Is Cipro (Ciprofloxacin) effective for treating sinusitis?

Ciprofloxacin is NOT Recommended for Acute Bacterial Sinusitis

Ciprofloxacin should not be used as first-line or even second-line therapy for acute bacterial sinusitis—it is explicitly reserved only for complicated sinusitis involving frontal, ethmoidal, or sphenoidal sinuses, or when first-line therapy fails. 1

Why Ciprofloxacin is Inappropriate for Routine Sinusitis

While the FDA label indicates ciprofloxacin has approval for acute sinusitis caused by Haemophilus influenzae, penicillin-susceptible Streptococcus pneumoniae, or Moraxella catarrhalis 2, current clinical guidelines explicitly recommend against using fluoroquinolones like ciprofloxacin as routine therapy due to resistance concerns and the need to preserve these agents for more serious infections 1.

• The American Academy of Allergy, Asthma, and Immunology recommends amoxicillin 500 mg twice daily as the first-line choice for most patients with acute bacterial sinusitis 1
• For more severe infections, higher doses of amoxicillin (875 mg twice daily) are recommended 1
• Fluoroquinolones (levofloxacin, moxifloxacin—not ciprofloxacin specifically) are reserved for frontal, ethmoidal, or sphenoidal sinusitis where major complications are likely 1

The Treatment Algorithm You Should Follow

For uncomplicated maxillary sinusitis (the most common type):

1. First-line: Amoxicillin 500-875 mg twice daily for 10-14 days 1
2. If penicillin-allergic: Cephalosporins (cefuroxime, cefpodoxime, cefdinir) 1
3. If first-line fails after 3-5 days: Switch to amoxicillin-clavulanate 875/125 mg twice daily 1
4. If second-line fails: Consider respiratory fluoroquinolones (levofloxacin or moxifloxacin—NOT ciprofloxacin) 1

For complicated sinusitis (frontal, ethmoidal, sphenoidal):

• Respiratory fluoroquinolones like levofloxacin or moxifloxacin may be considered from the start due to risk of serious complications 1

Critical Evidence Against Ciprofloxacin

• Guidelines consistently recommend levofloxacin or moxifloxacin when a fluoroquinolone is needed—not ciprofloxacin—because these respiratory fluoroquinolones have superior pneumococcal coverage 1
• The FDA label itself notes that "ciprofloxacin is not a drug of first choice in the treatment of presumed or confirmed pneumonia secondary to Streptococcus pneumoniae" 2, which is one of the three most common pathogens in sinusitis
• Overuse of fluoroquinolones promotes resistance, so they must be reserved for specific situations 1

What About the Older Studies?

While older research from 1994 showed ciprofloxacin had similar efficacy to amoxicillin-clavulanate for chronic sinusitis 3, 4, and a 1999 study showed equivalence to cefuroxime 5, these studies predate current resistance patterns and modern guideline recommendations that explicitly reserve fluoroquinolones for treatment failures or complicated cases 1.

The Bottom Line

Use amoxicillin or amoxicillin-clavulanate for routine acute bacterial sinusitis. 1 If you absolutely need a fluoroquinolone due to treatment failure or complicated disease, choose levofloxacin or moxifloxacin—not ciprofloxacin—as these have better pneumococcal coverage and are the agents specifically recommended in guidelines 1.