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• Skin and Skin Structure Infections.
  Ciprofloxacin and Levofloxacin are equally effective for the treatment of skin and skin structure 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. Drug-related 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 750 mg once daily for 5 days is at least as effective as ciprofloxacin 400 mg or 500 mg twice daily for 10 days in the treatment of acute 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. The clinical success rates, including cured plus improved patients, were similar (75% for levofloxacin and 72.8% for ciprofloxacin). Microbiologic eradication rates were 75% for levofloxacin and 76.8% for ciprofloxacin 7.

• Urinary tract infections in women.
  Both medications 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.
  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.
  7 days ciprofloxacin regimen is more effective than 14 days co-trimoxazole regimen 10.
  In randomized, double-blind comparative study at 4 to 11 days posttherapy, bacteriologic cure rates were 99% with ciprofloxacin therapy and 89% for the 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 trimethoprim-sulfamethoxazole (18%) than to ciprofloxacin (0%). Among trimethoprim-sulfamethoxazole-treated patients, drug resistance was associated with greater bacteriologic and clinical failure rates. Drug-related 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 comparative study ciprofloxacin produced a 91.8% success rate (complete success 21.9%; partial success 69.9%) while amoxicillin produced 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 amoxycillin/clavulanic acid 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 amoxycillin/clavulanic acid 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 after treatment. 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 amoxicillin/clavulanic acid in the treatment of uncomplicated urinary tract infections 17.
• Cystitis in women.
  Amoxicillin-clavulanate is not as effective as ciprofloxacin for the treatment of 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 among women infected with strains susceptible to amoxicillin-clavulanate (65 [60%] of 109 women in the amoxicillin-clavulanate group vs 114 [77%] of 149 women in the ciprofloxacin group). 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 (Chlamydia trachomatis).
  Azithromycin is significantly more effective than ciprofloxacin 2.
  Significantly higher eradication and a significantly higher clinical cure were achieved in the group of patients treated with azithromycin than in the ciprofloxacin group.
• 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%) patients receiving ciprofloxacin.
• Gonorrhea.
  1 g azithromycin is at least as effective and well tolerated as 500 mg of ciprofloxacin in the treatment of gonococcal infections. Azithromycin is particularly useful for sailors and people constantly on the move 13.
  59 men and 49 women with gonococcal infection were enrolled in clinical study. Data of 50 patients treated with azithromycin and 51 with ciprofloxacin were evaluable for efficacy and tolerability at the end of the study. After 2 weeks clinical and microbiological cure rates were 96.0% (48 out of 50) for the patients treated with azithromycin and 92.15% (47 out of 51) for the patients treated with ciprofloxacin. 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 of infection than clarithromycin 14.
  In double-blind study, the efficacy of ciprofloxacin was compared with that of 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 therapy 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 therapy. However relapses rates are twice as higher with clarithromycin than with clarithromycin at the 1-month follow-up 15.
  The clinical study compared the efficacy and safety of ciprofloxacin (500 mg twice daily for 10 days, placebo for 4 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 clarithromycin-treated patients. At the 1-month follow-up, more than twice as many clarithromycin-treated patients 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 ciprofloxacin and clarithromycin were statistically equivalent. Diarrhea, nausea, headache, and dizziness were the most frequently reported drug-related adverse events in both treatment groups. Diarrhea and taste perversion were reported more frequently with clarithromycin.

• Nongonococcal urethritis (Chlamydia trachomatis).
  Ciprofloxacin in dosages as high as 2 g daily is inadequate for treatment of chlamydial urethritis in men, often resulting in relapsing infections 3.
  Chlamydia trachomatis was reisolated within 4 weeks after treatment in none of 10 doxycycline-treated patients, in 11 (52%) of 21 patients treated with 750 mg of ciprofloxacin twice daily, and in six (38%) of 16 patients treated with 1000 mg of ciprofloxacin twice daily.
• Non-gonococcal urethritis.
  Ciprofloxacin 1 g for seven days is not effective in the treatment of non-gonococcal urethritis 23.
  Fourteen days after completion of ciprofloxacin therapy pyuria was absent in 30 of 100 patients; Chlamydia trachomatis was isolated from five and Ureaplasma urealyticum from eight patients. In the 100 mg doxycycline group pyuria was absent in 36 of 60 patients (60%) and Ureaplasma urealyticum was isolated from six patients. In the 200 mg doxycycline group pyuria was absent in 18 of 45 patients (40%) and Ureaplasma urealyticum was isolated from two patients. Side-effects were mild and transient in all groups.
  

• Legionella pneumonia.
  Ciprofloxacin is as effective as Erythromycin in the treatment of 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 treated with Ciprofloxacin were cured and 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 antibiotic treatment with Ciprofloxacin was significantly shorter than with Erythromycin.

• Sinusitis.
  Ciprofloxacin is as effective as cefuroxime axetil in the treatment of acute sinusitis 20.
  In randomized, double-blind clinical study of 453 adults valid for clinical efficacy (228 ciprofloxacin, 225 cefuroxime axetil), ciprofloxacin treatment was statistically equivalent to cefuroxime axetil 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 end of therapy was similar between the two groups (97% ciprofloxacin, 95% cefuroxime axetil). Both treatments were equally well tolerated.
• Rhinosinusitis.
  Ciprofloxacin (500 mg twice a day) and cefuroxime axetil (250 mg twice a day) are equally effective in the treatment of acute rhinosinusitis 21.
  In comparative study clinical resolution was observed in 559 of 613 (91.2%) ciprofloxacin-treated patients and 546 of 606 (90. 1%) cefuroxime axetil-treated patients. The two regimens were statistically equivalent. There were 80 drug-related adverse events reported in the ciprofloxacin-treated patients and 81 drug-related adverse events reported in the cefuroxime-treated patients. 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 axetil appears to be less effective than ciprofloxacin in treating urethral gonococcal infections in men, although both drugs 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%) male patients 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%) female patients treated with cefuroxime axetil and ciprofloxacin, respectively, and from the urethra in 35 of 36 (97%) and 34 of 34 (100%) male patients treated with cefuroxime axetil and ciprofloxacin, respectively. The incidences of drug-related adverse events were similar for the two study drugs.

• Skin and skin structure infections.
  Oral ciprofloxacin may be more effective than parenteral cefotaxime in the treatment of infections of the skin and skin structure.
  Cefotaxime therapy is associated with higher incidence of bacteriologic failure in patients with polymicrobial infected ulcers 24.
  In the double-blind, randomized study 25 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) Medical Facts

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• 3. Hooton TM, Rogers ME, Medina TG, Kuwamura LE, Ewers C, Roberts PL, Stamm WE. Ciprofloxacin compared with doxycycline for nongonococcal urethritis. Ineffectiveness against Chlamydia trachomatis due to relapsing infection. JAMA. 1990 Sep 19;264(11):1418-21. PubMed
• 4. Legent F, Bordure P, Beauvillain C, Berche P. Controlled prospective study of oral ciprofloxacin versus amoxycillin/clavulanic acid in chronic suppurative otitis media in adults. Chemotherapy. 1994;40 Suppl 1:16-23. PubMed
• 5. Nicodemo AC, Robledo JA, Jasovich A, Neto W. A multicentre, double-blind, randomised study comparing the efficacy and safety of oral levofloxacin versus ciprofloxacin in the treatment of uncomplicated skin and skin structure infections. Int J Clin Pract. 1998 Mar;52(2):69-74. PubMed
• 6. Klausner HA, Brown P, Peterson J, Kaul S, Khashab M, Fisher AC, Kahn JB. A trial of levofloxacin 750 mg once daily for 5 days versus ciprofloxacin 400 mg and/or 500 mg twice daily for 10 days in the treatment of acute pyelonephritis. Curr Med Res Opin. 2007 Sep 18. PubMed
• 7. Bundrick W, Heron SP, Ray P, Schiff WM, Tennenberg AM, Wiesinger BA, Wright PA, Wu SC, Zadeikis N, Kahn JB. Levofloxacin versus ciprofloxacin in the treatment of chronic bacterial prostatitis: a randomized double-blind multicenter study. Urology. 2003 Sep;62(3):537-41. PubMed
• 8. Talan DA, Stamm We, Reuning-Scherer J, et al: Ciprofloxacin 7-day vs tmp/smx 14-day +/- ceftriaxone for acute uncomplicated pyelonephritis: A randomized double-blind trial. 8th International Congress on Infectious Diseases. 1998.
• 9. Haranaga S, Tateyama M, Higa F, Miyagi K, Akamine M, Azuma M, Yara S, Koide M, Fujita J. Intravenous ciprofloxacin versus erythromycin in the treatment of Legionella pneumonia. Intern Med. 2007;46(7):353-7. Epub 2007 Apr 2. PubMed
• 10. Talan DA, Stamm WE, Hooton TM, Moran GJ, Burke T, Iravani A, Reuning-Scherer J, Church DA. Comparison of ciprofloxacin (7 days) and trimethoprim-sulfamethoxazole (14 days) for acute uncomplicated pyelonephritis pyelonephritis in women: a randomized trial. JAMA. 2000 Mar 22-29;283(12):1583-90. PubMed
• 11. Raz R, Naber KG, Raizenberg C, Rohana Y, Unamba-Oparah I, Korfman G, Yaniv I. Ciprofloxacin 250 mg twice daily versus ofloxacin 200 mg twice daily in the treatment of complicated urinary tract infections in women. Eur J Clin Microbiol Infect Dis. 2000 May;19(5):327-31. PubMed
• 12. Khan WA, Seas C, Dhar U, Salam MA, Bennish ML. Treatment of shigellosis: V. Comparison of azithromycin and ciprofloxacin. A double-blind, randomized, controlled trial. Ann Intern Med. 1997 May 1;126(9):697-703. PubMed
• 13. Gruber F, Brajac I, Jonjic A, Grubisic-Greblo H, Lenkovic M, Stasic A. Comparative trial of azithromycin and ciprofloxacin in the treatment of gonorrhea. J Chemother. 1997 Aug;9(4):263-6. PubMed
• 14. Chodosh S, Schreurs A, Siami G, Barkman HW Jr, Anzueto A, Shan M, Moesker H, Stack T, Kowalsky S. Efficacy of oral ciprofloxacin vs. clarithromycin for treatment of acute bacterial exacerbations of chronic bronchitis. The Bronchitis Study Group. Clin Infect Dis. 1998 Oct;27(4):730-8. PubMed
• 15. Clifford K, Huck W, Shan M, Tosiello R, Echols RM, Heyd A. Double-blind comparative trial of ciprofloxacin versus clarithromycin in the treatment of acute bacterial sinusitis. Sinusitis Infection Study Group. Ann Otol Rhinol Laryngol. 1999 Apr;108(4):360-7. PubMed
• 16. Legent F, Bordure P, Beauvillain C, Berche P. A double-blind comparison of ciprofloxacin and amoxycillin/clavulanic acid in the treatment of chronic sinusitis. Chemotherapy. 1994;40 Suppl 1:8-15. PubMed
• 17. Abbas AM, Chandra V, Dongaonkar PP, Goel PK, Kacker P, Patel NA, Shrivastava OP, Thakkar B, Tillotson GS. Ciprofloxacin versus amoxycillin/clavulanic acid in the treatment of urinary tract infections in general practice. J Antimicrob Chemother. 1989 Aug;24(2):235-9. PubMed
• 18. Hooton TM, Scholes D, Gupta K, Stapleton AE, Roberts PL, Stamm WE. Amoxicillin-clavulanate vs ciprofloxacin for the treatment of uncomplicated cystitis in women: a randomized trial. Hooton TM, Scholes D, Gupta K, Stapleton AE, Roberts PL, Stamm WE. JAMA. 2005 Feb 23;293(8):949-55. PubMed
• 19. Basran GS, Joseph J, Abbas AM, Hughes C, Tillotson GS. Treatment of acute exacerbations of chronic obstructive airways disease--a comparison of amoxycillin and ciprofloxacin. J Antimicrob Chemother. 1990 Dec;26 Suppl F:19-24. PubMed
• 20. Johnson PA, Rodriguez HP, Wazen JJ, Huck W, Shan M, Tosiello R, Heyd A, Echols RM. Ciprofloxacin versus cefuroxime axetil in the treatment of acute bacterial sinusitis. Sinusitis Infection Study Group. J Otolaryngol. 1999 Feb;28(1):3-12. PubMed
• 21. Weis M, Hendrick K, Tillotson G, Gravelle K. Multicenter comparative trial of ciprofloxacin versus cefuroxime axetil in the treatment of acute rhinosinusitis in a primary care setting. Rhinosinusitis Investigation Group. Clin Ther. 1998 Sep-Oct;20(5):921-32. PubMed
• 22. Thorpe EM, Schwebke JR, Hook EW 3rd, Rompalo A, McCormack WM, Mussari KL, Giguere GC, Collins JJ. Comparison of single-dose cefuroxime axetil with ciprofloxacin in treatment of uncomplicated gonorrhea caused by penicillinase-producing and non-penicillinase-producing Neisseria gonorrhoeae strains. Antimicrob Agents Chemother. 1996 Dec;40(12):2775-80. PubMed
• 23. van der Willigen AH, Polak-Vogelzang AA, Habbema L, Wagenvoort JH. Abstract Clinical efficacy of ciprofloxacin versus doxycycline in the treatment of non-gonococcal urethritis in males. Eur J Clin Microbiol Infect Dis. 1988 Oct;7(5):658-61. PubMed
• 24. Gentry LO, Ramirez-Ronda CH, Rodriguez-Noriega E, Thadepalli H, del Rosal PL, Ramirez C. Oral ciprofloxacin vs parenteral cefotaxime in the treatment of difficult skin and skin structure infections. A multicenter trial. Arch Intern Med. 1989 Nov;149(11):2579-83. PubMed
• 25. Parish LC, Asper R. Systemic treatment of cutaneous infections. A comparative study of ciprofloxacin and cefotaxime. Am J Med. 1987 Apr 27;82(4A):227-9. PubMed