Empiric Treatment of Uncomplicated Urinary Tract Infection with Fluoroquinolones in Older Women in Israel: Another Lost Treatment Option?

Kahan, Natan R.; Chinitz, David; Waitman, Dan‐Andrei; Dushnitzky, Doron; Kahan, Ernesto; Shapiro, Mervyn

doi:10.1345/aph.1h396

Cited by 41 publications

(28 citation statements)

References 21 publications

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“…In the North American Urinary Tract Infection Collaboration Alliance surveillance study, 5.5% and 5.1% of urinary E. coli isolates from outpatients in the United States and Canada were resistant to ciprofloxacin and levofloxacin, respectively (24). Similar results were reported for a cohort in Israel (12). Pseudomonas aeruginosa fluoroquinolone resistance is also problematic, with rates now exceeding 35% (7).…”

supporting

confidence: 54%

Intravenous Doripenem at 500 Milligrams versus Levofloxacin at 250 Milligrams, with an Option To Switch to Oral Therapy, for Treatment of Complicated Lower Urinary Tract Infection and Pyelonephritis

Naber

Llorens

Kaniga

et al. 2009

Antimicrob Agents Chemother

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The prospective, multicenter, double-blind study presented in this report evaluated whether or not intravenous (IV) administration of doripenem, a carbapenem with bactericidal activity against gram-negative and gram-positive uropathogens, is inferior to IV administration of levofloxacin in the treatment of complicated urinary tract infection (cUTI). Patients (n ‫؍‬ 753) with complicated lower UTI or pyelonephritis were randomly assigned to receive IV doripenem at 500 mg every 8 h (q8h) or IV levofloxacin at 250 mg q24h. Patients in both treatment arms were eligible to switch to oral levofloxacin after 3 days of IV therapy to complete a 10-day treatment course if they demonstrated significant clinical and microbiological improvements. The microbiological cure rate (primary end point) was determined at the test-of-cure (TOC) visit occurring 5 to 11 days after the last dose of antibiotic. For the microbiologically evaluable patients (n ‫؍‬ 545), the microbiological cure rates were 82.1% and 83.4% for doripenem and levofloxacin, respectively (95% confidence interval [CI] for the difference, ؊8.0 to 5.5%); in the microbiological modified intent-to-treat cohort (n ‫؍‬ 648), the cure rates were 79.2% and 78.2%, respectively. Clinical cure rates at the TOC visit were 95.1% in the doripenem arm and 90.2% in the levofloxacin arm (95% CI around the difference in cure rates [doripenem cure rate minus levofloxacin cure rate], 0.2% to 9.6%). Both treatment regimens were generally well tolerated. Doripenem was found not to be inferior to levofloxacin in terms of therapeutics and is now approved for use in the United States and Europe for the treatment of adults with cUTI, including pyelonephritis. As fluoroquinolone resistance increases, doripenem may become a more important option for successful treatment of cUTIs, including treatment of pyelonephritis.

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supporting

confidence: 54%

Intravenous Doripenem at 500 Milligrams versus Levofloxacin at 250 Milligrams, with an Option To Switch to Oral Therapy, for Treatment of Complicated Lower Urinary Tract Infection and Pyelonephritis

Naber

Llorens

Kaniga

et al. 2009

Antimicrob Agents Chemother

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“…The etiology of urinary tract infections (UTI) and the antibiotic resistance of uropathogens have been changing over the past years, both in the community and nosocomial infection. [11] However, there is not much information on etiology and resistance pattern of community acquired urinary tract infections (UTIs) in India. This retrospective study was done to compare the frequency and drug resistance pattern in uropathogens isolated from patients with urinary tract infections (UTIs) in IPD/OPD, Base Hospital Srikot and VCSG Medical College, Srinagar Garhwal, India.…”

Section: Introductionmentioning

confidence: 99%

Study of Antibiotic Resistance Pattern in Uropathogens at a Tertiary Care Hospital

Semwal¹,

Mathuria²,

Saklani³

2017

AIMDR

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Background: Urinary tract infection (UTI) is common infection in the world caused by uropathogens, to make a proper treatment of UTI should be a proper diagnosis of the cause and therefore a proper application of drugs. Keeping in mind the causes of urinary tract infections and the sensitivity pattern of uropathogens towards the antibiotic, the present study was proposed to study the uropathogens. An empiric treatment of UTI is find out by the antibiotic sensitivity patterns of uropathogens in a population. There is an resistance increased to the first line empirical drugs used in the treatment of UTI. This study was conducted in Garhwal Uttrakhand (India) to determine the resistance patterns of amongst uropathogens, to help in the establishment of local guidelines on the treatment of UTI. Methods: This is a retrospective study on 338 urine cultures from July 2013 to June 2014. Antibiotic susceptibility test (AST) method was done by Kirby-Bauer disc diffusion method and compared. Data Analysis was done by using simple percentage method. Results: Out of the 338 samples subjected to culture, 166(49.11%) were positive for growth. Out of the 166 culture isolates, Escherichia coli was the most common 67 (19.8%) followed by CoNS 30(8.8%), Staphylococcus 14(4.1%), Enterococcus 11(3.3%), Acinetobacter spp. 10(2.9%), Klebsiella 8(2.4%), and Candida albicans 7(2.1%). The antibiotic sensitivity pattern was analyzed for all the bacterial isolates together and drugs are sort in order of their sensitivity. On the basis of antibiotic sensitivity pattern it is found that all bacterial isolates were 24.6 % sensitive to Amikacin, 23.1 % sensitive to Gentamicin, 18 % sensitive to Nitrofurantoin Acid, 15.1 % sensitive to Ciprofloxacin, 13.3 % sensitive to Meropenem and Cefoperazone-sulbactam, 13% sensitive to Piperacillin-tazobactam and Co-trimoxazole, 10.7 % sensitive to Amoxicillin-clavulanic acid, 10.4 % sensitive to Aztreonam and 10.1% sensitive to Chloramphenicol. All the isolates were 16.9% resistant to Ciprofloxacin and Co-trimoxazole, 12.7% resistant to Amoxicillin-clavulanic acid, 12.4% resistant to Ampicillin, 10.7% resistant to Cefotaxime, Cefazolin &Ticarcillin-Clavulanic acid and 10.4 % resistant to Cefuroxime. Conclusion: The alarming rate of resistance to Ciprofloxacin, Co-trimoxazole, Amoxicillin-clavulanic acid, Ampicillin, Cefotaxime, Cefazolin &Ticarcillin-Clavulanic acid of urinary isolates, precludes the use of these commonly used antibiotics for empiric treatment of urinary tract infections (UTI) in India. Therefore, urine culture is necessarily recommended for screening and diagnosis.

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“…However in resource poor settings may be take longer and, as in most of cases, the urine culture and susceptibility testing costs more than antibiotic treatment itself. Furthermore, the contemporary studies demonstrate that etiology of CA-UTI and their antibiotic sensitivity have been shown geographical variation; in majority of community acquired urinary tract infection, treatment decision is empiric, based on available guidelines and published studies 5,6 . To be successful and complained from subjects , The empirical treatment provided must be guided by clinical evidences as well as the safety profile and cost -effectiveness of the drug , and adhere to " antimicrobial stewardship "(using antibiotic in a way that helps to limit the development of resistance) 7 .…”

Section: Community Acquired Urinary Tract Infection (Cauti)mentioning

confidence: 99%

Clinical, Etiological and Antibiotic Susceptibility Profiles of Community-Acquired Urinary Tract Infection in a Western Hemisphere of Baghdad

Hussein

2015

Bangladesh J Med Sci

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Background: In majority of community-acquired urinary tract infection (CA-UTI) cases, physicians can prescribe empirical therapy without a pretreatment urine culture especially in resource poor settings, where the cost of urine culture is more than cost of treatment itself. Objective: With growing problem of drug resistance globally as well as data on CA-UTI in Iraq are scare. We conduct this study to analyze clinical presentation, etiology and antibiotic sensitivity of bacteria causing community acquired urinary tract infection (CA-UTI). Material and Methods: Outpatients urine cultures and clinical presentations were collected from April 2012 to October 2012. A positive urine culture was defined as growth of a single bacteria with colony count of more than 100,000 CFU/ml and disk diffusion technique was performed to determine antibiotics susceptibility of isolated bacteria species. Clinical symptoms, causative uropathogens and their antibiotic sensitivity were recorded. Results: Of 299 urine cultures processed, a positive urine culture was detected in 100 subjects. Dysuria and bladder irritability (frequency and urgency) were the most common clinical presentation. 39% of isolated bacteria was Escherichia coli and Staphylococcus strains (30%). The isolated uropathogens showed a substantial sensitivity reduction to most of test antibiotics. Conclusion: Clinical presentation had a minor role in diagnosis of CA-UTI and this study revealed that E. coli and Staphylococcus strains were most prevalent isolated uropathogens. Susceptibility test showed there was a high sensitivity to nitrofurantoin, amikacin and imipenem.

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Empiric Treatment of Uncomplicated Urinary Tract Infection with Fluoroquinolones in Older Women in Israel: Another Lost Treatment Option?

Cited by 41 publications

References 21 publications

Intravenous Doripenem at 500 Milligrams versus Levofloxacin at 250 Milligrams, with an Option To Switch to Oral Therapy, for Treatment of Complicated Lower Urinary Tract Infection and Pyelonephritis

Intravenous Doripenem at 500 Milligrams versus Levofloxacin at 250 Milligrams, with an Option To Switch to Oral Therapy, for Treatment of Complicated Lower Urinary Tract Infection and Pyelonephritis

Study of Antibiotic Resistance Pattern in Uropathogens at a Tertiary Care Hospital

Clinical, Etiological and Antibiotic Susceptibility Profiles of Community-Acquired Urinary Tract Infection in a Western Hemisphere of Baghdad

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