For an adult with an uncomplicated lower urinary tract infection caused by a ciprofloxacin‑susceptible organism, how many days of ciprofloxacin should be prescribed?

Treatment Duration for Uncomplicated Lower UTI with Ciprofloxacin

For an uncomplicated lower urinary tract infection (simple cystitis) in an adult with a ciprofloxacin-susceptible organism, prescribe ciprofloxacin 250 mg twice daily for 3 days. 1

Key Distinction: This is NOT a Male UTI

Based on your question mentioning "Salmonella" (likely autocorrected from another pathogen), this appears to be an uncomplicated lower UTI (cystitis), not pyelonephritis or a male UTI. The treatment duration differs dramatically based on this classification.

Recommended Regimen for Uncomplicated Cystitis

• Ciprofloxacin 250-500 mg twice daily for 3 days is the standard duration for uncomplicated lower UTI in women 2, 3
• The 2024 European Association of Urology guidelines do not specifically address uncomplicated cystitis duration for ciprofloxacin, but research consistently supports 3-day courses 2, 3
• A 3-day course of ciprofloxacin 100 mg twice daily achieved 93-94% bacteriologic eradication and 97% clinical success in multiple randomized trials 2, 3

Critical Clinical Context

If this is actually a MALE patient with UTI:

• All UTIs in males are considered complicated by definition 4, 5
• Ciprofloxacin 500 mg twice daily for 7-14 days is required, with 14 days preferred when prostatitis cannot be excluded 4, 5
• A subgroup analysis showed 7-day ciprofloxacin was inferior to 14-day therapy in men (86% vs 98% cure rate) 1, 5

If this is pyelonephritis (upper UTI):

• Ciprofloxacin 500-750 mg twice daily for 7 days is the guideline-recommended duration 1
• The 2024 European Association of Urology guidelines explicitly recommend 7 days for uncomplicated pyelonephritis 1
• A high-quality 2012 randomized trial demonstrated 7 days was non-inferior to 14 days (97% vs 96% cure rate) 6

Evidence Quality and Nuances

• The strongest evidence for 3-day therapy comes from multiple randomized trials in women with uncomplicated cystitis showing 90-97% eradication rates 2, 3
• Single-dose ciprofloxacin (500 mg) was statistically less effective than 3-7 day courses (89% vs 98% eradication) 2
• Extended-release ciprofloxacin 1000 mg once daily for 7-14 days is an alternative for complicated UTI, but offers no advantage for simple cystitis 7

Common Pitfalls to Avoid

• Do not treat for 7-14 days if this is truly uncomplicated cystitis – this promotes unnecessary antibiotic exposure and resistance 2, 3
• Do not use single-dose therapy – it has inferior efficacy compared to 3-day courses 2
• Do not confuse male UTI with female cystitis – males require 7-14 days due to possible prostatic involvement 4, 5
• Verify fluoroquinolone resistance is <10% locally before prescribing ciprofloxacin empirically 1
• Confirm this is lower UTI (cystitis) and not pyelonephritis – fever, flank pain, or costovertebral angle tenderness mandate 7 days minimum 1