Short-course therapy of acute cystitis: a brief review of therapeutic strategies

Abstract

Moxifloxacin (BAY12-8039) is a new 8-methoxyquinolone shown to be active against Mycobacterium tuberculosis in vitro. We tested moxifloxacin for activity in mice against M. tuberculosis CSU93, a highly virulent, recently isolated clinical strain. The MIC of moxifloxacin for the CSU93 strain was 0.25 microg/ml. The serum moxifloxacin concentration after oral administration in mice peaked within 0.25 h, reaching 7.8 microg/ml with doses of 100 mg/kg of body weight; the maximum concentration and the analysis of the area under the concentration-time curve revealed dose dependency. When mice were infected with a sublethal inoculum of mycobacteria and then treated with moxifloxacin at 100 mg/kg per day for 8 weeks, the log10 CFU counts in the organs of treated mice were significantly lower than those for the control group (0.6 +/- 0.2 versus 5.6 +/- 0. 3 in the lungs and 1.5 +/- 0.7 versus 4.9 +/- 0.5 in the spleens, respectively; P < 0.001 in both organs). The effectiveness of moxifloxacin monotherapy was comparable to that seen in mice receiving isoniazid alone. Combination therapy with moxifloxacin plus isoniazid was superior to that with moxifloxacin or with isoniazid alone in reducing bacillary counts in the organs studied. Using a sensitive broth-passage subculture method, we demonstrated that 8 weeks of treatment with moxifloxacin (100 mg/kg per day) or with moxifloxacin plus isoniazid (100 mg/kg and 25 mg/kg, respectively, per day) sterilized the lungs in seven of eight and in eight of eight mice, respectively. Among surviving bacilli isolated from animals infected with a high-titer inoculum and treated for 7 weeks with low-dose moxifloxacin (20 mg/kg per day), breakthrough resistance to moxifloxacin was not observed. These results indicate that moxifloxacin is highly effective in reducing M. tuberculosis infection in mice and has activity comparable to that of isoniazid. Combination therapy with moxifloxacin and isoniazid was highly effective, suggesting that moxifloxacin may be useful in multiple-drug regimens for human tuberculosis.

Cefpodoxime-Proxetil versus Trimethoprim-Sulfamethoxazole for Short-Term Therapy of Uncomplicated Acute Cystitis in Women

“…Hooton et al (9) obtained bacteriological cure rates of 92 and 89% at 1 and 5 weeks, respectively, after the discontinuation of therapy with 200 mg of ofloxacin once daily for 3 days. These results were almost the same as those obtained with TMP-SMX for the treatment of acute cystitis (1,22). However, single-dose regimens with the newer quinolones as well as with fosfomycin trometamol had failure rates slightly higher than those obtained with the 3-day regimens (8,16).…”

“…TMP-SMX is one of the most widely used and efficacious antibacterial agents for the short-term treatment of acute uncomplicated UTIs in women (9,13,16,22). However, hypersensitivity reactions and the emergence of resistant isolates worldwide necessitate the search for other short-term treatment options (2,3,10,17).…”

“…Short-course, 3-day therapeutic regimens with trimethoprim-sulfamethoxazole (TMP-SMX) and fluoroquinolones have been proven to be as effective as longer courses of Ն5 days and are widely used (13,22). Their advantages are based on increased patient compliance, with decreased adverse effects, decreased costs, and deceased rates of resistance development among the gut and vaginal flora (20).…”

Trends in Antimicrobial Resistance among Urinary Tract Infection Isolates of Escherichia coli from Female Outpatients in the United States

“…It has been suggested that fluoroquinolones are a logical choice for empirical therapy of uncomplicated urinary tract infections (29). The data presented in this study appear to validate this supposition; however, the widespread use of fluoroquinolones for such a common infection raises concerns regarding the possibility of accelerated development of resistance (30).…”

A Retrospective Study of the Culture and Sensitivity Pattern of Urinary Tract Infection Causing Organisms at RIMS Teaching Hospital, Raichur, India

“…[1][2][3] UTI remains second most common infectious disease and approximately about 150 million people were diagnosed with UTI each year. [4] UTI can be caused by different microorganisms including bacteria, protozoa, parasites, fungi and viruses are the major causative organisms.…”