What is the recommended dose and duration of Cipro (Ciprofloxacin) for an adult patient with an uncomplicated urinary tract infection (UTI)?

Ciprofloxacin Dosing for UTI

For uncomplicated cystitis (simple bladder infection), use ciprofloxacin 250 mg orally twice daily for 3 days, but only when first-line agents like nitrofurantoin cannot be used due to fluoroquinolone resistance concerns. 1

Dosing by UTI Type

Uncomplicated Cystitis (Lower UTI)

• Standard regimen: 250 mg orally twice daily for 3 days 1, 2
• Extended-release alternative: 500 mg once daily for 3 days 1, 3
• The 3-day regimen is as effective as 7-day treatment but with significantly fewer adverse events 1
• Critical caveat: Fluoroquinolones should be reserved as second-line therapy due to collateral damage promoting resistance in other pathogens, including MRSA 1

Uncomplicated Pyelonephritis (Kidney Infection)

• Oral therapy: 500-750 mg twice daily for 7 days 4, 1
• Extended-release option: 750 mg once daily for 5 days (levofloxacin equivalent) 4
• IV therapy (if hospitalized): 400 mg IV twice daily 4
• Resistance threshold: Only use when local fluoroquinolone resistance is <10% 4, 1
• If resistance exceeds 10%, administer an initial IV dose of ceftriaxone 1g before starting oral ciprofloxacin 4, 1

Complicated UTI

• Oral therapy: 500-750 mg twice daily for 7-14 days 2
• Extended-release: 1000 mg once daily for 7-14 days 5
• Duration: 7 days for prompt symptom resolution; 14 days for delayed response or when prostatitis cannot be excluded in males 6
• Obtain urine culture before starting therapy to guide treatment 6

First-Line Alternatives to Consider First

You should preferentially use these agents before ciprofloxacin:

• Nitrofurantoin: 100 mg twice daily for 5 days—first-line for uncomplicated cystitis due to minimal resistance and less collateral damage 1
• Trimethoprim-sulfamethoxazole: 160/800 mg twice daily for 3 days if local resistance is <20% 1

Critical Resistance Considerations

• Never use fluoroquinolones empirically when local resistance exceeds 10% or in patients with recent fluoroquinolone exposure 6
• Fluoroquinolone use for simple cystitis promotes resistance not only in uropathogens but also in organisms causing more serious infections 1
• If symptoms persist or recur within 2-4 weeks, obtain urine culture and assume resistance to the original agent—use a different antimicrobial class for 7 days 1

Important Clinical Pitfalls

• Avoid single-dose therapy: Inadequate duration increases risk of bacteriological persistence and recurrence 6
• Do not use for complicated UTI without culture: Complicated UTIs have broader microbial spectrum and higher resistance rates 6
• Never use nitrofurantoin or fosfomycin for pyelonephritis or complicated UTI: These agents have limited tissue penetration 6
• Male UTIs are always complicated: Require longer treatment durations (7-14 days) 1
• Replace indwelling catheters that have been in place ≥2 weeks at treatment onset to hasten symptom resolution 6

Dosing in Renal Impairment

• CrCl 30-50 mL/min: 250-500 mg every 12 hours 2
• CrCl 5-29 mL/min: 250-500 mg every 18 hours 2
• Hemodialysis/peritoneal dialysis: 250-500 mg every 24 hours (after dialysis) 2

When to Switch from IV to Oral

• Switch when clinically indicated at physician discretion 2
• Equivalent dosing: 250 mg oral = 200 mg IV; 500 mg oral = 400 mg IV 2