Comparative Studies of Fluoroquinolones in the Treatment of Urinary Tract Infections

Abstract

The resultsof comparative trials of fluoroquinolones for the treatment of uncomplicated and complicated urinary tract infections (UTI) were reviewed. Severalrandomized, comparative trials showedthat in uncomplicated UTI norfloxacin, ciprofloxacin, and ofloxacin wereat least as effectiveas trimethoprim-sulfamethoxazole (TMP-SMZ) and amoxicillinand usually more effectivethan nalidixicacid, pipemidic acid, and nitrofurantoin. Comparativetrials of single-dose regimens have, however, been limited. A few randomized, comparative trials have shown that in complicated UTI norfloxacin, ciprofloxacin, and ofloxacin wereat least as effectiveas amoxicillinand TMP-SMZand usually more effective than pipemidic acid. Moreover, preliminary results indicate that fluoroquinolones might be effective for the oral treatment of complicated UTI that are difficult to treat, especially those due to Pseudomonas aeruginosa. Comparative trials are needed to establish the value of fluoroquinolones for chronic bacterial prostatitis. There are no conclusivedata on fluoroquinolone treatment of UTI in patients with renal failure. Emergence of resistantpathogens during therapywith fluoroquinolones has beeninfrequentbut might be more frequent in complicated UTI caused by P. aeruginosa.Although highly effective and well-established antibiotic regimens are available for the treatment of urinary tract infection (UTI), there is a need for new antimicrobial agents, especially for the treatment of outpatients with UTI that are difficult to treat and for which most of the drugs available for oral treatment are ineffective.The fluoroquinolones have several properties that suggest their potential clinical utility for the treatment of UTI, including high activity in vitro against virtually all urinary tract pathogens and good absorption after oral administration that results in prolonged high levels of drug in urine [1].The methodologic problems associated with open and comparative trials evaluating the efficacy of new antibiotics for the treatment of UTI have recently been reviewed [2]. For this review of the efficacy of fluoroquinolones for the treatment of UTI, we have emphasized those studies that have both sufficient data for a clear classification of UTI and data on We thank Mrs. Kathrin Zsirmik and Mrs. Alexandra Bloch for typing the manuscript.Please address requests for reprints to R. Malinverni, Medizinische Universitatsklinik, Inselspital, CH-3010 Bern, Switzerland. follow-up urine cultures 4-6 weeks after the end of treatment (unless otherwise mentioned). In this evaluation, bacteriologic cure (sterile urine) was considered as the end point of antibiotic treatment since the definitions of clinical response, when stated, varied from one study to another and symptoms may disappear in the absence of bacteriologic cure. In table 1, which outlines the efficacy of fluoroquinolone treatment of UTI by infecting organism, only data from studies (noncomparative and comparative) that provided sufficient information to permit a clear classification of UTI...

Use of ciprofloxacin versus use of aminoglycosides for therapy of complicated urinary tract infection: prospective, randomized clinical and pharmacokinetic study

“…Controlled comparative studies of the use of quinolones for complicated urinary tract infection are few (22,34), and most studies performed have used oral antibiotics as the standard for comparison (1,21,27). However, if organisms are generally susceptible to commercially available oral agents, we believe that these agents should be preferred over ciprofloxacin and other quinolone agents because of lower costs and established safety profiles.…”

“…Malinverni and Glauser have commented on the potential usefulness of the fluoroquinolones for oral therapy of complicated urinary tract infection-but noted that reported trials have failed to evaluate patients at long-term follow-up (22). Thus, we initiated a controlled, randomized, prospective comparative trial of the use of oral ciprofloxacin versus parenteral aminoglycosides for therapy of complicated urinary-tract infection.…”

Treatment of genitourinary tract infections with fluoroquinolones: activity in vitro, pharmacokinetics, and clinical efficacy in urinary tract infections and prostatitis

“…Additional studies are needed. The emergence of bacterial resistance during the therapy of uncomplicated urinary tract infections with fluoroquinolones has been uncommon (47). Decreased susceptibility occurred in strains isolated from only 3 of 492 patients (0.6%) in a large double-blind study with norfloxacin (74).…”

“…In the second minireview (37), treatment of genital infections and adverse effects are reviewed. More detailed discussions can be found in recent reviews on the use of fluoroquinolones for the treatment of urinary tract infections (47,54), prostatitis (47,54; K. G. Naber, Rev. Infect.…”

Prospective, randomized, placebo-controlled trial of norfloxacin for the prophylaxis of recurrent urinary tract infection in women

“…These agents have been extensively investigated for the treatment of urinary tract infections (8). With short courses of therapy, eradication of members of the family Enterobacteriaceae from the gut flora has been documented (11), an observation which has been exploited in the use of these agents for the prophylaxis of infection in granulocytopenic patients (3).…”