Single-Dose Antimicrobial Therapy for Urinary Tract Infections in Women

Eighty-nine college women with acute urinary tract infections were treated orally with either 1,000 mg of cefuroxime axetil in a single dose (n = 59) or 250 mg of cefaclor three times a day for 7 days (n = 30). At 1 week posttherapy, 88% of the patients in the cefuroxime axetil group and 97% in the cefaclor group were clinically and bacteriologically cured (P > 0.10). There was no statistically significant difference between the cure rates of the two treatment groups. However, this study has only a 50% power to detect a 10% difference. Therefore, there is a substantial possibility of a type II error, i.e., failing to find a difference that is actually present. At 4 weeks posttherapy, 78% of the patients in the cefuroxime group and 80% in the cefaclor group remained cured. By 36 weeks posttherapy, the cumulative rate of recurrence in both treatment groups was 60%. Of the patients with a positive antibody-coated bacteria test, fewer achieved a short-term cure after single-dose treatment with cefuroxime axetil than those with a negative antibody-coated bacteria test (67 versus 96%; P < 0.01).Urinary tract infections (UTIs) are a common medical problem in women (1,12,26,30). They are usually associated with symptoms of cystitis, although the kidneys may be involved (5-7, 11, 23, 41). Single-and multiple-dose regimens of a variety of antimicrobial agents have been reported to be effective in the treatment of these infections in women (15,19,21,33,35). Single-dose antibiotic therapy with simultaneous localization studies of the sites of infection has resulted in favorable responses in patients with infections confined to the bladder and poor responses in those with upper urinary tract involvement or complicated infections (2,10,34,35,38,39,41). Other advantages of single-dose therapy are lower cost, increased patient compliance, fewer adverse effects, and reduced potential for emergence of resistant bacteria in the gut. However, comparisons of long-term recurrence rates between single-dose therapy and conventional multidose therapy are not available.Cephalosporins have a broad spectrum of antimicrobial activity, but their efficacy in single-dose therapy remains controversial (5,14,32,35). The patient population studied, the types of infections, and the pharmacokinetic characteristics of the tested cephalosporin contribute in part to the conflicting results.Cefuroxime axetil was evaluated as a single dose in this clinical study. Cefuroxime is a broad-spectrum, P-lactamase-stable parenteral cephalosporin which is not well absorbed in the gastrointestinal tract, whereas cefuroxime axetil, a novel ester prodrug of cefuroxime, is de-esterified in the intestinal mucosa after oral administration into the active form of cefuroxime and subsequently absorbed to attain effective therapeutic concentrations in plasma and urine (16, 37). The purposes of this trial were (i) to compare the efficacy and safety of a single dose of cefuroxime axetil versus multiple doses of cefaclor for treatment of UTIs, (ii) to relate therapeutic resp...

Section: Discussionmentioning

confidence: 70%

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confidence: 99%

Single-dose cefuroxime axetil versus multiple-dose cefaclor in the treatment of acute urinary tract infections

Iravani

Richard

1989

“…This syndrome is associated with limited long-term morbidity but may have substantial short-term morbidity because of disruption in a woman's activities by symptomatic episodes. Women with acute uncomplicated urinary tract infections generally respond well to short courses of antimicrobial therapy (14,19). While short courses of therapy may be minimally less effective than longer courses of therapy of 7 to 14 days, the increased adverse effects associated with longer courses of therapy make short courses of therapy the treatment of choice.…”

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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

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.

“…Recently, several studies showed that a single-dose regimen is effective in treating acute uncomplicated UTI in a selected population of women (12,13). However, when unselected populations were studied, the single-dose regimen was less effective (6-8, 10, 11, 16).…”

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Single-dose cephalexin therapy for acute bacterial urinary tract infections and acute urethral syndrome with bladder bacteriuria

Cárdenas¹,

Quinn²,

Rooker³

et al. 1986

The efficacy of single-dose therapy with 3 g of cephalexin was evaluated in 129 women with symptoms of acute uncomplicated lower urinary tract infections. Of 91 patients with significant bacteriuria, 61 Urinary tract infections (UTI) affect at least 10% of the female population and are among the most common infections seen in general medical practice during a lifetime. In general, they are easy to diagnose and can be effectively treated with many different antimicrobial agents; however, the dosage and length of treatment are still controversial.Recently, several studies showed that a single-dose regimen is effective in treating acute uncomplicated UTI in a selected population of women (12, 13). However, when unselected populations were studied, the single-dose regimen was less effective (6-8, 10, 11, 16).Henry Ford Hospital is a 950-bed, outpatient, general medical facility in the inner-city area of Detroit with several satellite clinics in the suburbs. Observations of the patients in this institution gave us the opportunity to study different population groups living within the same large metropolitan area. We chose to investigate the efficacy of a single oral dose of cephalexin in treating -acute uncomplicated UTI in women. MATERIALS AND METHODSFemale patients who had symptoms suggestive of acute UTI (dysuria, frequency, hematuria) and had abnormal urinalysis results were entered in the study after informed consent was obtained. We excluded patients who were over 70 years ofage, were pregnant, or showed evidence of hepatic or renal impairment or other concomitant infection. We also excluded patients who had signs of acute pyelonephritis, had recently used antibiotics, or had a history of cephalosporin hypersensitivity or complicated UTI (e. g., nephrolithiasis, indwelling catheter, etc.). Initially, 129 patients were entered * Corresponding author.