Not Your Mother’s UTI: Cipro No Longer First-Line Agent

Not Your Mother's UTI: Cipro No Longer First-Line Treatment
(The following article was written to address Urinary Tract Infection guidelines in women. UTI’s in men are addressed differently)

I hear it time and time again. A request for cipro.

In a field where patients come in and out of the office for a myriad of complaints, a urinary tract infection can be a dime a dozen. For women especially, this can happen frequently, because of the way in which our bodies are built, with the proximity of our urethra to the rectum. Our bladder is also a shorter distance away, as compared with men, which doesn’t help matters much. This is why I’ll often see female patients in my office, and under their chief complaint are just three letters: ‘UTI’.

Which, of course, is erroneous, because a chief complaint should be a symptom, not a diagnosis. It should be exactly as it sounds- a chief ‘complaint‘. Examples are ‘cough’ or ‘tingling fingers’, or in this case, ‘frequency urinating’. It’s crucial to make that distinction because many times a patient may feel like they are having a UTI when, in fact, they’re experiencing something completely different.

The other day I had a male patient with that exact chief complaint typed in to his chart, but ended up diagnosed with diverticulitis, an infection of his intestine, a different organ system altogether. Another patient, a young female, came in with a similar presentation, but had no bacteria in her urine on her culture. I ended up diagnosing her with a yeast infection instead. Other possibilities also exist. I did a quick google search on the topic and found an epocrates list using data from the British Medical Journal with no less than 16 differentials. Other sites had even more.

In general, however, with UTI’s, my patients are, in fact, usually correct in their presumption.  They know what they’re feeling, especially when it’s something that they’ve felt before. This is also why an infection like this can sometimes be treated empirically, without testing.

But here’s something you may not have known. The guidelines for treatment of an uncomplicated urinary tract infection have changed over the past few years, with the rise in antibiotic resistance, and more updated side effect profiles. Which is why I feel that writing this post is important. To educate the patient and empower her with useful knowledge. Ultimately, your doctor makes the decision on how to treat, but it’s still a good idea to put knowledge into your hands, especially with a common ailment such as this.

In general, with UTI, my patients are, in fact, usually correct in their presumption.

Until fairly recently, Cipro (the brand name for ciprofloxacin) was the go-to medication for the treatment of a run-of-the-mill UTI. But that has changed. Cipro is no longer recommended in the treatment of a UTI in females. Not as first line, or even second, for that matter. Some hospitals have even gone as far as limiting access to its use.

In my practice, I see more and more sensitivity profiles showing resistance to this drug. Why? Because it’s been overused. Every phone call to the doctor was followed in the past by the doctor’s reflexive ‘Cipro-call’ into the pharmacy. Women held on to them in their bathroom cabinets, for just-in-case. But we’re now on the forefront of a worldwide antibiotic resistance crisis. Some facts from the World Health Organization on this matter here. Pay special attention to the Scope section, and follow it up by reading on Prevention and Control.

Cipro is no longer recommended in the treatment of a UTI in females. Not as first line, or second, for that matter.

In addition to the resistance aspect, just last year, the FDA (Food and Drug Administration) came out with a very strong warning, reminding practitioners of the dangers of flurouquinolones, a class of antibiotics of which Cipro is a member. While its adverse effect profile is extensive, the FDA chose to focus on tendonitis and tendon rupture as one of the main causes for alarm.

In fact, according to the latest guidelines published in up-to-date, the go-to subscription based publication that doctors turn to as their bible, the first line treatment of an outpatient, uncomplicated UTI is an antibiotic called nitrofurantoin, under the brand name of ‘Macrobid’ or ‘Macrodantin’. It is, in fact, given twice daily, as opposed to the old cipro, normally given in a convenient once daily dosing, but it’s the first line medication at this point in time and should be utilized as such. Allergies and other aspects of treatment-specifics should, of course, be considered on a per-patient basis, by the medical practitioner (we’ve been through so much training for a reason).

Why is it important for us all to follow guidelines? It’s important because we want to do it right. We want to treat ourselves based on data, the research that goes into finding the right cures, which yield the right numbers. We also want to do it because of the future of our children. When we follow guidelines, we decrease the chances of not only spreading antibiotic resistance, but of improperly treating the infection itself. Isn’t that ultimately what both patients and doctors both want?

To read  about Six Ways to Reduce UTI Symptoms, click on the link. Remember that the 6 ways don’t serve as substitutes for treatment of a UTI. That’s what the antibiotic is for.


Most importantly, discuss these issues with your doctor before following any advice on this blog. There are certain conditions which may warrant medications like Cipro to be prescribed: for example, structural abnormalities and immunocompromise.

Cipro no longer first line agent in treatment of UTI

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