Is Cipro (ciprofloxacin) effective for recurrent urinary tract infections (UTIs) caused by Escherichia coli (E. coli)?

From the Guidelines

Ciprofloxacin (Cipro) should not be used as a first-line treatment for recurrent urinary tract infections (UTIs) caused by E. coli due to concerns about antibiotic resistance and side effects, but it may be considered for recurrent infections with known E. coli susceptibility, with a typical dosage of 250-500 mg orally twice daily for 3-7 days. The most recent and highest quality study, published in 2021 1, recommends short-course antibiotics with either nitrofurantoin for 5 days, trimethoprim–sulfamethoxazole (TMP–SMZ) for 3 days, or fosfomycin as a single dose for uncomplicated bacterial cystitis. For men and women with uncomplicated pyelonephritis, the study recommends short-course therapy either with fluoroquinolones (5 to 7 days) or TMP–SMZ (14 days) based on antibiotic susceptibility. However, due to the high prevalence of resistance to fluoroquinolones, including ciprofloxacin, and the potential for serious side effects, alternative treatments should be considered first. Some patients with frequent recurrences may benefit from prophylactic approaches, such as a single 250 mg dose of ciprofloxacin taken after sexual intercourse (if UTIs are related to sexual activity) or a low-dose regimen of 125 mg daily at bedtime for 6-12 months. It's essential to complete the full prescribed course even if symptoms improve, drink plenty of water during treatment, and be aware of potential side effects, including tendon inflammation, digestive issues, and nervous system effects. The 2024 study 1 also highlights the importance of considering local resistance patterns and the potential risks and benefits of different antibiotic treatments. Overall, the treatment of recurrent UTIs should be individualized based on the patient's specific situation, medical history, and the results of urine culture and susceptibility testing. Key points to consider when treating recurrent UTIs include:

• The use of first-line antibiotics, such as nitrofurantoin or TMP-SMZ, for uncomplicated cystitis
• The consideration of alternative treatments, such as fosfomycin or ciprofloxacin, for uncomplicated pyelonephritis or recurrent infections with known E. coli susceptibility
• The importance of completing the full prescribed course of antibiotics and being aware of potential side effects
• The need for individualized treatment based on the patient's specific situation and medical history.

From the FDA Drug Label

Ciprofloxacin is indicated for the treatment of complicated urinary tract infections and pyelonephritis due to Escherichia coli Although effective in clinical trials, ciprofloxacin is not a drug of first choice in the pediatric population due to an increased incidence of adverse events compared to the controls, including events related to joints and/or surrounding tissues. Bacteriologic Eradication of the Baseline Pathogen at 5 to 9 Days Post-Treatment Escherichia coli 156/178 (88%)

Ciprofloxacin can be used to treat recurrent UTI with E coli.

• The drug label indicates that ciprofloxacin is effective against E coli in complicated urinary tract infections and pyelonephritis.
• However, it is not the first choice in the pediatric population due to the increased risk of adverse events.
• The bacteriologic eradication rate for E coli is 88% at 5 to 9 days post-treatment 2

From the Research

Ciprofloxacin for Recurrent UTI with E. coli

• Ciprofloxacin is a widely used fluoroquinolone for the treatment of urinary tract infections (UTIs) caused by E. coli 3.
• However, the emergence of ciprofloxacin-resistant E. coli has been reported, and risk factors for such resistance include recurrent UTI and prior exposure to fluoroquinolones 4, 5.
• A study found that patients with recurrent UTI had an increased risk of ciprofloxacin-resistant E. coli, with an odds ratio of 8.13 4 and 6.23 5.
• Another study showed that extended-release ciprofloxacin was effective in treating complicated UTIs and acute uncomplicated pyelonephritis, with bacteriological eradication rates of 89% and clinical cure rates of 97% 6.
• However, the use of ciprofloxacin may not be suitable for all patients, especially those with recurrent UTIs or prior fluoroquinolone use, and alternative antimicrobial agents such as nitrofurantoin or temocillin may be considered 4, 7.
• The susceptibility of E. coli to ciprofloxacin varies, with resistance rates ranging from 22% to 25% in different studies 3, 7.