Cipro vs. Cephalexin

See how Cipro and Cephalexin compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Cipro is a fluoroquinolone antibiotic that carries an FDA boxed warning for tendon, nerve, and central nervous system damage, so it's generally reserved for infections without safer alternatives.

  • Cephalexin is a first-generation cephalosporin with a decades-long safety record and no boxed warning, making it a common first-line choice for many outpatient infections.

  • Both drugs treat bacterial urinary tract infections, but Cipro covers a broader range of bacteria, including some gram-negative strains cephalexin cannot reach.

Cipro vs. Cephalexin Drug Summary

Cipro

Cipro (ciprofloxacin) is a fluoroquinolone antibiotic used to treat serious bacterial infections such as complicated urinary tract infections, bone and joint infections, and certain respiratory and skin infections. It's typically taken as an oral tablet every 12 hours, with treatment lasting anywhere from 3 to 14 days depending on the infection.

Cephalexin

Cephalexin is a first-generation cephalosporin antibiotic used to treat respiratory, skin, bone, and urinary tract infections caused by susceptible bacteria. It's taken by mouth, usually every 6 to 12 hours, with the exact dose based on the infection type and, in children, on body weight.

Cipro vs. Cephalexin Side Effects

Cipro

Most common
Vomiting (up to 4.8%)
Diarrhea (up to 4.8%)
Nausea (up to 2.7%)
Rash (up to 1.8%)

Cephalexin

Most common
Vomiting (rate not specified in FDA label)
Diarrhea (rate not specified in FDA label)
Nausea (rate not specified in FDA label)
Dyspepsia (rate not specified in FDA label)

Cipro vs. Cephalexin Dosage

Cipro

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 250 mg every 12 hours At the start
Maximum dose 750 mg every 12 hours If needed
Dose changes 2 increases As tolerated

Cephalexin

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 25-50 mg/kg/day divided At the start
Maximum dose 1 to 4 g/day divided If needed
Dose changes 4 increases As tolerated

Cipro vs. Cephalexin Indications

Cipro

Cipro is FDA-approved for a wide range of bacterial infections, including complicated and uncomplicated UTIs, bone and joint infections, and certain respiratory and skin infections. Because of its serious side-effect profile, the FDA recommends reserving it for infections without safer alternative treatment options.

  • Complicated and uncomplicated urinary tract infections

  • Bone and joint infections

  • Respiratory tract infections (bronchitis, pneumonia)

  • Skin and skin structure infections

  • Anthrax post-exposure prophylaxis and plague

Cephalexin

Cephalexin is FDA-approved to treat respiratory tract infections, otitis media, skin and skin structure infections, bone infections, and certain genitourinary infections caused by susceptible bacteria. It's also used off-label as an adjunct for acne and for surgical site infection prevention.

  • Urinary tract infections, including acute prostatitis

  • Bone infections (staph or Proteus)

  • Respiratory tract infections (strep)

  • Skin and skin structure infections

  • Otitis media

Cipro vs. Cephalexin Pros and Cons

Cipro

Cipro is a fluoroquinolone with broad gram-negative coverage, including Pseudomonas, which makes it useful for serious or resistant infections. It carries an FDA boxed warning for tendon, nerve, and CNS effects, so doctors generally reserve it for infections without safer options.

Pros

  • Effective against a broad range of gram-negative bacteria, including Pseudomonas

  • Short oral course, often just twice daily

  • Used for serious infections like anthrax and plague where few oral options exist

Cons

  • Carries an FDA boxed warning for tendon rupture, nerve damage, and CNS effects

  • FDA advises against use for sinusitis, bronchitis, or uncomplicated UTIs if alternatives exist

  • Interacts with many drugs, including a contraindication with tizanidine

  • Linked to rare but serious aortic aneurysm and dissection risk

Cephalexin

Cephalexin is a first-generation cephalosporin with a decades-long safety record and no boxed warning. It doesn't cover the gram-negative range Cipro does, so it's typically reserved for skin, respiratory, and urinary infections caused by more predictable bacteria.

Pros

  • No boxed warning and a long safety record since the early 1970s

  • Often the preferred first-line choice for outpatient skin and urinary infections

  • Fewer serious drug interactions than Cipro

Cons

  • Not effective against many gram-negative bacteria that Cipro covers, like Pseudomonas

  • Requires more frequent dosing, every 6 to 12 hours

  • Cross-reactivity risk in patients with severe penicillin allergy

  • Only available as a generic; brand-name Keflex has been discontinued

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