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
Cephalexin
Cipro vs. Cephalexin Dosage
Cipro
Cephalexin
| 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 |
| 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
| 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
| 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
Common Symptoms and Related Diseases You Can Explore
Explore a range of common symptoms the Doctronic Symptom Checker can help you understand.