Cephalexin, a cephalosporin, and ciprofloxacin, a fluoroquinolone, are effective and well tolerated as prophylaxis against urinary tract infection (UTI) in patients who are unable to receive sulfamethoxazole-trimethoprim, investigators reported at the 2022 American Transplant Congress (ATC 2022) in Boston, Massachusetts.

The finding is from a single-center retrospective analysis of 78 patients who received cephalexin 500 mg or ciprofloxacin 500 mg daily for UTI prophylaxis following receipt of a kidney transplant. Each group had 39 patients. All patients were either intolerant or allergic to sulfamethoxazole-trimethoprim. The primary outcome was prophylaxis failure, which investigators defined as development of a clinically relevant UTI.

The proportion of patients who experienced UTIs was numerically higher in the cephalexin than ciprofloxacin groups (36% vs 18%), but the difference was not statistically significant, investigators Nicholas Pauley, PharmD, of Transplant Institute at Henry Ford Hospital in Detroit, Michigan, and colleagues reported.

Continue Reading

Significantly more patients in the cephalexin than ciprofloxacin group had postoperative complications (15 vs 7 patients), a finding that potentially could explain the higher incidence of UTIs, according to the investigators.

Dr Pauley and colleagues observed a significantly lower creatinine clearance level among ciprofloxacin than cephalexin recipients at day 180 (48.3 vs 60.5 mL/min), but found no significant difference in change from baseline to day 180. They also observed no significant difference in the occurrence of adverse events. Although a higher proportion of ciprofloxacin than cephalexin recipients discontinued treatment (15% vs 5%), the difference was not statistically significant.

The authors concluded that both antibiotics were effective at providing UTI prophylaxis following kidney transplantation and that cephalexin is a suitable alternative that avoids unnecessary exposure to fluoroquinolones.


Pauley NA, Fizmaurice M, Poparad-Stezar A, Summers B, Jantz A. Comparison of cephalexin and ciprofloxacin prophylaxis for urinary tract infection in kidney transplant recipients. Presented at: ATC 2022; June 4-8, 2022, Boston, Massachusetts. Abstract 1007.