Bactrim vs. Cipro

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

What's the Difference Between Bactrim and Cipro?

  • Bactrim (sulfamethoxazole and trimethoprim) and Cipro (ciprofloxacin) are antibiotics used to treat bacterial infections.
  • The drugs are in different drug classes. Bactrim is a combination of sulfamethoxazole, an anti-bacterial sulfonamide (a "sulfa" drug), and trimethoprim, a folic acid inhibitor. Cipro is a fluoroquinolone antibiotic.
  • Side effects of Bactrim and Cipro that are similar include nausea, vomiting, diarrhea, rash, and headache.
  • Side effects of Bactrim that are different from Cipro include dizziness, lethargy, and loss of appetite.
  • Side effects of Cipro that are different from Bactrim include abdominal pain and restlessness.
  • Cipro as well as other antibiotics in the fluoroquinolone class of antibiotics has been associated with tendonitis and even tendon rupture, particularly the Achilles tendon.

What Are Bactrim and Cipro?

Bactrim (sulfamethoxazole and trimethoprim) is a combination of two antibiotics. Sulfamethoxazole is an anti-bacterial sulfonamide, a "sulfa" drug, and trimethoprim is a folic acid inhibitor. Bactrim is used for treating infections due to susceptible bacteria. Examples include urinary tract infections, flares of chronic bronchitis due to bacteria, middle ear infections, for prevention of infections due to pneumococcus in organ transplant recipients, for the treatment or prevention of Pneumocystis carinii pneumonia, chancroid, and prevention of toxoplasma encephalitis in patients with AIDS.

Cipro (ciprofloxacin) is an antibiotic that is used to treat bacterial infections. It stops the multiplication of bacteria by inhibiting the reproduction and repair of their genetic material (DNA). Cipro is in the fluoroquinolone class of antibiotics. Other fluoroquinolones include levofloxacin (Levaquin), ofloxacin (Floxin), gatifloxacin (Tequin), norfloxacin (Noroxin), moxifloxacin (Avelox), and trovafloxacin (Trovan). Cipro is prescribed for infections of the skin, lungs or airways, bones, joints, urinary tract infections (UTI), infectious diarrheas, anthrax patients with fever and low white blood cell counts and intra-abdominal infections, typhoid fever, gonorrhea, chronic bacterial prostatitis, and acute uncomplicated cystitis.

What Are the Side Effects of Bactrim vs. Cipro?

Bactrim

Common side effects of sulfamethoxazole/trimethoprim are:

  • dizziness,
  • headache,
  • lethargy,
  • diarrhea,
  • anorexia,
  • nausea,
  • vomiting, and
  • rash.

Other side effects include:

  • liver damage,
  • low white blood cell count,
  • low platelet count (thrombocytopenia), and
  • anemia.

Cipro

Warning: Serious adverse reactions of this medication Cipro and Cipro XR as well as other antibiotics in the fluoroquinolone class of antibiotics has been associated with tendonitis and even tendon rupture, particularly the Achilles tendon. Some doctors and other medical professionals recommend that their patients discontinue vigorous exercise while they are taking fluoroquinolone antibiotics.

Fluoroquinolones have neuromuscular blocking activity and can worsen muscle weakness in individuals with myasthenia gravis.

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 you are experiencing these symptoms seek medical immediately.

Symptoms of shock include:

  • Cardiovascular collapse
  • Facial or throat swelling
  • Shortness of breath
  • Hives
  • Itching

What are the serious side effects and adverse events of Cirpo?

Possible serious side effects of Cipro, Cipro XR include:

  • Peripheral neuropathy
  • Central nervous system effects (CNS), for example,
    • toxic psychosis,
    • nervousness,
    • agitation,
    • insomnia,
    • anxiety,
    • nightmares,
    • paranoia,
    • dizziness,
    • tremors,
    • depression, and
    • hallucinations.
  • Hyperglycemia
  • Clostridiumdifficile-associated diarrhea (CDAD)
  • Abnormal heart beats
  • 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

What is the Dosage of Bactrim vs. Cipro

Bactrim

  • The recommended adult dose for urinary tract infections is one double strength tablet (Bactrim DS, Septra DS) or two single strength tablets every 12 hours for 10 to 14 days.
  • Flares of chronic bronchitis are treated with a similar regimen for 14 days.
  • Sulfamethoxazole/trimethoprim should be taken with 6 to 8 ounces of liquid to prevent crystals from forming in the urine. Persons with advanced kidney disease may require lower doses.

Cipro

  • 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 Bactrim and Cipro?

Bactrim

Sulfamethoxazole/trimethoprim can enhance the blood-thinning effects of warfarin (Coumadin), possibly leading to bleeding. Sulfonamides such as sulfamethoxazole can increase the metabolism (break-down and elimination) of cyclosporine (causing loss of effectiveness of cyclosporine), and can add to the kidney damage caused by cyclosporine.

All sulfonamides can crystallize in urine when the urine is acidic. Since methenamine (Hiprex, Urex, Mandelamine) causes acidic urine, it should not be used with sulfonamides.

Blood levels of phenytoin (Dilantin) may be increased by treatment with sulfamethoxazole/trimethoprim. This may lead to side effects associated with phenytoin (Dilantin, Dilantin-125) such as dizziness, and reduced attention.

Sulfamethoxazole/trimethoprim also may increase blood levels of digoxin (Lanoxin) and possibly lead to serious toxic effects. Anemia, due to a reduction in folic acid, can occur in persons receiving sulfamethoxazole/trimethoprim in combination with:

  • divalproex,
  • valproic acid (Depakote, Depakote ER, Depakene, Depacon, Stavzor),
  • methotrexate (Rheumatrex, Trexall),
  • pyrimethamine,
  • triamterene, or
  • trimetrexate.

Increased blood levels of potassium may occur when sulfamethoxazole/trimethoprim is combined with ACE inhibitors.

Cipro

  • 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 Bactrim and Cipro Safe to Use While Pregnant or Breastfeeding?

Bactrim

Use of sulfonamides may cause bilirubin to be displaced from proteins in the infant's blood. Displacement of bilirubin can lead to jaundice and a dangerous condition called kernicterus in the infant. For this reason, sulfamethoxazole/trimethoprim should not be used near term (late in pregnancy) among women.

Sulfamethoxazole/trimethoprim should not be used by nursing mothers because sulfamethoxazole is excreted in milk and can cause kernicterus.

Cipro

Doctors suggest that should not use this antibiotic if you are pregnant or breastfeeding because they do not know if it is safe.

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Summary

Bactrim (sulfamethoxazole and trimethoprim) and Cipro (ciprofloxacin) are antibiotics used to treat bacterial infections. The drugs are in different drug classes. Bactrim is a combination of sulfamethoxazole, an anti-bacterial sulfonamide (a "sulfa" drug), and trimethoprim, a folic acid inhibitor. Cipro is a fluoroquinolone antibiotic.

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Medically Reviewed on 2/16/2018
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