Nitrofurantoin vs. Ciprofloxacin: What’s the difference?
- Nitrofurantoin and ciprofloxacin (Cipro) are antibiotics used to treat urinary tract infections (UTIs).
- Ciprofloxacin is also used to treat other bacterial infections including infections of the skin, lungs or airways, bones, and joints, infectious diarrheas, anthrax patients with fever and low white blood cell counts and intra-abdominal infections, typhoid fever, cervical and urethral gonorrhea, chronic bacterial prostatitis, and acute uncomplicated cystitis.
- Brand names of nitrofurantoin include Macrobid, Macrodantin, and Furadantin.
- Side effects of nitrofurantoin and ciprofloxacin that are similar include headache, rash, nausea, vomiting, diarrhea, and abdominal pain.
- Side effects of nitrofurantoin that are different from ciprofloxacin include itching, change in urine color, and loss of appetite.
- Side effects of ciprofloxacin that are different from nitrofurantoin include restlessness. Fluoroquinolones including ciprofloxacin have been associated with serious adverse reactions such as tendinitis or tendon rupture, particularly the Achilles tendon.
What are nitrofurantoin and ciprofloxacin?
Nitrofurantoin is an antibiotic specifically used for treating urinary tract infections (UTIs) caused by several types of bacteria including E. Coli, Enterobacter cystitis, Enterococcus, Klebsiella, and Staphylococcus aureus. Nitrofurantoin interferes with the production of bacterial proteins, DNA, and cell walls. Bacteria cannot survive without a cell wall or multiply without DNA. There are three forms of nitrofurantoin: Furadantin, a microcrystalline form; Macrodantin, a macrocrystalline; and Macrobid, a sustained release form of macrocrystalline. The macrocrystalline form is more slowly absorbed than the microcrystalline form and is used for patients who cannot tolerate the microcrystalline form.
Ciprofloxacin (Cipro) is a fluoroquinolone antibiotic used to treat bacterial infections. It stops the multiplication of bacteria by inhibiting the reproduction and repair of their genetic material (DNA). Other fluoroquinolones include levofloxacin (Levaquin), ofloxacin (Floxin), gatifloxacin (Tequin), norfloxacin (Noroxin), moxifloxacin (Avelox), and trovafloxacin (Trovan). Ciprofloxacin is used to treat infections of the skin, lungs or airways, bones, joints, and urinary tract, infectious diarrheas, anthrax patients with fever and low white blood cell counts and intra-abdominal infections, typhoid fever, cervical and urethral gonorrhea, chronic bacterial prostatitis, and acute uncomplicated cystitis.
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What are the side effects of nitrofurantoin and ciprofloxacin?
Nitrofurantoin
Common side effects of nitrofurantoin include:
- Headache
- Rash
- Itching
- Nausea
- Vomiting
- Change in urine color
- Loss of appetite
- Diarrhea
- Abdominal pain
The macrocrystalline form (Macrodantin) appears to cause less stomach upset. Stomach upset also can be minimized by using a lower dose or by taking nitrofurantoin with food or milk.
Possible serious side effects include:
- Lung injury
- Anemia
- Liver damage
- Exfoliative dermatitis
- Clostridium difficile colitis
- Vasculitis
Nitrofurantoin can cause serious lung injury. The reaction can occur within hours of the start of treatment if the patient has previously received nitrofurantoin, or within a few days of starting nitrofurantoin for the first time. Symptoms include:
- Difficulty breathing
- Chills
- Fever
- Chest pain
- Cough
In other persons, lung injury may occur after approximately a month of treatment. Symptoms include:
- Difficulty breathing
- Rapid breathing
- Cough
Fortunately, the symptoms usually resolve within a week if the medication is stopped. In other individuals, lung injury may not develop until after several months or years of therapy. Unless it is recognized and treated, this delayed lung injury can result in permanent lung damage that remains even after the drug is stopped.
Nitrofurantoin can also cause damage to the sensory nerves of the arms and legs (peripheral neuropathy), which can cause tingling in the extremities. The condition can become severe and is more likely to occur in people with diabetes, vitamin B deficiency, or general debilitation.
Reduced red blood cell count (anemia) by breaking red blood cells (hemolytic anemia) can occur from nitrofurantoin. This reaction occurs most frequently in persons with a deficiency of an enzyme called glucose-6-phosphate dehydrogenase that is very important to the survival of red blood cells.
Nitrofurantoin also can cause liver damage leading to jaundice or a form of hepatitis that can be fatal. Elevated liver enzymes indicate liver damage and are a reason to stop the drug.
Treatment with nitrofurantoin can cause urine to change color to a dark yellow or brown.
Ciprofloxacin
The most common side effects of Cipro, Cipro XR are:
- Nausea
- Vomiting
- Diarrhea
- Abdominal pain
- Rash
- Headache
- Restlessness
Anaphylaxis, or shock, is a rare allergic reaction to this drug. This allergic reaction is a medical emergency and if you are experiencing these symptoms seek medical care immediately.
Symptoms of shock include:
- Cardiovascular collapse
- Facial or throat swelling
- Shortness of breath
- Hives
- Itching
Possible serious side effects of Cipro, Cipro XR include:
- Peripheral neuropathy
- Central nervous system (CNS) effects, for example —
- Toxic psychosis
- Nervousness
- Agitation
- Insomnia
- Anxiety
- Nightmares
- Paranoia
- Dizziness
- Tremors
- Depression
- Hallucinations
- Hyperglycemia
- Clostridium difficile-associated diarrhea (CDAD)
- Abnormal heartbeats
- Liver dysfunction
- Stroke
- Convulsions
- Toxic epidermal necrolysis
- Stevens-Johnson syndrome
- Vasculitis
- Allergic pneumonitis
- Interstitial nephritis
- Acute kidney failure
- Hepatitis
- Jaundice
- Liver failure
- Anemia
- Leukopenia
Other serious side effects and adverse events of Cipro, Cipro XR include:
- Cipro, Cipro XR should be used with caution in patients with central nervous system diseases such as seizures, because rare seizures have been reported in patients receiving Cipro, Cipro XR.
- Cipro, Cipro XR should be avoided in children and adolescents less than 18 years of age, as safe use in these patients has not been established.
- Many antibiotics, including Cipro, Cipro XR, can alter the normal bacteria in the colon and encourage overgrowth of a bacterium responsible for the development of inflammation of the colon (C. difficile or pseudomembranous colitis). Patients who develop signs of pseudomembranous colitis after starting Cipro, Cipro XR (diarrhea, fever, abdominal pain, and possibly shock) should contact their doctor immediately.
- Cardiac arrest
- Respiratory failure
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What is the dosage of nitrofurantoin vs. ciprofloxacin?
Nitrofurantoin
- The recommended adult dose for treating urinary tract infections is 50-100 mg 4 times daily (Macrodantin, Furadantin) or 100 mg every 12 hours (Macrobid) for 7 days or for 3 days after obtaining sterile urine.
- Nitrofurantoin can be taken with or without meals. Taking it with meals increases its absorption into the body.
- The suspension can be mixed with water, milk, juice, or infant formula.
- It also is used once a day (or in some children, twice daily) to prevent urinary tract infections.
- It should not be used in persons with poor kidney function.
Ciprofloxacin
- For most infections, the recommended oral dose for adults is 250-750 mg (immediate release tablets) every 12 hours or 500-1000 mg (extended release tablets) every 24 hours.
- The usual intravenous dose is 200-400 mg every 8-12 hours.
What drugs interact with nitrofurantoin and ciprofloxacin?
Nitrofurantoin
- High doses of probenecid (Benemid) or sulfinpyrazone (Anturane) can partially block the kidneys' elimination of nitrofurantoin. This can increase the blood concentrations of nitrofurantoin and the risk of toxicity from nitrofurantoin.
- Concomitant administration of a magnesium trisilicate antacid may decrease the absorption of nitrofurantoin, reducing the effectiveness of nitrofurantoin.
- Nitrofurantoin may reduce the activity of live tuberculosis vaccine (BCG vaccine) and live typhoid vaccine. In laboratory tests, nitrofurantoin reduced the effect of quinolone antibiotics, for example, norfloxacin (Noroxin). Therefore, nitrofurantoin should not be combined with quinolone antibiotics.
Ciprofloxacin
- Ciprofloxacin administered together with theophylline (Respbid, Slo-Bid, Theo-24, Theolair) can lead to elevated, toxic blood levels of theophylline. Theophylline is used to open airways in the treatment of asthma. Toxic levels of theophylline can lead to seizures and disturbances in heart rhythm. If concurrent use of ciprofloxacin and theophylline cannot be avoided, frequent blood tests to monitor theophylline blood levels are recommended.
- Ciprofloxacin increases the effect of tizanidine (Zanaflex) that is used to treat muscle spasticity. Therefore, the two drugs should not be combined.
- Iron salts (for example, ferrous sulfate) may reduce the absorption of ciprofloxacin because of formation of a ciprofloxacin-iron complex that is not absorbable. Antacids also may reduce the absorption of ciprofloxacin. If patients are receiving iron salts or antacids and ciprofloxacin, the ciprofloxacin should be given two hours before or six hours after the iron salt or antacid.
- Ciprofloxacin may increase the blood thinning effect of warfarin (Coumadin, Jantoven). The reason for this is unknown. Anticoagulant activity should be monitored after starting or stopping ciprofloxacin.
- Sevelamer (Renagel) may reduce the absorption of ciprofloxacin and possibly reduce the effectiveness of ciprofloxacin. Milk and orange juice also may reduce the absorption of ciprofloxacin. Ciprofloxacin, as with iron and antacids, should be given two hours before or six hours after milk or orange juice.
- Administration of ciprofloxacin with diabetic medications — for example glyburide (Micronase, Diabeta, Glynase, Prestab) — may lead to severe low blood glucose.
- Ciprofloxacin may increase blood concentrations of sildenafil (Viagra) that is used for treating erectile dysfunction. This combination should be avoided if possible.
- Patients taking Cipro, Cipro XR can develop sensitivity of the skin to direct sunlight (photosensitivity) and should avoid exposure to sunlight or use sunblock.
- Fluoroquinolones worsen low blood glucose levels when combined with sulfonylureas — for example, glyburide (Micronase, Diabeta, Glynase, Prestab).
Are nitrofurantoin and ciprofloxacin safe to use while pregnant or breastfeeding?
Nitrofurantoin
Although there are no adequate studies of nitrofurantoin in pregnant women, many women have safely used it during pregnancy. However, nitrofurantoin should not be used near the time of delivery (38-42 weeks gestation) since it interferes with the immature enzyme systems in newborns' red blood cells, damaging the cells and resulting in anemia.
Nitrofurantoin is distributed into breast milk, and women who are breastfeeding should use with caution.
Ciprofloxacin
Doctors suggest that women who are pregnant or breastfeeding should not use this antibiotic, because they do not know if it is safe.