S. aureus in HIV-infected patients.

Neisseria meningitidis Infections

Elimination of nasopharyngeal carriage of N. meningitidis†. CDC and AAP consider rifampin, ceftriaxone, or ciprofloxacin the drugs of choice for such carriers.

Postexposure prophylaxis to prevent meningococcal disease in household or other close contacts of patients with invasive meningococcal disease†. Recommended regimens for such prophylaxis are rifampin (not recommended in pregnant women), ceftriaxone, or ciprofloxacin (not recommended in individuals <18 years of age unless no other regimen can be used and not recommended for pregnant or lactating women).

Consider that fluoroquinolone-resistant N. meningitidis has been reported rarely in the US and elsewhere (e.g., India). CDC states ciprofloxacin should not be used for prophylaxis in close contacts of individuals with meningococcal disease in areas where fluoroquinolone-resistant strains have been reported (e.g., selected counties of North Dakota and Minnesota).

Plague

Alternative for treatment of plague† caused by Yersinia pestis, including naturally occurring plague and plague that occurs following exposure to Y. pestis in the context of biologic warfare or bioterrorism. Regimen of choice is streptomycin (or gentamicin) with or without doxycycline; alternatives are doxycycline, chloramphenicol (drug of choice for plague meningitis), fluoroquinolones, or co-trimoxazole (may be less effective than other alternatives).

Postexposure prophylaxis† following a high-risk exposure to Y. pestis (e.g., household, hospital, or other close contact with an individual who has pneumonic plague; laboratory exposure to viable Y. pestis; confirmed exposure in the context of biologic warfare or bioterrorism). Drugs of choice for such prophylaxis are doxycycline (or tetracycline) or a fluoroquinolone (e.g., ciprofloxacin, levofloxacin, ofloxacin); co-trimoxazole and chloramphenicol are alternatives.

Rickettsial Infections

Treatment of rickettsial infections†. Has been effective for Q fever endocarditis caused by Coxiella burnetii† and Mediterranean spotted fever caused by Rickettsia conorii†. Tetracyclines (usually doxycycline) are drugs of choice for treatment of most rickettsial infections; fluoroquinolones are alternatives when tetracyclines cannot be used. Because of better CNS penetration, some experts suggest fluoroquinolones may be a better choice than tetracyclines for patients with meningoencephalitis. (See Distribution under Pharmacokinetics.)

Selective Decontamination of the GI Tract

Selective decontamination of the GI tract† in granulocytopenic patients or other debilitated patients (e.g., those with cirrhosis).

Tularemia

Treatment of tularemia† caused by Francisella tularensis, including naturally occurring or endemic tularemia or tularemia that occurs following exposure to F. tularensis in the context of biologic warfare or bioterrorism. Considered an alternative to streptomycin (or gentamicin); risk of relapse may be higher than with aminoglycosides.

Postexposure prophylaxis of tularemia† following a high-risk laboratory exposure to F. tularensis (e.g., spill, centrifuge accident, needlestick injury) or in individuals exposed to the organism in the context of biologic warfare or bioterrorism. Postexposure prophylaxis usually not recommended after exposure to natural or endemic tularemia (e.g., tick bite, rabbit or other animal exposure) and is unnecessary in close contacts of tularemia patients since human-to-human transmission does not occur.

Typhoid Fever and Other Salmonella Infections

Treatment of typhoid fever (enteric fever) caused by susceptible Salmonella typhi, including chloramphenicol-resistant strains.

Treatment of chronic typhoid carriers†. Considered a drug of choice by some clinicians, but manufacturer cautions that efficacy of ciprofloxacin in eradication of the chronic typhoid carrier state has not been demonstrated.

Treatment of gastroenteritis caused by non-typhi Salmonella (e.g., S. enteritidis, S. typhimurium). Anti-infective treatment is indicated only in those with severe disease and in those at increased risk of invasive disease, including those <3–6 months of age or >50 years of age, those with hemoglobinopathies, severe atherosclerosis or valvular heart disease, prostheses, uremia, chronic GI disease, or severe colitis, and those immunocompromised because of malignancy, immunosuppressive therapy, HIV infection, or other immunosuppressive illness. Choice of anti-infective is based on in vitro susceptibility.

Treatment of HIV-infected adults with Salmonella gastroenteritis to prevent extraintestinal spread of the infection. Recommended by USPHS/IDSA as drug of choice for treatment of salmonella gastroenteritis in HIV-infected adults, but pregnant HIV-infected women with Salmonella gastroenteritis should receive ampicillin, cefotaxime, ceftriaxone, or co-trimoxazole and children should receive co-trimoxazole, ampicillin, cefotaxime, ceftriaxone, or chloramphenicol.

Has been used alone or in conjunction with a third generation cephalosporin (cefotaxime, ceftriaxone) for treatment of meningitis and other CNS infections† caused by susceptible Salmonella. (See Meningitis and CNS Infections under Uses.)

Long-term suppressive or maintenance therapy (secondary prophylaxis) in HIV-infected adults to prevent recurrence of nontyphi Salmonella septicemia†.

Vibrio Infections

Treatment of cholera† caused by Vibrio cholerae 01 or 0139. Tetracyclines generally drugs of choice for treatment of cholera in conjunction with fluid and electrolyte replacement therapy; ciprofloxacin is an alternative, especially for infections caused by V. cholerae resistant to tetracyclines.

Alternative to tetracyclines for treatment of other Vibrio infections, including gastroenteritis or wound infections caused by V. parahaemolyticus† or V. vulnificus†.

Treatment of infections caused by V. vulnificus†. Optimum anti-infective therapy has not been identified; a tetracycline or third generation cephalosporin (e.g., cefotaxime, ceftazidime), a fluoroquinolone, or aminoglycoside has been recommended. Because the case fatality rate associated with V. vulnificus is high, initiate anti-infective therapy promptly if indicated.

Perioperative Prophylaxis

Perioperative prophylaxis† in high risk patients undergoing genitourinary surgery.

Not recommended for patients with sterile urine undergoing most urologic surgical procedures. Those who have positive (or unavailable) urine cultures and those with preoperative catheters should be treated to sterilize the urine before surgery or receive a single preoperative dose of an anti-infective (e.g., ciprofloxacin) active against the most likely urologic pathogens.

Perioperative prophylaxis using an appropriate anti-infective (e.g., ciprofloxacin) also recommended in patients undergoing transurethral prostatectomy, transrectal prostatic biopsies, or a procedure that involves placement of a urologic prosthesis (e.g., penile transplant, artificial sphincter, synthetic pubovaginal sling, bone anchors for pelvic floor reconstruction).

Empiric Therapy in Febrile Neutropenic Patients

Empiric anti-infective therapy of presumed bacterial infections in febrile neutropenic patients; used in conjunction with IV piperacillin (no longer commercially available in the US as a single-entity preparation).