Once Weekly Ciprofloxacin for SBP Prophylaxis

We had a patient today whose med history showed ciprofloxacin 750mg PO weekly for chronic SBP prophylaxis. Given that the usual standard in guidelines is 500-750mg daily, this was a bit confusing. I found this study from 1995 which showed efficacy for once weekly dosing. However, this review from Pharmacy and Therapeutics mentions it’s not preferred due to reduced efficacy compared to daily, and this review from Hospital Pharmacy cites concern for resistance as a reason against using weekly. (Intuitively I would think that daily exposure would be worse for resistance given the ongoing bacterial exposure to drug…) I would therefore suggest daily unless perhaps there was a concern about tolerance/ADRs. But at least the med rec seemed to be accurate.

(Was this a post for the sake of making a post? Yes! But I am just trying to get in the habit of writing more.)