Uses
Ciprofloxacin ophthalmic solution is used in the treatment of keratitis and conjunctivitis caused by susceptible bacteria. Ciprofloxacin ophthalmic ointment is used in the treatment of conjunctivitis caused by susceptible bacteria.
Ciprofloxacin in fixed combination with hydrocortisone is applied to the ear canal for the treatment of acute otitis externa caused by susceptible bacteria.
Ciprofloxacin in fixed combination with dexamethasone is instilled into the ear for the treatment of acute otitis media caused by susceptible bacteria in pediatric patients with tympanostomy tubes. Ciprofloxacin in fixed combination with dexamethasone also is applied to the ear canal for the treatment of acute otitis externa caused by susceptible bacteria.
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Ophthalmic Infections
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Keratitis
Ciprofloxacin ophthalmic solution is used in the treatment of keratitis (corneal ulcer) caused by susceptible Pseudomonas aeruginosa, Serratia marcescens, Staphylococcus aureus, S. epidermidis, Streptococcus pneumoniae, or viridans streptococci. Results of comparative studies in patients receiving a fluoroquinolone ophthalmic solution (e.g., ciprofloxacin, ofloxacin) for bacterial keratitis suggests that such therapy produces results comparable to those observed with more complex treatment regimens (e.g., a topical ''fortified'' aminoglycoside used in conjunction with a topical cephalosporin).
In a multicenter study, treatment with ciprofloxacin 0.3% ophthalmic solution in the recommended dosage resulted in clinical cure (i.e., complete reepithelization, no evidence of bacterial infection, absence of symptoms) in 76% of patients with bacterial keratitis; complete reepithelization with no evidence of bacterial infection occurred in 92% of patients. In this study, success of ciprofloxacin therapy did not depend on the severity (initial size) of the corneal ulcer, and such therapy also was effective in most patients with bacterial keratitis that did not respond to treatment with other ophthalmic anti-infectives. Ciprofloxacin ophthalmic solution also has been used with variable success with other systemic and/or ophthalmic anti-infectives in the management of keratitis caused by opportunistic mycobacteria (e.g., Mycobacterium gordonae, M. fortuitum, M. chelonae). Treatment with more than one anti-infective agent may be needed for the treatment of keratitis caused by such organisms.
Ciprofloxacin also has been used successfully as a 0.3% ophthalmic ointment in patients with bacterial keratitis.
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Conjunctivitis
Ciprofloxacin ophthalmic solution is used in the treatment of conjunctivitis caused by susceptible Staphylococcus aureus , S. epidermidis,Streptococcus pneumoniae, or Haemophilus influenzae.
Ciprofloxacin ophthalmic ointment is used in the treatment of conjunctivitis caused by susceptible S. aureus, S. epidermidis, S. pneumoniae, viridans streptococci, or H. influenzae.
Although most cases of acute bacterial conjunctivitis improve without anti-infective therapy, topical application of anti-infectives may shorten the infectious process. In addition, topical application of anti-infectives may reduce recurrence rate and morbidity associated with bacterial conjunctivitis.
Results from a placebo-controlled and a comparative study indicate that ciprofloxacin 0.3% ophthalmic solution is more effective than placebo (e.g., vehicle) and as effective as tobramycin 0.3% ophthalmic solution in patients with acute bacterial conjunctivitis caused by various gram-positive and -negative bacteria. In these studies, topical application of ciprofloxacin 0.3% ophthalmic solution to the eye for 3-7 days was effective in reducing or eradicating all conjunctival pathogens in approximately 70-95% of patients with acute bacterial conjunctivitis but produced clinical cures less frequently.
In clinical studies, treatment with ciprofloxacin ophthalmic ointment was associated with clinical cure in approximately 75% of patients with bacterial conjunctivitis and positive conjunctival cultures, and the presumed pathogens were eradicated by day 7 in approximately 80% of patients.
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Otic Infections
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Otitis Externa
Ciprofloxacin hydrochloride and hydrocortisone otic suspension is applied to the ear canal for the treatment of acute bacterial otitis externa caused by susceptible strains of S. aureus, Ps. aeruginosa, or Proteus mirabilis. Because commercially available ciprofloxacin and hydrocortisone otic suspension is nonsterile, it should not be used if the tympanic membrane is perforated.
Ciprofloxacin hydrochloride and dexamethasone otic suspension is applied to the external ear canal for the treatment of acute otitis externa caused by susceptible strains of S. aureus or Ps. aeruginosa. The commercially available formulation is a sterile suspension.
Although acute bacterial otitis externa localized in the external auditory canal may be effectively treated using topical anti-infectives (e.g., ciprofloxacin otic suspension, ofloxacin otic solution), malignant otitis externa is an invasive, potentially life-threatening infection, especially in immunocompromised patients such as those with diabetes mellitus or human immunodeficiency virus (HIV) infection, and requires prompt diagnosis and long-term treatment with parenteral anti-infectives (e.g., ceftazidime and/or ciprofloxacin).
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Acute Otitis Media
Ciprofloxacin hydrochloride and dexamethasone otic suspension is applied to the ear canal and middle ear for the treatment of acute otitis media caused by susceptible strains of S. aureus, S. pneumoniae, H. influenzae, Moraxella catarrhalis, or Ps. aeruginosa in pediatric patients' tympanostomy tubes.
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Systemic Uses
For systemic uses of ciprofloxacin,