A trial comparing low-dose, short-course ciprofloxacin and standard 7 day therapy with co-trimoxazole or nitrofurantoin in the treatment of uncomplicated urinary tract infection

Abstract

The therapeutic antitumor effect of clarithromycin (CAM) was examined with the 13762NF mammary adenocarcinoma and F-344 rat system. When CAM treatment at a dosage of 2 mg/kg of body weight orally for 21 days was commenced after inoculation of the tumor, no significant decrease in death rate was observed, although the loss in body weight was less than that in the untreated group. When tumor-bearing (TB) rats were treated with CAM in combination with carboplatin or cyclophosphamide, a significant decrease in the death rate was obtained, although neither treatment alone proved to be effective. A beneficial effect was also observed when CAM treatment was combined with surgical treatment. CAM showed no direct cytotoxicity to this tumor in vitro according to the MTT (3-[4, 5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide) assay. Spleen cells obtained from TB rats receiving CAM treatment showed a stronger tumor-neutralizing activity than those from rats which had not received CAM treatment (Winn assay). Enhanced induction of cytotoxic cells to allogeneic tumor was also observed in rats immunized with allogeneic tumor cells together with CAM treatment (51Cr release assay). The 13762NF tumor produces transforming growth factor-beta (TGF-beta), tumor necrosis factor alpha, and matrix metalloproteinase-9, and treatment of tumor cells with CAM in vitro for 24 h significantly inhibited the expression of the genes coding for these proteins (reverse transcription-PCR). Levels of expression of the TGF-beta and interleukin-6 genes of spleen cells obtained from CAM-treated TB rats were both significantly lower than those of spleen cells from CAM-untreated TB rats. This study suggests that CAM has biological response modifier activities resulting in a beneficial therapeutic antitumor effect and might be useful for the treatment of human cancers.

Nitrofurantoin Compares Favorably to Recommended Agents as Empirical Treatment of Uncomplicated Urinary Tract Infections in a Decision and Cost Analysis

“…In these studies, a total of only 14 patients were infected with such organisms. 8,23 There was a similar lack of data for fluoroquinolones 24,25 but relatively more data for TMP-SMX. 8,40,41 More research is needed to better determine the probability of curing UTIs when the causative organism is resistant to the antibiotic used, especially given how increasingly common this scenario is in primary care.…”

“…For simplicity, the Figure does not include the probability of vaginal yeast infection, which was calculated for each outcome on the basis of published probabilities. 7,[22][23][24][25] Other potential antibiotic effects or complications (eg, StevensJohnson syndrome) were considered rare and not included in our model, given that a previous investigation of uncomplicated UTIs found that expensive but uncommon events had almost no effect on overall treatment costs. 26 Finally, a model was constructed that compared all 3 treatments: nitrofurantoin, TMP-SMX, and fluoroquinolones.…”

“…Probabilities for clinical events were obtained from published estimates, [3][4][5]7,8,[23][24][25]31,37,[40][41][42][43][44][45][46][47][48][49] with use of the mean value as the point estimate in the model (Table 2). These estimates were derived from previous models and the systematic review of the literature.…”

Cefpodoxime-Proxetil versus Trimethoprim-Sulfamethoxazole for Short-Term Therapy of Uncomplicated Acute Cystitis in Women

“…The effectiveness of the study drugs was evaluated as follows (11). The patients were considered to be clinically cured when all symptoms had subsided and to have treatment failure when symptoms persisted during therapy or relapsed after the discontinuation of therapy.…”

Tackling antimicrobial resistance in lower urinary tract infections: treatment options

“…For women with acute uncomplicated cystitis who are able to take oral medication, nitrofurantoin (NTF), trimethoprim-sulfamethoxazole (SXT), fosfomycin (FOS) or pivmecillinam (PVM) should be prescribed for a 3-5 day course depending on the agent used. Nitrofurantoin monohydrate/macrocrystals is an appropriate treatment choice due to the minimal resistance [62], efficacy and propensity to cause alteration in the host's flora compared to a 3-day course of SXT [73]. Although SXT is still widely used and recommended for acute cystitis therapy, the caveat is that local resistance rates of uropathogens should not exceed 20%, or if the infecting strain is confirmed to be susceptible [62].…”