Is Cipro (ciprofloxacin) an alternative to Ancef (cefazolin)?

From the Guidelines

No, Cipro (ciprofloxacin) and Ancef (cefazolin) are not the same medication, and their use should be guided by the specific type of infection, local resistance patterns, and patient factors, as recommended by the Infectious Diseases Society of America and other guidelines 1. They are different antibiotics that belong to separate classes. Cipro is a fluoroquinolone antibiotic that works by inhibiting bacterial DNA gyrase and topoisomerase IV, preventing DNA replication in bacteria. Ancef is a first-generation cephalosporin that works by inhibiting bacterial cell wall synthesis. These medications have different spectrums of activity, with Cipro being particularly effective against gram-negative bacteria including Pseudomonas, while Ancef is more effective against gram-positive organisms like Staphylococcus. Some key points to consider when choosing between these antibiotics include:

• The type of infection being treated, with Cipro being recommended for urinary tract infections, including pyelonephritis and prostatitis, if local resistance patterns allow its use 1
• Local resistance patterns, with the Infectious Diseases Society of America recommending that local resistance rates for empirically selected antibiotics should be <10% for pyelonephritis and <20% for treatment of lower urinary tract infection 1
• Patient factors, such as allergies and comorbidities, with Cipro carrying risks of tendon damage and peripheral neuropathy, while Ancef may cause allergic reactions in those with penicillin allergies 1 The choice between Cipro and Ancef should be guided by the most recent and highest-quality evidence, with consideration of the specific clinical scenario and patient factors, as recommended by the Infectious Diseases Society of America and other guidelines 1. Some of the key recommendations from the guidelines include:
• Using Cipro as a first-choice option for empiric treatment of mild-to-moderate pyelonephritis and prostatitis if local/national data on antimicrobial resistance patterns allow its use 1
• Using Ancef as a first-choice option for skin and soft tissue infections, including impetigo, purulent skin and soft tissue infections, and necrotizing fasciitis 1
• Considering alternative antibiotics, such as amoxicillin-clavulanic acid, nitrofurantoin, and sulfamethoxazole-trimethoprim, for the treatment of lower urinary tract infections, based on local resistance patterns and patient factors 1

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Ciprofloxacin and Cefepime Comparison

• Ciprofloxacin is a broad-spectrum fluoroquinolone antibacterial agent effective against Gram-negative bacteria, while cefepime is a fourth-generation antibiotic stable in the presence of Bush group 1 beta-lactamases 2, 3.
• Cefepime has poor activity against methicillin-resistant Staphylococcus aureus and enterococci, but is active against most isolates of methicillin-sensitive staphylococci, Streptococcus pyogenes, viridans streptococci, and Streptococcus pneumoniae 3.
• Ciprofloxacin is more active against Gram-negative bacilli, including Pseudomonas aeruginosa, than cefepime 3.

Ciprofloxacin Efficacy

• Ciprofloxacin has been shown to be effective in the treatment of various infections, including urinary tract infections, sexually transmitted diseases, skin and bone infections, and lower respiratory tract infections 2, 4.
• A single oral dose of ciprofloxacin was found to be equally effective as intravenous cefazolin in preventing postoperative urinary tract infection in patients undergoing outpatient endourologic surgery 5.

Antibiotic Resistance

• The incidence of ciprofloxacin-related side effects has been reported to be minimal, with most reports related to the gastrointestinal tract 4.
• Cefepime has been found to have a lower incidence of resistance among Gram-negative bacilli compared to other antibiotics 3.
• Clarithromycin, a macrolide antimicrobial agent, has been shown to have superior in vitro activity against common streptococci, while cefprozil and other beta-lactam antibiotics provide greater activity against methicillin-susceptible Staphylococcus aureus and Gram-negative pathogens 6.