Treatment duration for urinary tract infections in adults

Gleckman, Richard A.

doi:10.1128/aac.31.1.1

Cited by 33 publications

(12 citation statements)

References 48 publications

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“…Thirty-seven patients were administered ciprofloxacin, and 28 were given an aminoglycoside (12 gentamicin, 14 tobramycin, and 2 amikacin). The patient groups were comparable with respect to underlying disease and type of urinary tract abnormality, although chronic obstructive pulmonary disease occurred more frequently in the patients randomized to the aminoglycoside group ( Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…However, it is also well known that relapse is common even if therapy is prolonged (7,10). Consequently, short-term therapy has been deemed reasonable for chronically catheterized patients (14). In any case, this weakness existed for both antibiotic regimens.…”

Section: Discussionmentioning

confidence: 99%

“…This is pertinent in that the fever, chills, and costovertebral angle tenderness considered typical (but not diagnostic) of upper tract disease occurred in some patients. Unfortunately, there are no universally accepted noninvasive methods for localization (14), and they are not generally available in the convalescent-care setting. In any case, this possibility existed for both antibiotic regimens.…”

Section: Discussionmentioning

confidence: 99%

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Use of ciprofloxacin versus use of aminoglycosides for therapy of complicated urinary tract infection: prospective, randomized clinical and pharmacokinetic study

Fang¹,

Brennen²,

Wagener³

et al. 1991

Antimicrob Agents Chemother

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The efficacy of oral ciprofloxacin was compared with that of parenteral aminoglycoside for therapy of complicated urinary tract infection in a prospective randomized trial. The setting was a chronic-care Veterans Administration facility in which long-term bladder catheterization and resistant bacteria were common.Sixty-five consecutive patients were stratified for presence and type of bladder catheter, the presence of Providencia and Pseudomonas aeruginosa organisms versus other urinary pathogens, and renal dysfunction. A pharmacokinetic study of ciprofloxacin concentrations in serum and urine was performed with selected patients. Urinary catheters were present in 94%. All patients were symptomatic, and 58.5% had fever. Ciprofloxacin, 500 mg every 12 h orally, was compared with parenteral aminoglycoside for 7 to 10 days. Clinical response, defined by resolution of symptoms and fever at 5 to 9 days posttherapy (short-term) and 28 to 30 days posttherapy (long-term), was essentially identical for both treatment groups. Bacteriologic response, defined by sterile urine cultures, showed that ciprofloxacin was significantly more efficacious (P = 0.0005) than aminoglycoside at 5 to 9 days posttherapy. However, by 28 to 30 days, the response rate was essentially identical. Emergence of resistance to the study antibiotic was seen in 62 and 70% of those who did not show a bacteriological response and were receiving ciprofloxacin and aminoglycosides, respectively. Concentrations of ciprofloxacin and aminoglycoside in the urine substantially exceeded the MIC for the urinary pathogens isolated, although these concentrations did not correlate with short-term bacteriologic response for either antibiotic. Ciprofloxacin was efficacious in complicated urinary tract infection compared with the current standard of parenteral aminoglycoside among catheterized patients with relatively resistant bacteria.Urinary tract infection has become the leading infection and major cause of morbidity in convalescent-care facilities and nursing homes. Furthermore, because antibiotic therapy is given so frequently for symptomatic bacteriuria, the emergence of resistant organisms is becoming increasingly accepted as a consequence of indwelling bladder catheters in an elderly population (3, 31).For example, at our convalescent-care facility, 50% of nosocomial infections occur in the urinary tract and 70% of the cases of bacteremia begin in the urinary tract. Furthermore, aerobic gram-negative rods resistant to first-generation cephalosporins, trimethoprim-sulfamethoxazole, and ampicillin constitute a major proportion of the etiologic agents. These organisms include Enterobacter species, Pseudomonas aeruginosa, Providencia stuartii, Morganella morganii, and Proteus species. Thus, oral antimicrobial agents have become notably less useful, so that parenteral agents are often required for patients with symptomatic bacteriuria and systemic signs of infection.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Use of ciprofloxacin versus use of aminoglycosides for therapy of complicated urinary tract infection: prospective, randomized clinical and pharmacokinetic study

Fang¹,

Brennen²,

Wagener³

et al. 1991

Antimicrob Agents Chemother

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“…Depending on the severity of the condition, the rate of previous recurrence, and the underlying pathology, recommendations vary enormously and many are not based on clinical data [18]. New guidelines for studying new therapeutic agents in UTI have been proposed [10,19] and should help in the design of clinical trials.…”

Section: Introductionmentioning

confidence: 99%

Pharmacologic basis for the treatment of pyelonephritis

Beauchamp

Bergeron²

1999

Curr Infect Dis Rep

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Urinary tract infections (UTIs) are among the most common bacterial infections in humans. Even though physicians have been treating UTIs for 60 years, there has been no standardized approach regarding the rational choice of antimicrobial agents and optimal treatment duration for these infections. This review discusses the pharmacologic basis for the treatment of UTIs. Although most antibiotics concentrate well in the urine and can eradicate most of the sensitive uropathogens that cause lower UTI, antibiotics given for the treatment of pyelonephritis must concentrate and kill bacteria embedded within the renal parenchyma. Investigators once believed that antibiotics must concentrate in sufficient amounts in the urine of infected patients to be effective in treating pyelonephritis. In fact, the efficacy of an antibiotic in the treatment of pyelonephritis is proportional to its capacity to converge in high concentration not only in urine but also in the renal parenchyma because serum and urine levels of antibiotics are poor predictors of the intrarenal levels. Other factors should also be taken into consideration in the management of UTIs, such as the time of day antibiotics are given because significant time-dependent differences have been observed in the pharmacokinetics and rate of excretion in urine of several antibiotics. Finally, the authors review the recent development in the inflammatory response in the urinary tract that may explain the clinical features of UTI and may be useful in the diagnosis as well as better management of UTI.

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“…Single-dose treatment is recommended by some authors (6), but most studies of such regimens have been too small to avoid 1 error. This type of treatment has been statistically validated only for the combination of trimethoprim and sulfamethoxazole (9).…”

mentioning

confidence: 99%

Enoxacin relieves symptoms of recurrent urinary infections more rapidly than cefuroxime axetil

Brumfitt

Hamilton‐Miller

Walker

1993

Antimicrob Agents Chemother

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In patients with a history of recurrent infections, treatment with enoxacin (200 mg/12 h for 3 days) relieved symptoms of acute urinary infection significantly more rapidly than treatment with cefuroxime axetil (125 mg/12 h for 7 days). Other parameters, including clinical and bacteriological cure rates and patients' overall opinion of their treatment, did not differ significantly between the treatments.Recurring infections of the urinary tract (cystitis) are usually accompanied by symptoms of dysuria and frequency and urgency of urination and can have a profound effect on the social, domestic, and professional life of the sufferer. Treatment with one of any of several appropriate antibiotics usually cures the infection, and recurrence can often be well controlled by the use of long-term, low-dose antibiotic prophylaxis (2). However, it is surprising that little attention has been paid to the speed with which the debilitating symptoms of the acute attack can be relieved. Clearly, the more quickly this can be done the better.We have now studied this neglected aspect of management by determining, with diary cards, the speed of abatement of symptoms. This was done as an integral part of a trial in which enoxacin was compared with cefuroxime axetil for the treatment of recurrent infections in women.Patients were referred to the Urinary Infection Clinic at the Royal Free Hospital by their family doctor or by a consultant in another speciality. Such patients typically have a history of between 4 and 20 symptomatic episodes per year. We have found over the past 18 years that neither the age nor the presence of a radiological abnormality in this type of patient influences the outcome of treatment. Thus, all patients who presented were eligible for consideration for entry in this trial. At the first visit, a history was taken, a physical examination was carried out, and blood and midstream urine specimens were taken for appropriate tests. Midstream urine specimens were examined microscopically and were cultured on cystine-lactose-electrolyte-deficient agar; sensitivity testing was carried out on IsoSensitest medium. Women with significant bacteriuria (2105 bacteria per ml) were eligible for the study, provided they were 218 years old, neither pregnant nor lactating, had no history of allergy to quinolones or cephalosporins, and were infected by an organism sensitive to enoxacin and cefuroxime.Patients were allocated, by means of a randomization chart, to receive either enoxacin (200 mg/12 h for 3 days) or cefuroxime axetil (125 mg/12 h for 7 days). Informed consent was given, patients being told that both regimens were being performed as recommended by the drugs' manufacturers and that both regimens were officially licensed for the treatment of urinary infections. Patients were not told specifically that the regimens were of different durations. Treatment packs * Corresponding author.were of identical size and appearance, so that neither the physician nor the laboratory staff knew which treatment had been allocated. At t...

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Treatment duration for urinary tract infections in adults

Cited by 33 publications

References 48 publications

Use of ciprofloxacin versus use of aminoglycosides for therapy of complicated urinary tract infection: prospective, randomized clinical and pharmacokinetic study

Use of ciprofloxacin versus use of aminoglycosides for therapy of complicated urinary tract infection: prospective, randomized clinical and pharmacokinetic study

Pharmacologic basis for the treatment of pyelonephritis

Enoxacin relieves symptoms of recurrent urinary infections more rapidly than cefuroxime axetil

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