Macrobid vs. Cipro for UTI Treatment: 6 Differences to Consider

If you have a urinary tract infection (UTI), fast symptom relief is likely top of mind. And the best way to treat a UTI is with antibiotics. Macrobid (nitrofurantoin) and Cipro (ciprofloxacin) are two antibiotics that are often prescribed for UTIs. But which antibiotic is best for treating UTIs?

Cipro and Macrobid both have pros and cons to consider. And which is best for you depends on several factors. Below, we’ll review six key differences between Macrobid and Cipro for treating UTIs.

1. Macrobid is preferred over Cipro for most UTIs

Both Macrobid and Cipro are FDA approved for treating UTIs. But most experts recommend Macrobid as a first-choice option for most UTIs. Cipro is generally reserved for more serious infections that involve the bladder and/or kidneys. It’s also a back-up option if you’re unable to take a first-choice antibiotic like Macrobid or Bactrim (sulfamethoxazole / trimethoprim).

Macrobid is preferred over Cipro for UTIs because it helps fight bacteria directly in the bladder. It stays mainly in your urine and doesn’t have significant effects on the rest of your body. Cipro, on the other hand, is absorbed into your bloodstream and many tissues throughout your body. So it’s more likely to cause side effects.

Cipro is also more known for causing antibiotic resistance. When this happens, Cipro is no longer effective at killing the bacteria causing your infection. Which can lead to more serious infections and more severe symptoms.

2. Cipro can treat more than just UTIs

Macrobid is a nitrofuran antibiotic. As mentioned, it concentrates in your urine to fight the bacteria that cause UTIs. But Macrobid is only approved to treat UTIs. It’s not prescribed for any other type of infection.

Cipro, on the other hand, is part of the quinolone antibiotic class. This class also includes medications like levofloxacin. Cipro enters your bloodstream and travels throughout your body. So, it can treat UTIs as well as infections in other areas of the body. This includes:

• Bone, joint, and skin infections

• Sexually transmitted infections

• Infectious diarrhea

• Lower respiratory tract infections

• Sinus infections

3. Cipro and Macrobid have different dosages for UTIs

Both Cipro and Macrobid are usually dosed twice a day for treating UTIs. But their dosages and how long you take them are different:

• Macrobid dosage for UTI: The suggested dosage is 100 mg by mouth every 12 hours for 5 to 7 days. It’s approved for adults and children ages 12 and older.

• Cipro dosage for UTI: The suggested dosage is 250 mg or 500 mg by mouth every 12 hours for 7 to 14 days. In some cases, your provider may prescribe 250 mg every 12 hours for 3 days. Cipro is only approved for simple UTIs in adults. Children should only take Cipro if they have a more serious UTI that involves the bladder or kidneys.

Remember that your healthcare provider may recommend a different dosage of Macrobid or Cipro, or even a different medication, to treat your UTI. This often depends on antibiotic resistance patterns in the area where you live.

Good to know: There are several different antibiotics that contain nitrofurantoin. Macrobid is the only nitrofurantoin antibiotic that’s dosed twice a day to treat UTIs. Other nitrofurantoin antibiotics (Macrodantin and Furadantin) are dosed four times a day. They can also be used by children under the age of 12.

4. Macrobid is also preferred to help prevent UTIs

Some people have recurrent UTIs. This is defined as having 3 or more UTIs in 1 year. If you’re getting recurrent UTIs, your healthcare provider may suggest a daily dose of nitrofurantoin to help prevent them. Macrodantin is the nitrofurantoin antibiotic used most often in this case.

Cipro isn’t approved for preventing UTIs. It’s possible your healthcare provider may prescribe it off-label for this use in rare cases. But usually, Cipro and other quinolone antibiotics aren’t used to prevent UTIs because of the risk of side effects and antibiotic resistance.

5. Serious side effects may be more likely with Cipro than with Macrobid

All medications can have side effects, and Cipro and Macrobid are no different. But, Cipro’s side effects are more likely to be serious than Macrobid’s.

Cipro has a boxed warning for tendonitis, tendon rupture, and nerve damage. It can also cause mental health changes, such as agitation, confusion, and suicidal thoughts. A boxed warning is the most serious type of warning the FDA can give to a medication. More common Cipro side effects include nausea, diarrhea, and enhanced sun sensitivity.

Macrobid can also cause nausea and diarrhea in some people. In rare cases, more serious side effects can include nerve pain, liver damage, and lung damage.

6. Macrobid and Cipro are both available as lower-cost generics

Macrobid and Cipro are both available as brand-name medications. But you can also find them as lower-cost generics. GoodRx can help you save over 75% off the average retail price of the generic versions.

Generic Macrobid’s price at certain pharmacies is as low as $9.38 with a free GoodRx discount. And generic Cipro’s price at certain pharmacies is as low as $4.06 using GoodRx.

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Written by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

Edited by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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