Oral vs Intravenous Ciprofloxacin in the Initial Empirical Management of Severe Pyelonephritis or Complicated Urinary Tract Infections

Mombelli, G; Pezzoli, Romina; Pinoja-Lutz, G.; Monotti, R.; Marone, Claudio; Franciolli, M.

doi:10.1001/archinte.159.1.53

Cited by 82 publications

(31 citation statements)

References 23 publications

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“…Based on the current antimicrobial resistance rates in our geographic area, third- and fourth-generation cephalosporins, for example, are favored, rather than fluoroquinolones, for the empiric therapy of upper UTI in moderately and severely ill patients who require admission to the hospital. In addition, because fluoroquinolones are safe and effective in the treatment of bacteremic UTI and have the highest bioavailability among all available oral antimicrobials with gram-negative activity,26,27 the trend of increasing resistance to fluoroquinolones will likely restrict availability of a reliable oral therapy as “switch” therapy for bacteremic UTI. If this trend of increasing resistance to fluoroquinolones continues, it may result in a sizable increase in the cost of healthcare if parenteral therapy has to be extended due to lack of effective oral options.…”

Section: Discussionmentioning

confidence: 99%

Bacteremia complicating gram-negative urinary tract infections: A population-based study

Al-Hasan¹,

Eckel‐Passow²,

Baddour³

2010

Journal of Infection

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Background-Urinary tract infection (UTI) is common and bacteremia complicating this infection is frequently seen. There has been limited data published that characterize bacteremic UTI in a population-based setting over an extended period. We therefore examined the incidence rate, microbiology, outcome, and in vitro antimicrobial resistance trends of bacteremic UTI due to gramnegative bacilli in Olmsted County, Minnesota, from 1/1/1998 to 12/31/2007.

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Section: Discussionmentioning

confidence: 99%

Bacteremia complicating gram-negative urinary tract infections: A population-based study

Al-Hasan¹,

Eckel‐Passow²,

Baddour³

2010

Journal of Infection

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“…We note that all secondary admitted patients were discharged after a short and uncomplicated hospital stay. Two readmissions because of E coli bacteremia might have been avoided, because ciprofloxacin has been shown to be equally effective orally as intravenously in bacteremic UTI [20]. Among secondary admissions were patients with primary bacteremia caused by salmonella, staphylococci and streptococci, in whom presenting aspecific symptoms, e.g.…”

Section: Discussionmentioning

confidence: 99%

Hospitalization for community-acquired febrile urinary tract infection: validation and impact assessment of a clinical prediction rule

et al. 2017

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BackgroundThere is a lack of severity assessment tools to identify adults presenting with febrile urinary tract infection (FUTI) at risk for complicated outcome and guide admission policy. We aimed to validate the Prediction Rule for Admission policy in Complicated urinary Tract InfeCtion LEiden (PRACTICE), a modified form of the pneumonia severity index, and to subsequentially assess its use in clinical practice.MethodsA prospective observational multicenter study for model validation (2004–2009), followed by a multicenter controlled clinical trial with stepped wedge cluster-randomization for impact assessment (2010–2014), with a follow up of 3 months. Paricipants were 1157 consecutive patients with a presumptive diagnosis of acute febrile UTI (787 in validation cohort and 370 in the randomized trial), enrolled at emergency departments of 7 hospitals and 35 primary care centers in the Netherlands.The clinical prediction rule contained 12 predictors of complicated course. In the randomized trial the PRACTICE included guidance on hospitalization for high risk (>100 points) and home discharge for low risk patients (<75 points), in the control period the standard policy regarding hospital admission was applied. Main outcomes were effectiveness of the clinical prediction rule, as measured by primary hospital admission rate, and its safety, as measured by the rate of low-risk patients who needed to be hospitalized for FUTI after initial home-based treatment, and 30-day mortality.ResultsA total of 370 patients were included in the randomized trial, 237 in the control period and 133 in the intervention period. Use of PRACTICE significantly reduced the primary hospitalization rate (from 219/237, 92%, in the control group to 96/133, 72%, in the intervention group, p < 0.01). The secondary hospital admission rate after initial outpatient treatment was 6% in control patients and 27% in intervention patients (1/17 and 10/37; p < 0.001).ConclusionsAlthough the proposed PRACTICE prediction rule is associated with a lower number of hospital admissions of patients presenting to the ED with presumptive febrile urinary tract infection, futher improvement is necessary to reduce the occurrence of secondary hospital admissions.Trial registrationNTR4480 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4480, registered retrospectively 25 mrt 2014 (during enrollment of subjects).Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2509-3) contains supplementary material, which is available to authorized users.

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“…Therefore, Mombelli and colleagues [33] analyzed the efficacy of ciprofloxacin in the empirical management of severe febrile UTIs. In a multicenter prospective randomized study, patients with serious (including febrile) UTI were randomized in the hospital setting to empirical antibiotic treatment with ciprofloxacin received either orally or intravenously.…”

Section: Febrile Uti In the Elderly And Patients With Comorbiditiesmentioning

confidence: 99%

Treatment Duration of Febrile Urinary Tract Infections

Starre

Dissel

Nieuwkoop

2011

Curr Infect Dis Rep

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Although febrile urinary tract infections (UTIs) are relatively common in adults, data on optimal treatment duration are limited. Randomized controlled trials specifically addressing the elderly and patients with comorbidities have not been performed. This review highlights current available evidence. Premenopausal, non-pregnant women without comorbidities can be treated with a 5–7 day regimen of fluoroquinolones in countries with low levels of fluoroquinolone resistance, or, if proven susceptible, with 14 days of trimethoprim-sulfamethoxazole. Oral β-lactams are less effective compared with fluoroquinolones and trimethoprim-sulfamethoxazole. In men with mild to moderate febrile UTI, a 2-week regimen of an oral fluoroquinolone is likely sufficient. Although data are limited, this possibly holds even in the elderly patients with comorbidities or bacteremia.

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Oral vs Intravenous Ciprofloxacin in the Initial Empirical Management of Severe Pyelonephritis or Complicated Urinary Tract Infections

Abstract: Background: There are few data on the efficacy of oral antibiotics in the initial empirical management of severe forms of urinary tract infection (UTI).

Cited by 82 publications

References 23 publications

Bacteremia complicating gram-negative urinary tract infections: A population-based study

Bacteremia complicating gram-negative urinary tract infections: A population-based study

Hospitalization for community-acquired febrile urinary tract infection: validation and impact assessment of a clinical prediction rule

Treatment Duration of Febrile Urinary Tract Infections

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