What is the global resistance rate for fluoroquinolones in E. coli causing urinary tract infections?
Fluoroquinolones, such as ciprofloxacin and levofloxacin, are common antibiotics for urinary tract infections (UTIs). However, resistance in E. coli, the main cause of UTIs, is rising worldwide. A 2025 meta-analysis provides a current estimate of this resistance rate.
What the research says
A 2025 systematic review and meta-analysis pooled data from 36 studies worldwide and found that the overall prevalence of fluoroquinolone resistance in E. coli causing UTIs is 31.09% (95% CI, 24.89%–38.05%) 1. This means about 1 in 3 E. coli infections may not respond to fluoroquinolones. For specific drugs, resistance to ciprofloxacin was 30.32% and to levofloxacin was 27.57% 1. Other studies also report high resistance rates. For example, a study in Mexico found high fluoroquinolone resistance in community E. coli isolates, especially among ESBL-producing strains 3. In Canada, the emerging clone ST1193, which is often fluoroquinolone-resistant, is increasing, particularly in elderly women in long-term care 5. Wastewater surveillance in the US also found that 72.7% of ST131 clade A isolates were resistant to ciprofloxacin 7. These findings highlight the challenge of using fluoroquinolones for empiric UTI treatment.
What to ask your doctor
- Given the high resistance rates, are fluoroquinolones still the best choice for my UTI?
- Should I have a urine culture and sensitivity test to guide antibiotic selection?
- What alternative antibiotics, such as fosfomycin or nitrofurantoin, might be effective?
- Are there local resistance patterns I should be aware of for my area?
This question is drawn from common patient questions about Nephrology and answered using cited medical research. We do not provide individualized advice.