What you should know about ciprofloxacin for UTIs

Most urinary tract infections (UTIs) require antibiotics to kill the bacteria causing your symptoms. Does it matter which antibiotic your healthcare provider prescribes? 

Like many other types of infections, yes: certain classes of antibiotics work better to treat certain types of bacterial infections. Your provider will choose the most effective antibiotic for the infection you have after weighing the drug’s side effects and risk factors. This antibiotic will be sent to the pharmacy. Your physician will explain precautions, and when to make another appointment. If you have continued pain with urination, fever, or blood in the urine, your infection may be resistant to the antibiotic chosen.

As a quinolone antibiotic, ciprofloxacin is not a first-line treatment for UTIs, but there is a time and place for its use. Here’s what you should know about using ciprofloxacin to treat UTI. 

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Cipro for UTIs

Ciprofloxacin is also commonly known by its brand names Cipro (immediate-release) and Cipro XR (extended-release). It is one of many medications that can be used to treat a UTI, but it’s not the first choice for most patients unless the infection has spread to their kidneys, according to ambulatory care pharmacist MaRanda Herring, Pharm.D. Macrobid (nitrofurantoin) and Bactrim (sulfamethoxazole trimethoprim) are typically prescribed before Cipro in uncomplicated urinary tract infections.

Why? There are fewer side effects with those drugs, notes Dr. Herring, especially Macrobid (which also has lower antimicrobial resistance rates). However, there are times when Cipro is the best antibiotic to treat UTI, like when:

• the infection has affected your kidneys, causing pyelonephritis;
• you have a known sulfa drug allergy (Macrobid or Bactrim);
• or your UTI doesn’t respond to treatment with first-line drugs, suggesting possible antimicrobial resistance.

UTIs involving your kidneys are considered complicated urinary tract infections, and Cipro is indicated as a treatment. “As we use more antibiotics over time,” says Dr. Herring, “we see more and more resistance emerging to commonly used antimicrobial agents like Bactrim, which may lead doctors to prescribe Cipro more often for uncomplicated UTIs.”

Cipro is considered generally safe, but it can cause both common and serious side effects. Cipro is not recommended for pregnant women due to a lack of safety information. It is used with caution in patients younger than 18 years of age because it could affect their bone or joint development in higher concentrations. However, it is considered safe for breastfeeding women as the amount secreted in breast milk is low.

Cipro dose for UTI

The dosage and length of Cipro antibiotic treatment of urinary tract infections depend on the precise location of your UTI, says Alisha Reed, Pharm.D., of The Fly Pharmacist. The dose of ciprofloxacin should be decreased in chronic kidney disease patients. There are three types of UTIs, encompassing different parts of the urinary tract: the bladder, ureters, and kidneys.

For adult men and women, Dr. Reed says a typical dose for acute uncomplicated cystitis (aka lower UTI or bladder infection) is 250 milligrams every 12 hours for three days. For a combined UTI, the dosage may be as high as 500 milligrams every 12 hours for seven to 14 days. 

The dosage may increase to 1,000 milligrams for pyelonephritis or a UTI with other complications. Store Cipro in a dark, dry place at room temperature.

As far as how quickly Cipro works, the good news is that you may notice an improvement after a single dose on the first day you start treatment, says Dr. Herring, though it can take several more days before you’re feeling 100% better. Even if you do feel better quickly, it’s important to finish your full course of antibiotics as this decreases the chance of the bacteria developing resistance to the antibiotic and of prolongation of symptoms.

But what if you don’t feel better after a few days? “All antibiotics take time to work, but if UTI symptoms do not resolve after three days of antibiotics, it’s likely they have a resistant strain of bacteria that will require a different antibiotic for treatment,” explains Dr. Herring. For example, the Escherichia coli (E.Coli) bacteria is the most common cause of UTIs and is frequently resistant to Cipro.

Side effects of ciprofloxacin for UTI

All antibiotics come with risks of side effects, and Cipro is no different. However, there are both common and more serious side effects that can occur. 

Common side effects include gastrointestinal issues, such as:

• Nausea (This side effect can be lessened by taking the cipro with non-dairy food.)
• Vomiting
• Diarrhea

One lesser-known side effect of Cipro—and some other drugs—is sun sensitivity. Dr. Herring notes it’s important to wear sunscreen while taking Cipro because the drug can make you more susceptible to sunburn and sun-related allergic reactions.

More serious side effects can also be caused by Cipro, though these are rare. They include:

• Dizziness
• Headaches
• Muscle pain or muscle weakness
• Joint pain and stiffness
• Confusion
• Tendonitis and tendon rupture
• Anxiety
• Increased heart rate
• Peripheral neuropathy

According to Dr. Herring, Cipro is generally considered safe when used according to its FDA-approved indication, but severe adverse events can occur in some people after only one dose and there’s no way to predict who will respond poorly. In very rare cases, Cipro can cause life-threatening side effects, including severe skin reactions, liver failure, heart arrhythmia, and acute kidney damage. Cipro, or any fluoroquinolone antibiotics, should be avoided by people with myasthenia gravis.

Cipro interactions

There are also many known contraindications associated with Cipro. Some common drug interactions are: 

• Antacids containing magnesium
• Corticosteroids
• Cymbalta (duloxetine)
• Iron supplements
• Multivitamins
• NSAIDs
• Zocor (simvastatin)
• Zanaflex (tizanidine)
• Ambien (zolpidem)
• Warfarin
• Theophylline
• Glyburide
• Methotrexate
• Phenytoin

There are also a few food interactions, including caffeine and dairy. Most experts suggest waiting at least two hours after taking Cipro to consume dairy products or caffeinated beverages.

Alternatives to Cipro for UTI

There is another antibiotic option in the fluoroquinolone family. Levofloxacin may be used in place of Cipro, though there may not be much of a clinical difference between the two, per a 2021 clinical trial in Frontiers. 

If you cannot take Cipro, Dr. Reed says most patients without contraindications will be able to take first-line UTI treatment options such as Macrobid or Bactrim. The good news is that all three of these drugs begin working quickly to kill the bacteria in your urinary tract, so many people experience improved symptoms within 24 hours regardless of the antibiotic they’re taking.