Objective:To evaluate the appropriateness of ciprofloxacin‐prescribing in the long‐term care setting.Design:Retrospective chart review.Setting:A large academically oriented long‐term care facility.Patients:Institutionalized elderly patients with a mean age of 88 years.Methods:One hundred orders were randomly selected for review from all ciprofloxacin orders initiated over a 3‐year period. Criteria for appropriateness of ciprofloxacin‐prescribing were developed based on a comprehensive review of the medical literature. Evaluation of appropriateness of prescribing was based on the indication for therapy and the availability of more effective and/or less expensive alternative antibiotic regimens. Only information available to the physician at the time of the order was used to judge appropriateness. Abstracted medical records were evaluated independently by a geriatrician and an infectious diseases specialist.Results:With respect to site of infection, the urinary tract accounted for 43% of all ciprofloxacin orders; the lower respiratory tract, 28%; and skin and soft‐tissue infections, 17%. Only 25% of orders were judged appropriate. Twenty‐three percent of orders were judged less than appropriate based on indication, and 49% due to the availability of a more effective and/or less expensive alternative antibiotic choice. There was insufficient information in the medical record to judge 3% of the orders.Conclusion:These results indicate less than optimal prescribing of oral fluoroquinolones in the long‐term care setting, with potential consequences including the development of resistant bacterial strains and increased health care costs.J Am Geriatr So