Comparison of single-dose administration and three-day course of amoxicillin with those of clavulanic acid for treatment of uncomplicated urinary tract infection in women

Abstract

In a double-blind randomized study we compared a single-dose amoxicillin-clavulanate combination with a regular 3-day regimen in 109 women with cystitis. Clinical cure rates at 7 and 28 days posttreatment were 78 versus 87% and 67 versus 78%, respectively. The 3-day regimen was significantly better (P <0.001) only in women with recurrent urinary tract infections.The preferred treatment for uncomplicated cystitis in nonpregnant women is controversial. Single-dose regimens have been shown to be as effective as 7-to 10-day courses (10). The advantages of single-dose therapy include lower cost, better compliance, fewer side effects, and a diminished pressure on the intestinal and vaginal flora (4). However, several studies have shown that the rate of recurrent infection following single-dose treatment is significantly higher than after longer courses (8,9 clavulanic acid disk was used for susceptibility testing, and a zone diameter of less than 19 mm was considered to be indicative of resistance.Treatment was given on a randomized and double-blind basis. Women in the single-dose group received five caplets of amoxicillin (500 mg each) plus one caplet of augmentin containing 500 mg of amoxicillin plus 125 mg of clavulanic acid. This was followed by single placebo caplets every 8 h for 3 days. Women in the second group received one caplet of augmentin containing 250 mg of amoxicillin plus 125 mg of clavulanic acid and five placebo caplets; this was followed by augmentin (250 mg) every 8 h for 3 days. Each patient was monitored clinically and bacteriologically at 7 and 28 days. Women with persistent bacteriuria and sensitive organisms were further evaluated by intravenous pyelogram or renal ultrasound.Statistical analysis was performed by the chi-square test with Yates' correction where appropriate, and P values of <0.005 were considered statistically significant.A total of 109 patients completed the treatment and both follow-up points; 55 received the single-dose regimen, and 54

Treatment of acute uncomplicated urinary tract infections with 3 days of lomefloxacin compared with treatment with 3 days of norfloxacin

“…The outcomes with 3 days of norfloxacin therapy in this study are consistent with the results with this same therapeutic regimen in a previous multicenter Canadian study of uncomplicated urinary tract infections (17). The reported success rates of more than 90% are also consistent with those from other reports of short-term therapy with quinolones or trimethoprim-sulfamethoxazole in the treatment of acute uncomplicated urinary tract infections (4,8 from outcome analysis (6,9,16). Since such subjects would frequently not be identified or excluded in usual clinical practice, the study observations from such trials may not be relevant to actual clinical use of the antimicrobial agent.…”

“…For trimethoprim-sulfamethoxazole, single-dose therapy is likely optimal (4,12,15). For other antimicrobial agents effective as short courses of therapy, 3 days of therapy has been suggested to be appropriate (6,8,9,16). For the fluoroquinolone antimicrobial agents, in particular, 3 days of therapy seems necessary because of the high failure rates of single-dose therapy of infection with Staphylococcus saprophyticus, the second most frequent infecting organism in this syndrome (5,8,17).…”

Amoxicillin-Clavulanate vs Ciprofloxacin for the Treatment of Uncomplicated Cystitis in Women

“…[14][15][16][17][18][19][20][21][22][23] In studies of uncomplicated cystitis, a 3-day regimen of amoxicillin-clavulanate and a 7-day regimen of trimethoprim-sulfamethoxazole have been shown to be superior to a single-dose regimen of amoxicillinclavulanate. 24,25 Exposure to amoxicillinclavulanate has been shown previously to select for subsequent amoxicillinclavulanate-resistant E coli UTIs. 26 In our study, 5 women originally infected with amoxicillin-clavulanate-susceptible strains who were treated with amoxicillin-clavulanate were found to have recurrent UTIs with strains nonsusceptible to amoxicillin-clavulanate, but only one was genetically identical to the initial strain.…”