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

Hooton, Thomas M.; Johnson, Carolyn; Winter, Carol; Kuwamura, Lisa E.; Rogers, Meighan; Roberts, Pacita L.; Stamm, Walter E.

doi:10.1128/aac.35.7.1479

Cited by 82 publications

(38 citation statements)

References 19 publications

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“…Furthermore, when the effects of treatment were evaluated 5 to 9 days after therapy, both drugs provided marked improvement or relief from the signs and symptoms of UTI in more than 92% of all patients treated, including those who were not evaluable because of low urine colony counts (Ͻ10 5 CFU/ml) at study entry (2). The clinical and bacteriologic outcome rates in the ofloxacin arm of this study are similar to those reported previously for the drug used for this indication (5,24). Clinical findings and bacteriologic results in this study were in agreement for all but a few patients; one in each group was deemed a success clinically but had a bacteriologic response of failure, while three in the sparfloxacin group and seven in the ofloxacin group had positive bacteriologic responses but were designated clinical failures.…”

Section: Discussionsupporting

confidence: 79%

“…There was a relatively high level of adverse events reported in both arms of the study (43.2% of patients overall), but this level was not atypical given the active method used for elicitation (5,20). The incidence of adverse events possibly or probably related to study drug, 27.9%, was also high, but again, it was not atypical for a conservative causative analysis (9).…”

Section: Discussionmentioning

confidence: 95%

“…For example, although mean ages in such studies have varied widely, from 24 to more than 48 years (5,6,10,24,28), the mean age of 36 years in this study is typical of the narrower range of 30 to 40 years for multicenter studies with an upper age limit for enrollment (7,12,19,20) and is appropriate for the disease population (2). In addition, the organisms isolated here, predominantly E. coli (188 of 219; 85.8%) and S. saprophyticus (4.6%), are consistent with the spectrum of pathogens expected in acute uncomplicated UTI (4,31), although a relatively high percentage of E. faecalis (5.0%), which is more commonly associated with nosocomial UTIs (8), was also found.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of Community-Acquired Acute Uncomplicated Urinary Tract Infection With Sparfloxacin Versus Ofloxacin

Henry¹,

Ellison²,

Sullivan³

et al. 1999

The Journal of Urology

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The efficacy and safety of a 3-day regimen of sparfloxacin were compared with those of a 3-day regimen of ofloxacin for the treatment of community-acquired acute uncomplicated urinary tract infections. Four hundred nineteen women were enrolled in a randomized, open-label, observer-blinded, multicenter study; 204 received sparfloxacin as a 400-mg loading dose on the first day and 200 mg once daily thereafter, and 215 received ofloxacin as 200 mg twice daily. A total of 383 patients met the criteria for clinical evaluability, and 174 were also bacteriologically evaluable; all treated patients were included in the safety analysis. Escherichia coli (86%) and Staphylococcus saprophyticus (4.6%) were the organisms most commonly isolated. Positive clinical responses were obtained 5 to 9 days after therapy in more than 92% of the patients in each group; sustained clinical cure rates 4 to 6 weeks after therapy were 78.3 and 76.9% in the sparfloxacin and ofloxacin groups, respectively. A positive bacteriologic response was observed in 98% of the bacteriologically evaluable patients in each treatment group at 5 to 9 days posttherapy and in 88.2 and 92.6% of the patients in the sparfloxacin and ofloxacin groups, respectively, 4 to 6 weeks after therapy. Almost 90% of all adverse events were of mild or moderate severity; the most frequent events at least possibly related to drug treatment were those common to the fluoroquinolones, namely, nausea, diarrhea, headache, insomnia, and photosensitivity. Photosensitivity was more frequent in the sparfloxacin group (6.9% versus 0.5% in the ofloxacin group); insomnia was more frequent in the ofloxacin group (3.7% versus 1.0% in the sparfloxacin group). These data suggest that a oncedaily, 3-day regimen of sparfloxacin is effective and generally well tolerated in the treatment of acute uncomplicated urinary tract infections.Standard therapy for acute uncomplicated urinary tract infections (UTIs) consists of a 3-day regimen with trimethoprim-sulfamethoxazole (TMP-SMZ), trimethoprim, or fluoroquinolones. Although TMP-SMZ is often the drug of choice, fluoroquinolones are recommended for patients with recurrent infection, treatment failures, and allergies to other antimicrobial agents (27,31). With the development of resistance, fluoroquinolones may be preferred since UTI pathogens demonstrate lower levels of resistance to fluoroquinolones compared to other therapies such as TMP-SMZ, amoxicillin, and sulfonamides (5, 27).Single-dose regimens have also been tested but have been less effective, with lower cure rates and more frequent recurrences than those achieved with the more optimal 3-to 5-day therapy (5, 21, 27). Short-course treatment offers distinct advantages in terms of patient compliance and convenience, as well as providing cost benefits, fewer side effects, and reduced levels of bacterial exposure to drugs. Sparfloxacin is extremely effective against a broad spectrum of gram-negative and gram-positive organisms (16, 22), including those implicated in UTIs. It is excreted unchang...

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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Treatment of Community-Acquired Acute Uncomplicated Urinary Tract Infection With Sparfloxacin Versus Ofloxacin

Henry¹,

Ellison²,

Sullivan³

et al. 1999

The Journal of Urology

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“…For trimethoprim-sulfamethoxazole, single-dose therapy is likely optimal (4,12,15). For other antimicrobial agents effective as short courses of therapy, 3 days of therapy has been suggested to be appropriate (6,8,9,16). For the fluoroquinolone antimicrobial agents, in particular, 3 days of therapy seems necessary because of the high failure rates of single-dose therapy of infection with Staphylococcus saprophyticus, the second most frequent infecting organism in this syndrome (5,8,17).…”

mentioning

confidence: 99%

Treatment of acute uncomplicated urinary tract infections with 3 days of lomefloxacin compared with treatment with 3 days of norfloxacin

Nicolle

Dubois

Martel

et al. 1993

Antimicrob Agents Chemother

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The bacteriologic and clinical efficacies of 3 days of lomefloxacin therapy were compared with those of 3 days of norfloxacin therapy for the treatment of acute uncomplicated urinary tract infections in a prospective, randomized, double-blind study. One hundred sixty-four subjects were enrolled at five Canadian centers; 84 received lomefloxacin, and 80 received norfloxacin. Escherichia coli (84%) and Staphylococcus saprophyticus (11%) were the most common organisms isolated. Forty subjects (24%) had low quantitative counts in their pretherapy urine specimens. In the intent-to-treat analysis, 76 lomefloxacin subjects (91%) and 76 norfloxacin subjects (95%) were cured or improved at follow-up 5 to 9 days posttreatment and 73 (87%) and 71 (89%o) subjects from the lomefloxacin and norfloxacin groups, respectively, were cured or improved at 4 to 6 weeks posttreatment. Bacteriologic eradication occurred in 61 of 63 lomefloxacin subjects (97%) with .108 CFU/liter in their pretherapy specimens and 56 of 59 norfloxacin subjects (95%) at 5 to 9 days and 55 (87%) and 53 (90%o) subjects from the lomefloxacin and norfloxacin groups, respectively, at 4 to 6 weeks. There were no statistically significant differences in outcome. Adverse effects which were potentially related to the study medications were reported by 26% of the subjects who received lomefloxacin and 25% of the subjects who received norfloxacin.

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“…3). The efficacy of ofloxacin is greater than TMP-SMX with recurrence rates of 8% to 9% 6 weeks after therapy has been completed (Hooton et al 1991). Other fluoroqinolones have similar efficacy however they should be regarded as a second line treatment option due to their high cost and to preserve their sensitivity against uropathogens.…”

Section: Managementmentioning

confidence: 96%

Current Management Strategies for Uncomplicated and Complicated Cystitis

Davis¹,

Flood²

2011

Urinary Tract Infections

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

Cited by 82 publications

References 19 publications

Treatment of Community-Acquired Acute Uncomplicated Urinary Tract Infection With Sparfloxacin Versus Ofloxacin

Treatment of Community-Acquired Acute Uncomplicated Urinary Tract Infection With Sparfloxacin Versus Ofloxacin

Treatment of acute uncomplicated urinary tract infections with 3 days of lomefloxacin compared with treatment with 3 days of norfloxacin

Current Management Strategies for Uncomplicated and Complicated Cystitis

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