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Skin and Skin Structure Infections

Ciprofloxacin and Levofloxacin are equally effective for the treatment of skin infections 5.

In clinical study among 253 patients (129 levofloxacin, 124 ciprofloxacin), cure and improvement were observed in 96.1% of levofloxacin-treated patients and in 93.5% of ciprofloxacin-treated patients. Bacteriological eradication rates by pathogen were 93.2% and 91.7%, respectively. Levofloxacin eradicated 94% (66/70) of Staphylococcus aureus and 94% (17/18) of Streptococcus pyogenes isolates, compared with 93% (70/75) and 92% (12/13) for ciprofloxacin. Microbiological eradication rates by subject were approximately 93% and 90% for the levofloxacin and ciprofloxacin groups, respectively. Adverse events were reported by 8.9% of those receiving levofloxacin and 8.2% of those administered ciprofloxacin.

Acute Pyelonephritis, Urinary tract infections (UTI)

Levofloxacin is at least as effective as ciprofloxacin in the treatment of pyelonephritis 6.

In the modified intent-to-treat (mITT) population (levofloxacin 94, ciprofloxacin 98), 83% of levofloxacin-treated and 79.6% of ciprofloxacin-treated persons achieved microbiological eradication. In the microbiologically evaluable (ME) population (levofloxacin 80, ciprofloxacin 76), 92.5% of levofloxacin-treated vs. 93.4% of ciprofloxacin-treated persons achieved microbiologic eradication. Clinical success was achieved in 86.2% vs. 80.6% (mITT) and in 92.5% vs. 89.5% (ME) of levofloxacin-treated and ciprofloxacin-treated patients, respectively. Side effects were similar to those seen previously with both agents.

Chronic bacterial prostatitis

Levofloxacin 500 mg once daily for 28 days is as effective as ciprofloxacin 500 mg twice daily for 28 days for the treatment of chronic bacterial prostatitis. Both provide similar clinical success rates, including cured plus improved patients (75% for levofloxacin and 72.8% for ciprofloxacin) and icrobiologic eradication rates (75% for levofloxacin and 76.8% for ciprofloxacin) 7.

Urinary tract infections in women

Both agents are equally effective 10. In a double-blind, randomized controlled study 114 patients receiving ciprofloxacin and 112 receiving norfloxacin were evaluated. Bacteriologic cure was 91.2% in the ciprofloxacin group and 91.9% in the norfloxacin group. Clinical resolution was 91.2 and 93.8%, respectively.

Complicated urinary tract infections in women

Ciprofloxacin 250 mg 2 times per day is at least as effective as ofloxacin 200 mg 2 times per day in women with complicated lower urinary tract infection 11. In the study 90.1% of the ciprofloxacin group and 87.2% of the ofloxacin group had sterile urine 5-9 days after the end of therapy; 77.1% and 76.1% had sterile cultures, respectively. Clinical cure was achieved in 97.2% of both groups 5-9 days after cessation of therapy and a month later in 87.7% and 87.3%, respectively. Adverse events were mild and similar in both groups.

Pyelonephritis

Ciprofloxacin is more effective than co-trimoxazole (Trimethoprim-Sulfamethoxazole) for pyelonephritis 10.

In randomized, double-blind comparative study at 4 to 11 days posttherapy, bacteriologic cure rates were 99% with ciprofloxacin and 89% with trimethoprim-sulfamethoxazole therapy. Clinical cure rates were 96% for the ciprofloxacin and 83% for the trimethoprim-sulfamethoxazole regimen. Escherichia coli, which caused more than 90% of infections, was more frequently resistant to co-trimoxazole (18%) than to ciprofloxacin (0%). Among trimethoprim-sulfamethoxazole-treated patients, resistance was associated with greater bacteriologic and clinical failure rates. Adverse events occurred in 24% of ciprofloxacin-treated patients and in 33% of trimethoprim-sulfamethoxazole-treated patients.

Chronic obstructive airways disease (acute exacerbations)

Ciprofloxacin is much more effective than amoxicillin in the treatment of acute exacerbations of chronic obstructive airways disease 19. In a comparative study ciprofloxacin produced a 91.8% success rate (complete success 21.9%; partial success 69.9%) while amoxicillin produced only 73.1% rate (complete success 10.4%; partial success 62.7%).

Chronic suppurative otitis media

Ciprofloxacin seems to be an effective treatment of chronic otitis media, and superior to Augmentin 4.

Ciprofloxacin (500 mg twice daily) was compared with amoxicillin/clavulanic acid (500 mg three times daily) in 76 persons with chronic suppurative otitis media. At the end of treatment, otorrhoea disappeared in 57.5% of the ciprofloxacin group and 37.1% of the amoxicillin/clavulanic acid group. Bacterial eradication rate was also significantly greater with ciprofloxacin (69.7%) than with amoxicillin/clavulanic acid (27.3%).

Sinusitis

Ciprofloxacin appears to be at least as effective as Augmentin in the treatment of chronic sinusitis 16.

Adults with chronic sinusitis were enrolled into prospective double-blind, double-placebo comparison of ciprofloxacin (500 mg twice daily) with amoxicillin/clavulanic acid (500 mg three times daily). Treatment lasted 9 days, at the end of which nasal discharge disappeared in 71/118 (60.2%) patients of the ciprofloxacin group and 69/123 (56.1%) of those in the amoxicillin/clavulanic acid group. The clinical cure and bacteriological eradication rates were 58.6% versus 51.2% and 88.9% versus 90.5% for ciprofloxacin and amoxicillin/clavulanic acid, respectively. These differences were not significant, however, among patients who had a positive initial culture and who were evaluated 40 days later. Ciprofloxacin recipients had a significantly higher cure rate than those treated with amoxicillin/clavulanic acid (83.3% vs. 67.6%). Tolerance was significantly better with ciprofloxacin, essentially due to a large number of gastro-intestinal side-effects in the amoxicillin/clavulanic acid group.

Urinary tract infections

Ciprofloxacin is significantly more effective than Augmentin in the treatment of uncomplicated urinary tract infections 17.

Cystitis in women

Amoxicillin-clavulanate is not as effective as ciprofloxacin for acute uncomplicated cystitis, even in women infected with susceptible bacteria 18.

In randomized trial clinical cure was achieved in 93 (58%) of 160 women treated with amoxicillin-clavulanate compared with 124 (77%) of 162 women treated with ciprofloxacin. Amoxicillin-clavulanate was not as effective as ciprofloxacin even against susceptible strains. The difference in clinical cure rates occurred almost entirely within the first 2 weeks after therapy. Microbiological cure at 2 weeks was observed in 118 (76%) of 156 women treated with amoxicillin-clavulanate compared with 153 (95%) of 161 women treated with ciprofloxacin. At this visit, 45% of women in the amoxicillin-clavulanate group compared with 10% in the ciprofloxacin group had vaginal colonization with E. coli.

Chronic prostatitis

Azithromycin is significantly more effective than ciprofloxacin in the treatment of chronic prostatitis caused by Chlamydia trachomatis. According to the comparative analysis2 azithromycin has significantly higher eradication and a significantly higher clinical cure rates than ciprofloxacin.

Shigellosis

Ciprofloxacin is somewhat more effective than azithromycin in the treatment of Shigellosis (a type of infective diarrhea) 12.

In a double-blind, randomized, controlled study azithromycin therapy was clinically successful in 28 (82%) patients and ciprofloxacin therapy in 32 (89%) patients. Therapy was bacteriologically successful in 32 (94%) patients receiving azithromycin and 36 (100%) those receiving ciprofloxacin.

Gonorrhea

Azithromycin is at least as effective and well tolerated as ciprofloxacin in the treatment of gonococcal infections. Azithromycin is particularly useful for sailors and people constantly on the move 13.

In the clinical study patients with gonorrhea were treated with azithromycin (n=50) and ciprofloxacin (n=51). After 2 weeks clinical and microbiological cure rates were 96.0% (48 out of 50) in azithromycin group and 92.15% (47 out of 51) in ciprofloxacin group. Side effects were reported in 5 patients treated with azithromycin and 6 with ciprofloxacin.

Chronic bronchitis (acute bacterial exacerbations)

Ciprofloxacin provides longer infection-free interval and higher bacteriologic cure rate than clarithromycin 14.

In double-blind study, ciprofloxacin was compared with clarithromycin for treatment of acute bacterial exacerbations of chronic bronchitis (ABECB). Patients randomly received either ciprofloxacin or clarithromycin (500 mg twice a day for 14 days). 376 patients with acute exacerbations of chronic bronchitis were enrolled in the study of whom 234 had an ABECB. Clinical resolution was achieved in 90% (89 of 99) of ciprofloxacin treated patients and 82% (75 of 91) of clarithromycin treated patients. The median infection-free interval was 142 days for ciprofloxacin and 51 days for clarithromycin therapy. Bacteriologic eradication rates were 91% (86 of 95) for ciprofloxacin and 77% (67 of 87) for clarithromycin.

Sinusitis

Cure rates immediately after antibiotic therapy are higher with clarithromycin. However relapses rates are twice as higher with clarithromycin15.

The clinical study compared the efficacy and safety of ciprofloxacin (500 mg twice daily for 10 days) and clarithromycin (500 mg twice daily for 14 days) in adults with acute sinusitis. Of 457 adults (236 ciprofloxacin, 221 clarithromycin), clinical resolution plus improvement at the end of therapy was 84% for ciprofloxacin-treated patients compared to 91% of those treated with clarithromycin. At the 1-month follow-up, more than twice as many clarithromycin-treated patients, 18 (10%), experienced a relapse, compared to 7 (4%) ciprofloxaci-treated patients. The combined clinical response analyses (end of therapy and 1-month follow-up) demonstrated that both treatments were statistically equivalent. Diarrhea, nausea, headache, and dizziness were the most frequently reported adverse events in both groups. Diarrhea and taste perversion were reported more frequently with clarithromycin.

Legionella pneumonia

Ciprofloxacin is as effective as Erythromycin for Legionella pneumonia. The treatment effects may appear earlier and the duration of treatment is significantly shorter with ciprofloxacin than with Erythromycin 9.

In clinical study all of the petients with Legionella pneumonia, who were treated with Ciprofloxacin, were cured. In the Erythromycin group 16 out of the 18 patients were cured. Although there were no significant differences, the time to apyrexia, normalization of leukocytosis and a 50% decrease in C-reactive protein (CRP) occurred within a relatively shorter time frame in the Ciprofloxacin group than in the Erythromycin group (3.5 versus 4 days, 4 versus 5.2 days, and 2.9 versus 10.3 days, respectively). And, the duration of treatment with Ciprofloxacin was significantly shorter than with Erythromycin.

Sinusitis

Ciprofloxacin is as effective as cefuroxime axetil in the treatment of acute sinusitis20.

In randomized, double-blind clinical study of 453 adults valid for clinical efficacy (228 ciprofloxacin, 225 cefuroxime axetil), ciprofloxacin was statistically equivalent to cefuroxime at the end of treatment (87% vs. 83%) and at follow-up (91% vs. 88%). The clinical response was similar for subgroups of patients with positive cultures, including the subset with target organisms. Bacteriologic eradication at the end of therapy was similar between the two groups (97% ciprofloxacin, 95% cefuroxime axetil). Both treatments were equally well tolerated.

Rhinosinusitis

Ciprofloxacin and cefuroxime are equally effective in acute rhinosinusitis21.

In comparative study clinical resolution was observed in 559 of 613 (91.2%) ciprofloxacin-treated patients and 546 of 606 (90.1%) cefuroxime treated patients. The two regimens were statistically equivalent. There were 80 adverse events reported in the ciprofloxacin group and 81 adverse events reported in the cefuroxime group. The main adverse events were nausea (n = 18) and diarrhea (n = 7) in patients treated with ciprofloxacin and diarrhea (n = 14), nausea (n = 12), headache (n = 7), and vaginitis (n = 7) in those treated with cefuroxime.

Gonorrhea

Single dose cefuroxime axetil is as effective as a single dose of ciprofloxacin in the treatment of uncomplicated gonorrhea caused by penicillinase-producing Neisseria gonorrhoeae (PPNG). However cefuroxime appears to be less effective than ciprofloxacin in treating urethral gonococcal infections in men, although both are highly effective in treating cervical gonococcal infections in women 22.

In a randomized, multicenter, investigator-blind trial a total of 832 patients (434 females and 398 males) received a single oral dose of cefuroxime axetil 1,000 mg (417 patients) or ciprofloxacin 500 mg (415 patients). Neisseria gonorrhoeae was eradicated from the cervix in 114 of 118 (97%) and 118 of 119 (99%) females treated with cefuroxime axetil and ciprofloxacin, respectively, and from the urethra in 154 of 166 (93%) and 171 of 171 (100%) males treated with cefuroxime axetil and ciprofloxacin, respectively. Both medications were effective in eradicating N. gonorrhoeae in females with rectal infections (cefuroxime axetil, 29 of 30 [97%]; ciprofloxacin, 25 of 25 [100%]). In small numbers of patients, cefuroxime axetil was less effective than ciprofloxacin in treating males with pharyngeal infections (eradication in 4 of 10 and in 8 of 8 patients).

Penicillinase-producing Neisseria gonorrhoeae was eradicated from the cervix in 22 of 23 (96%) and 32 of 32 (100%) females treated with cefuroxime axetil and ciprofloxacin, respectively, and from the urethra in 35 of 36 (97%) and 34 of 34 (100%) males treated with cefuroxime axetil and ciprofloxacin, respectively. The incidences of adverse events were similar for the two study gropes.

Skin infections

Oral ciprofloxacin may be more effective than parenteral cefotaxime in the treatment of infections of the skin and skin structure. Cefotaxime is associated with higher incidence of bacteriologic failure in patients with polymicrobial infected ulcers 23.

In the double-blind, randomized study 3 of hospitalized patients with skin and skin structure infections clinical response per infected site in the ciprofloxacin group was as follows: resolution in 88%, improvement in 8%, and failure in 4%. In the cefotaxime group, there was resolution in 69%, improvement in 25% and failure in 6%. Bacteriologic response per site in the ciprofloxacin group was eradication in 88% and persistence in 12%. With cefotaxime there was 69% eradication, 3% marked reduction, 6% recurrence, and 22% persistence. Clinical and bacteriologic responses were combined using an algorithm to derive a cure rate, which was 91% for ciprofloxacin and 61% for cefotaxime.

• Ciprofloxacin (Cipro) Facts

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Published: March 31, 2008
Last updated: March 18, 2011