Long-term prophylaxis with norfloxacin versus nitrofurantoin in women with recurrent urinary tract infection

Abstract

A total of 102 women with recurrent urinary tract infections were included in this open randomized study; 55 received 200 mg of norfloxacin daily and 47 received 50 mg of nitrofurantoin daily over 6 months. Fifty-three and 41 women from the norfloxacin-and nitrofurantoin-treated groups, respectively, completed the 6-month follow-up period. Forty-four (81%) of the norfloxacin-treated patients and 27 (65%) of the nitrofurantointreated patients remained free of symptoms (P = 0.05), and urine samples from 49 (92.4%) and 29 (70.7%) of the patients, respectively, were sterile (P < 0.005). Side effects occurred with similar frequencies in both groups (15 and 17%) but were more severe in the women who received nitrofurantoin. Despite the better results obtained with norfloxacin, the difference in the costs of the two agents must be considered.Recurrent urinary tract infection (UTI) is a common problem affecting approximately 6 to 10% of women of all ages. Most of those affected have a normal urogenital tract, and most of the infections are caused by recurrent colonization of the periurethral area by microorganisms from the intestinal flora with subsequent ascension to the bladder (6).Effective antibiotic regimens to prevent recurrent UTIs have used low doses of trimethoprim-sulfamethoxazole, trimethoprim alone, nitrofurantoin, and cephalosporins over a prolonged period of time (5).The new fluoroquinolones are ideal agents for the treatment of UTIs because of their broad-spectrum activity against most uropathogens and their ability to achieve high levels in the urinary tract. Numerous studies have shown their efficacy in the treatment of complicated and uncomplicated UTIs (1, 7), but few studies have evaluated their effectiveness as prophylactic agents (3, 4).The present study was designed to evaluate the efficacy and safety of prolonged use of a low dose of norfloxacin and to compare these results with those obtained with a prolonged treatment with nitrofurantoin in the prevention of recurrent UTI in women. A feature of this study is the inclusion of women with recurrent UTIs who had different diseases, urinary or gynecological abnormalities, and menstrual status of the patients were recorded. Pregnant women and those who were planning pregnancy were excluded.A clear-voided midstream urine specimen was collected from each patient and cultured with the Uritest system (Nylab dip slides; Rehovot, Israel). Once a negative urine culture was obtained, the women were randomized by an open schedule into two groups: one group received 200 mg of norfloxacin nightly and the second group received 50 mg of nitrofurantoin nightly. Both groups were treated for 6 months.All patients were seen once a month or when symptoms relating to UTIs appeared. Urine cultures were performed on each visit, and clinical bacteriological infections were recorded. Hematological, liver, and renal function tests were performed before initiation of treatment and at 2, 4, and 6 months after treatment began. All possible drug-related side effects were also r...

Is More Than One Quinolone Needed in Clinical Practice?

“…Long-term prophylaxis with norfloxacin 200 mg/d has been demonstrated to prevent recurrent cystitis in women with chronic UTIs. 58…”

Guidelines for the diagnosis and management of recurrent urinary tract infection in women

“…36 The evidence behind lactobacillus probiotics in UTI prophylaxis is also inconclusive. 37,38 45 TMP/SMX (40 mg/200 mg to 80 mg/400 mg ) 46 Trimethoprim (100 mg daily) 45,47 Ciprofloxacin (125 mg daily) 48 Ciprofloxacin (125 mg) 48 Cephalexin (125 mg to 250 mg daily) 49 Cephalexin (250 mg) 50 Cefaclor (250 mg daily) 51 Nitrofurantoin (50 mg to 100 mg) 52 Nitrofurantoin (50 mg-100 mg daily) 46 Norfloxacin (200 mg daily) 53 Norfloxacin (200 mg) 56 Fosfomycin (3 g every 10 days) 55 Ofloxacin (100 mg) 56 Female without a prior history of structural or functional abnormalities of the urinary tract presenting with 3…”

Antibacterial prophylaxis in children with urinary tract infection

“…Cephalosporins are not well documented for prophylaxis. Chinolones, like norfloxacin, demonstrate a satisfying prophylactic effect in adults but are not yet approved for use in children (14).…”