Bacterial conjunctivitis; treatment: Ophthalmic: Solution: Instill 1 to 2 drops into the conjunctival sac of the affected eye(s) every 2 hours while awake for 2 days, then 1 to 2 drops every 4 hours while awake for the next 5 days.
Corneal ulcers; treatment: Ophthalmic: Solution: Instill 2 drops into the conjunctival sac every 15 minutes for the first 6 hours, then 2 drops every 30 minutes for the remainder of the first day; on the second day, instill 2 drops every hour; on the third day and for the duration of therapy, instill 2 drops every 4 hours thereafter for a total of 14 days; treatment may continue longer if re-epithelialization has not occurred.
Bacterial conjunctivitis; treatment: Ophthalmic:
Solution: Infants, Children, and Adolescents: Instill 1 to 2 drops into the conjunctival sac of the affected eye(s) every 2 hours while awake for 2 days, then 1 to 2 drops every 4 hours while awake for the next 5 days.
Ointment: Children ≥2 years and Adolescents: Apply 1/2-inch ribbon into the conjunctival sac 3 times daily for 2 days, then twice daily for the next 5 days.
Canadian labeling: Children ≥1 year and Adolescents: Apply 1/2-inch ribbon into the conjunctival sac 3 times daily for 2 days, then twice daily for the next 5 days.
Corneal ulcers; treatment: Ophthalmic:
Solution: Infants, Children, and Adolescents: Instill 2 drops into the conjunctival sac every 15 minutes for the first 6 hours, then 2 drops every 30 minutes for the remainder of the first day; on the second day, instill 2 drops every hour; on the third day and for the duration of therapy, instill 2 drops every 4 hours thereafter for a total of 14 days; treatment may be extended if re-epithelialization has not occurred.
Ointment [Canadian Product]: Children ≥12 years and Adolescents: Apply 1/2-inch ribbon into the conjunctival sac every 1 to 2 hours around the clock for 2 days, then every 4 hours for up to 12 days; treatment may be extended if re-epithelialization has not occurred.
There are no dosage adjustments provided in the manufacturer's labeling; however, dosage adjustment may not be necessary as systemic absorption is minimal.
There are no dosage adjustments provided in the manufacturer's labeling; however, dosage adjustment may not be necessary as systemic absorption is minimal.
(For additional information see "Ciprofloxacin (ophthalmic): Drug information")
Bacterial conjunctivitis: Ophthalmic:
Solution: Instill 1 to 2 drops into the conjunctival sac every 2 hours while awake for 2 days and 1 to 2 drops every 4 hours while awake for the next 5 days.
Ointment: Apply a 1/2 inch ribbon into the conjunctival sac 3 times/day for the first 2 days, followed by a 1/2 inch ribbon applied twice daily for the next 5 days.
Corneal ulcer: Ophthalmic:
Solution: Instill 2 drops into affected eye every 15 minutes for the first 6 hours, then 2 drops into the affected eye every 30 minutes for the remainder of the first day. On day 2, instill 2 drops into the affected eye hourly. On days 3 to 14, instill 2 drops into affected eye every 4 hours. Treatment may continue after day 14 if re-epithelialization has not occurred.
Ointment (off-label): Apply 1/2 inch ribbon into the conjunctival sac every 1 to 2 hours around the clock on the first 2 days, then apply 1/2 inch ribbon every 4 hours for up to 12 days. Treatment may continue after day 12 if re-epithelialization has not occurred (Ciloxan Canadian product labeling).
There are no dosage adjustments provided in the manufacturer’s labeling; however, dosage adjustment may not be necessary as systemic absorption is minimal.
There are no dosage adjustments provided in the manufacturer’s labeling; however, dosage adjustment may not be necessary as systemic absorption is minimal.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Ointment, Ophthalmic, as hydrochloride:
Ciloxan: 0.3% (3.5 g)
Solution, Ophthalmic, as hydrochloride:
Ciloxan: 0.3% (5 mL [DSC]) [contains benzalkonium chloride, edetate (edta) disodium]
Generic: 0.3% (2.5 mL, 5 mL, 10 mL)
May be product dependent
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Ointment, Ophthalmic, as hydrochloride:
Ciloxan: 0.3% (3.5 g)
Solution, Ophthalmic, as hydrochloride:
Ciloxan: 0.3% (5 mL, 10 mL) [contains benzalkonium chloride, edetate (edta) disodium]
Generic: 0.3% (5 mL)
For topical ophthalmic use only. Avoid touching the dropper tip to skin, eye, or other surfaces. Contact lenses should be removed prior to administration.
Ointment: Instill in the lower conjunctival sac.
Solution: Apply gentle pressure to lacrimal sac during and for 1 to 2 minutes after instillation or instruct patient to gently close eyelid after administration to decrease risk of absorption and systemic effects (Urtti 1993; Zimmerman 1984).
Ophthalmic: For topical ophthalmic use only; avoid touching tip of applicator to eye or other surfaces. Contact lenses should be removed prior to administration.
Store at 2°C to 25°C (36°F to 77°F). Protect solution from light.
Treatment of bacterial conjunctivitis due to susceptible organisms (Ointment: FDA approved in ages ≥2 years and adults; Solution: FDA approved in all ages); treatment of corneal ulcers (Solution: FDA approved in all ages).
Ciprofloxacin may be confused with cephalexin
Ciloxan may be confused with Cytoxan
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
Frequency not always defined.
>10%: Ophthalmic: Crystalline eye deposits (solution: 17%; white crystalline precipitate in superficial portion of corneal defect in those with corneal ulcer; reversible after completion of therapy)
1% to 10%:
Gastrointestinal: Unpleasant taste (immediately after instillation)
Ophthalmic: Corneal disease (ointment: 2%), burning sensation of eyes, conjunctival hyperemia, crusting of eyelid, eye discomfort, eye pruritus, foreign body sensation of eye
<1%, postmarketing, and/or case reports: Blurred vision, corneal infiltrates, corneal staining, dermatitis, epitheliopathy, eye pain, eye irritation, eyelid edema, keratitis, keratoconjunctivitis, lacrimation, nausea, photophobia, vision loss, xerophthalmia
Hypersensitivity to ciprofloxacin, other quinolones, or any component of the formulation.
Concerns related to adverse effects:
• Delayed healing: Corneal healing may be delayed.
• Hypersensitivity reactions: Severe hypersensitivity reactions, including anaphylaxis (some fatal), have occurred with quinolone therapy (primarily with systemic use). Prompt discontinuation of drug should occur if skin rash or other symptoms arise.
• Superinfection: Prolonged use may result in fungal or bacterial superinfection. If superinfection is suspected, institute appropriate alternative therapy.
Special populations:
• Contact lens wearers: Some products contain benzalkonium chloride which may be absorbed by soft contact lenses; contact lenses should not be worn during treatment of ophthalmologic infections.
Other warnings/precautions:
• Ophthalmic use: For ophthalmic use only. Not for subconjunctival injection or for introduction into the anterior chamber of the eye. To avoid contamination, do not touch tip of container to any surface.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program
There are no known significant interactions.
When administered orally or IV, ciprofloxacin crosses the placenta (Giamarellou 1989; Ludlam 1997). The amount of ciprofloxacin available systemically following topical application of the ophthalmic drops is significantly less in comparison to oral or IV doses. If ophthalmic agents are needed during pregnancy, the minimum effective dose should be used in combination with punctal occlusion for 3 to 5 minutes after application to decrease potential exposure to the fetus (Samples 1988).
Inhibits DNA-gyrase in susceptible organisms; inhibits relaxation of supercoiled DNA and promotes breakage of double-stranded DNA
Absorption: Only small amounts are absorbed systemically after ophthalmic instillation
Ointment (Ciloxan Ophthalmic)
0.3% (per gram): $77.17
Solution (Ciprofloxacin HCl Ophthalmic)
0.3% (per mL): $3.74 - $10.36
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