Cipro vs. Keflex
See how Cipro and Keflex compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Cipro can clear an uncomplicated UTI in as few as 3 days, but its boxed warnings for tendon rupture and nerve damage limit it to cases without safer options.
Keflex has a milder safety profile with no boxed warnings, but it does not cover Pseudomonas and usually needs 7 to 14 days of treatment for a UTI.
Both are taken by mouth, but Cipro is typically dosed twice daily while Keflex may be needed every 6 to 12 hours depending on the infection.
Cipro vs. Keflex Drug Summary
Cipro
Cipro (ciprofloxacin) is a fluoroquinolone antibiotic used for urinary tract infections and several other bacterial infections. It is taken by mouth, typically every 12 hours, with the dose and length of treatment set by how severe the infection is.
Keflex
Keflex (cephalexin) is a first-generation cephalosporin antibiotic used for urinary tract infections along with skin, respiratory, and bone infections. It is taken by mouth, typically every 6 to 12 hours, with dosing based on the type and severity of infection.
Cipro vs. Keflex Side Effects
Cipro
Keflex
Cipro vs. Keflex Dosage
Cipro
Keflex
| 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 | 250 mg every 6 hours | At the start |
| Maximum dose | 25-50 mg/kg/day divided | If needed |
| Dose changes | 3 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 |
Keflex
| STAGE | DOSE | WHEN |
| Starting dose | 250 mg every 6 hours | At the start |
| Maximum dose | 25-50 mg/kg/day divided | If needed |
| Dose changes | 3 increases | As tolerated |
Cipro vs. Keflex Indications
Cipro
Cipro is FDA-approved for uncomplicated and complicated urinary tract infections, including pyelonephritis caused by E. coli and other gram-negative bacteria. It also treats skin, bone and joint, respiratory, and intra-abdominal infections, plus certain cases of infectious diarrhea and typhoid fever.
Uncomplicated UTI (cystitis)
Complicated UTI and pyelonephritis
Skin and skin structure infections
Bone and joint infections
Infectious diarrhea and typhoid fever
Keflex
Keflex is FDA-approved for genitourinary tract infections, including UTIs, along with respiratory tract infections, otitis media, and skin and skin structure infections. It is also approved for bone infections but is not effective against Pseudomonas or Acinetobacter species.
Urinary tract infections
Respiratory tract infections
Otitis media
Skin and skin structure infections
Bone infections
Cipro vs. Keflex Pros and Cons
Cipro
Cipro is a fluoroquinolone that reaches high concentrations in urine and works quickly against many gram-negative bacteria, including Pseudomonas. That broad coverage comes with boxed warnings that push it toward infections without safer alternative treatments.
Pros
Covers Pseudomonas and other tough gram-negative bacteria
Only 3 days of treatment for an uncomplicated UTI
Available in extended-release and IV forms for severe infections
Specifically FDA-approved for pyelonephritis
Cons
Boxed warnings for tendon rupture, nerve damage, and aortic issues
Rising bacterial resistance limits first-line use for simple UTIs
Must be timed away from dairy, antacids, and mineral supplements
FDA advises reserving it when other options aren't suitable
Keflex
Keflex is an older cephalosporin with a well-documented safety record and fewer serious warnings than fluoroquinolones. It covers many common UTI pathogens but not Pseudomonas, and its treatment courses tend to run longer.
Pros
No boxed warnings on the label
Long track record of use since 1971
Fewer significant drug interactions to manage
Often preferred when fluoroquinolones aren't appropriate
Cons
Not effective against Pseudomonas or Acinetobacter
Dosed as often as every 6 hours for some infections
UTI treatment often runs 7 to 14 days instead of 3
Carries C. diff diarrhea and seizure risks in kidney impairment
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