Cipro prescription is no longer the first-line treatment for UTIs

Dear Dr. Roach: I was diagnosed with a UTI on my yearly physical urinalysis, but had no symptoms. I was prescribed Cipro. The five pages of warnings attached to the prescription scared me! So, I checked the FDA and Mayo Clinic websites. Both said that the “risks outweigh benefits” and it “should not be first choice to treat UTI.” But my doctor says to take it, so I will —

500 mg twice a day for seven days. Possible side effects include tendon ruptures (including the aorta), nerve damage and more. Scary! I am 71 and in good health, with high blood pressure as my only problem, but it’s under control.

I wasn’t told if my UTI is complicated or uncomplicated, but I assume uncomplicated as my blood work, including kidney tests, were all normal. Is this drug safe? Why does the FDA say not to prescribe this as the first choice? — C.J.

Dear C.J.: There is a lot wrong here.

First off, asymptomatic bacteria in the urine does not normally get treated, so I wouldn’t have recommended treatment in the first place. I’m not even sure why your doctor ordered a urinalysis — it’s not recommended as a screening test for most.

Second, I agree with your research that ciprofloxacin (Cipro) should not be the first-line treatment for symptomatic urine infections. Ciprofloxacin does increase risk of tendon rupture very slightly (three to four cases per 100,000 people treated); may damage the aorta (eight cases per 100,000 in one study, while another large study showed no risk); and may cause neuropathy (nerve damage) in one case per 150,000.

Resistance to drugs like ciprofloxacin has been increasing. Other choices, like nitrofurantoin, trimethoprim/sulfamethoxazole, or cephalexin, have more effectiveness with less risk of toxicity. That’s why Cipro is no longer a first-line choice. It can be hard for doctors to unlearn behaviors.

Usually, Cipro is effective and doesn’t cause side effects, but practicing evidence-based medicine means changing behaviors to reflect new information, even if your personal experience has generally been good. An individual doctor isn’t likely to see damage to tendons, the aorta or nerves, but if all doctors changed their behavior, there would be even fewer of these rare events.

When it is used, a short course of ciprofloxacin is normally prescribed for three days, not seven, for uncomplicated urine infections in women. The less a person uses this drug, the lower the risk of these rare but severe side effects, and three days is normally sufficient.

Dear Dr. Roach: I want to know how to reduce my blood pressure because it is currently 142/90. — S.L.

Dear S.L.: Treatment of mildly elevated blood pressure of the type you have starts with lifestyle changes. The first thing is to try to reduce sodium in your diet. Some sodium comes from what you add to food, but much more is in prepackaged foods, especially canned foods. Potassium, found in most fresh fruits and vegetables, has a beneficial effect on blood pressure, especially when sodium is also reduced.

Regular exercise can drop blood pressure by 3 to 5 points. Avoiding alcohol can reduce blood pressure as well. Excess alcohol — more than one drink a day for women or more than two drinks a day for men

— is particularly likely to increase blood pressure, so cutting down or stopping helps to reduce blood pressure.

Combining all of this advice can reduce the risk of requiring medicines by almost half. Additional treatments, such as meditation and stress reduction, further reduces blood pressure and the need for medication. However, some people, even if they do everything right, can still benefit from medication, which can reduce the risk of heart disease and stroke when appropriately given to patients.

Dr. Keith Roach