Short-Term Treatment of Uncomplicated Lower Urinary Tract Infections in Women

Norrby, S. Ragnar

doi:10.1093/clinids/12.3.458

Cited by 186 publications

(71 citation statements)

References 32 publications

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“…The rate of persistent or recurrent significant bacteriuria was higher in both ofloxacin groups than in the trimethoprim-sulfamethoxazole group after controlling for prior history of UTI, diaphragm use, and quantity of uropathogens at enrollment alone ( ampicillin and sulfonamides (25 to 35% of E. coli strains) (10) and the increasing prevalence of resistance to trimethoprim in some parts of the world (14,17). Moreover, short-course regimens, such as single-dose or 3-day regimens, have gained widespread popularity because of the potential advantages of better compliance, fewer side effects, lower costs, and less risk of developing antimicrobial resistance (10,15). Although the new fluoroquinolones, norfloxacin (20,22,24), ciprofloxacin (1,8,24), and ofloxacin (9,23,24), have all been demonstrated to be effective in the treatment of uncomplicated and complicated UTIs when given for 7 to 10 days, there are few studies of short-course regimens with these agents for treatment of uncomplicated cystitis.…”

Section: Resultsmentioning

confidence: 99%

Single-dose and three-day regimens of ofloxacin versus trimethoprim-sulfamethoxazole for acute cystitis in women

Hooton

Johnson

Winter

et al. 1991

Antimicrob Agents Chemother

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We compared the safety and efficacy of a single 400-mg dose of ofloxacin, ofloxacin (200 mg) once daily for 3 days, and trimethoprim-sulfamethoxazole (160:800 mg) twice daily for 7 days for the treatment of acute uncomplicated cystitis (urinary tract infection [UTI]) in women. At 5 weeks posttreatment, 35 (81%) of 43 patients treated with single-dose ofloxacin, 40 (89%) of 45 treated with 3 days of ofloxacin, and 41 (98%) of 42 treated with trimethoprim-sulfamethoxazole were cured (P = 0.03, single-dose ofloxacin group versus trimethoprim-sulfamethoxazole group). Retreatment for symptomatic recurrent UTI was given to 7 (16%) of 43 patients initially treated with single-dose ofloxacin, 3 (7%) of 45 patients treated with 3 days of ofloxacin, and 0 of 42 patients treated with trimethoprim-sulfamethoxazole (P = 0.01, single-dose ofloxacin group versus trimethoprim-sulfamethoxazole group). There was a trend in each of the three treatment groups toward an association between persistent or recurrent episodes of significant bacteriuria and a history of UTI in the past year and with diaphragm use. Ofloxacin was more effective than trimethoprim-sulfamethoxazole in eradicating Escherichia coli from rectal cultures during or soon after therapy, but there were no differences at later follow-up visits. Adverse effects were equally common among the three treatment groups. We conclude that single-dose ofloxacin was less effective than 7 days of trimethoprim-sulfamethoxazole for treatment of uncomplicated cystitis in women, while the 3-day ofloxacin regimen and the trimethoprim-sulfamethoxazole regimen were not significantly different in efficacy.The majority of cases of acute cystitis in young healthy women are effectively treated with conventional oral antimicrobial agents such as trimethoprim-sulfamethoxazole or nitrofurantoin. Ampicillin and sulfonamides have become less reliable in such cases because of the high prevalence of resistance to these agents among common uropathogens (10). The new fluoroquinolone antimicrobial agents, of which ofloxacin is one, have also been demonstrated to be effective for treatment of cystitis (24). While these agents are not considered the treatment of choice for uncomplicated cystitis, they are often used in patients who are intolerant of conventional agents, who have resistant pathogens, or in whom the presence of a complicating factor is more likely.Single-dose or 3-day regimens of antimicrobial agents are becoming increasingly popular for the treatment of uncomplicated cystitis because, compared with conventional regimens, they tend to be as effective and are associated with fewer adverse effects, better compliance, and lower cost (10). However, there are no published data on the use of the new fluoroquinolones in single-dose regimens for the treatment of uncomplicated cystitis in the United States. We therefore compared the safety and efficacy of ofloxacin in a single-dose regimen with a regimen of once-daily doses of ofloxacin for 3 days and with a conventional 7-day regimen of trimet...

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Section: Resultsmentioning

confidence: 99%

Single-dose and three-day regimens of ofloxacin versus trimethoprim-sulfamethoxazole for acute cystitis in women

Hooton

Johnson

Winter

et al. 1991

Antimicrob Agents Chemother

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“…[17][18][19] The guidelines of the Infectious Disease Society of America also concluded that 3-day regimens of trimethoprim, trimethoprim-sulfamethoxazole, and fluoroquinolones were more effective than single-dose regimens and that singleor 3-day regimens were better tolerated than longer regimens (7-10 days). Patients who may require 7 days of therapy include pregnant women, patients with diabetes mellitus, and those with symptoms lasting longer than 1 week.…”

Section: Short-course Therapymentioning

confidence: 99%

Management of uncomplicated urinary tract infections

Jancel

Dudas²

2002

Western Journal of Medicine

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Uncomplicated urinary tract infections are among the most frequently occurring infections in the United States, resulting in an estimated 8 million office visits and 1 million hospital admissions each year.1-3 Between 40% and 50% of women have reported having at least one urinary tract infection in their lives. 4Urinary tract infections can be classified by anatomic site of involvement into lower and upper urinary tract infections. Infections of the lower urinary tract include cystitis, urethritis, prostatitis, and epididymitis, and those of the upper urinary tract include pyelonephritis. Urinary tract infections may be further classified as complicated or uncomplicated. In women with a structurally and functionally normal urinary tract, cystitis and pyelonephritis are considered uncomplicated urinary tract infections. Urinary tract infections in men, elderly people, pregnant women, or patients who have an indwelling catheter or an anatomic or functional abnormality are considered complicated urinary tract infections. In this article, we outline the pharmacologic approach to the prevention and treatment of uncomplicated cystitis. ETIOLOGYRisk factors for urinary tract infections in women include frequent sexual intercourse, lack of urination after intercourse, use of a diaphragm, use of a spermicide, and a history of recurrent urinary tract infections.5,6 Although the long-term adverse effects associated with uncomplicated urinary tract infections appear to be minimal, if left untreated, urinary tract infections can interfere with daily living. As many as 80% of uncomplicated urinary tract infections are caused by Escherichia coli, followed by Staphylococcus saprophyticus in as many as 5% to 15% of cases. Enterococci, Klebsiella species and Proteus mirabilis account for a small percentage of overall infections. 7 OVERVIEW OF ANTIBIOTICSThe antimicrobial agents most commonly used to treat uncomplicated urinary tract infections include the combination drug trimethoprim and sulfamethoxazole, trimethoprim, ␤-lactams, fluoroquinolones, nitrofurantoin, and fosfomycin tromethamine. These agents are used primarily because of their tolerability, spectrum of activity against suspected uropathogens, and favorable pharmacokinetic profiles.8 In the treatment of urinary tract infections, the resolution of bacteriuria has been correlated with the concentration of the antimicrobial agent in the urine rather than serum levels.9 All the antimicrobial agents approved for the treatment of urinary tract infections achieve inhibitory urinary concentrations that significantly exceed serum levels. Also, agents such as trimethoprimsulfamethoxazole or the fluoroquinolones that eradicate aerobic gram-negative flora but have little effect on the vaginal and fecal anaerobic flora seem to provide the best long-term cures for uncomplicated urinary tract infections. 8 Resistance to antibioticsBecause most uncomplicated urinary tract infections are treated empirically, it is important for clinicians to recognize resistance patterns of uropathog...

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“…Treatments for cystitis are well documented, especially different strategies concerning short-term treatment with a number of antibiotics (15,21,28), while the documentation concerning the duration of treatment of pyelonephritis is poor (1,6,27), with the failure rate for the treatment of pyelonephritis being approximately 30% (5). The importance of a sufficient antibiotic concentration in the kidneys, especially in the medulla, has been emphasized by several investigators (6,8,25).…”

mentioning

confidence: 99%

Development of a Long-Term Ascending Urinary Tract Infection Mouse Model for Antibiotic Treatment Studies

Hvidberg¹,

Struve

Krogfelt

et al. 2000

Antimicrob Agents Chemother

129

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A model of ascending unobstructed urinary tract infection (UTI) in mice was developed to study the significance of the antibiotic concentration in urine, serum, and kidney tissue for efficacy of treatment of UTI in general and pyelonephritis in particular. Outbred Ssc-CF1 female mice were used throughout the study, and Escherichia coli was used as the pathogen. The virulence of 11 uropathogenic E. coli isolates and 1 nonpathogenic laboratory E. coli strain was examined. Strain C175-94 achieved the highest counts in the kidneys, and this strain was subsequently used as the infecting organism. The model gave reproducible bladder infections, i.e., bacteria were recovered from 22 of 23 control mice after 3 days, and histological examination of kidney tissue showed that of 14 infected kidneys, 7 (50%) showed major histological changes, whereas 3 of 36 uninfected kidneys showed major histological changes (P ‫؍‬ 0.018). Once the model was established, the efficacies of different doses of cefuroxime and gentamicin, corresponding to active concentrations in urine only or in urine, serum, and kidney tissue simultaneously, were examined. All cefuroxime doses resulted in significantly lower counts in urine than control treatments, but the dose which produced concentrations of cefuroxime only in urine and not in serum or kidney tissue had no effect on kidney infection. Even low doses of gentamicin (0.05 mg/mouse) resulted in concentrations in renal tissue for prolonged times due to accumulation. All gentamicin doses had a significant effect (compared to the effect of the control treatment) on bacterial counts in urine and kidneys. The antibiotic effect on bacterial counts in bladders was negligible for unknown reasons. Use of the mouse UTI model is feasible for study of the effect of an antibiotic in the urinary system, although the missing antibacterial effect in the bladder needs further evaluation.Urinary tract infections (UTIs) are among the most commonly observed infections in clinical practice, and more than 25% of all women experience an UTI at least once during their lifetimes (6). The majority of UTIs are far from severe; i.e., they are not life-threatening and do not produce any irreversible damage. However, when the kidneys are involved in the infection, there is a risk of irreversible kidney tissue damage as well as an increased risk of bacteremia (6).Escherichia coli is the causative agent in about 85% of community-acquired UTIs, 50% of nosocomial UTIs, and more than 80% of cases of uncomplicated pyelonephritis (6, 35). Several virulence factors among uropathogenic strains of E. coli have been recognized, including different types of adhesins, serum resistance, iron sequestration, and hemolysin production (17,22,30,31).Treatments for cystitis are well documented, especially different strategies concerning short-term treatment with a number of antibiotics (15,21,28), while the documentation concerning the duration of treatment of pyelonephritis is poor (1, 6, 27), with the failure rate for the treatment of pyelon...

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Short-Term Treatment of Uncomplicated Lower Urinary Tract Infections in Women

Cited by 186 publications

References 32 publications

Single-dose and three-day regimens of ofloxacin versus trimethoprim-sulfamethoxazole for acute cystitis in women

Single-dose and three-day regimens of ofloxacin versus trimethoprim-sulfamethoxazole for acute cystitis in women

Management of uncomplicated urinary tract infections

Development of a Long-Term Ascending Urinary Tract Infection Mouse Model for Antibiotic Treatment Studies

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