Comparative Studies of Fluoroquinolones in the Treatment of Urinary Tract Infections

Abstract

The resultsof comparative trials of fluoroquinolones for the treatment of uncomplicated and complicated urinary tract infections (UTI) were reviewed. Severalrandomized, comparative trials showedthat in uncomplicated UTI norfloxacin, ciprofloxacin, and ofloxacin wereat least as effectiveas trimethoprim-sulfamethoxazole (TMP-SMZ) and amoxicillinand usually more effectivethan nalidixicacid, pipemidic acid, and nitrofurantoin. Comparativetrials of single-dose regimens have, however, been limited. A few randomized, comparative trials have shown that in complicated UTI norfloxacin, ciprofloxacin, and ofloxacin wereat least as effectiveas amoxicillinand TMP-SMZand usually more effective than pipemidic acid. Moreover, preliminary results indicate that fluoroquinolones might be effective for the oral treatment of complicated UTI that are difficult to treat, especially those due to Pseudomonas aeruginosa. Comparative trials are needed to establish the value of fluoroquinolones for chronic bacterial prostatitis. There are no conclusivedata on fluoroquinolone treatment of UTI in patients with renal failure. Emergence of resistantpathogens during therapywith fluoroquinolones has beeninfrequentbut might be more frequent in complicated UTI caused by P. aeruginosa.Although highly effective and well-established antibiotic regimens are available for the treatment of urinary tract infection (UTI), there is a need for new antimicrobial agents, especially for the treatment of outpatients with UTI that are difficult to treat and for which most of the drugs available for oral treatment are ineffective.The fluoroquinolones have several properties that suggest their potential clinical utility for the treatment of UTI, including high activity in vitro against virtually all urinary tract pathogens and good absorption after oral administration that results in prolonged high levels of drug in urine [1].The methodologic problems associated with open and comparative trials evaluating the efficacy of new antibiotics for the treatment of UTI have recently been reviewed [2]. For this review of the efficacy of fluoroquinolones for the treatment of UTI, we have emphasized those studies that have both sufficient data for a clear classification of UTI and data on We thank Mrs. Kathrin Zsirmik and Mrs. Alexandra Bloch for typing the manuscript.Please address requests for reprints to R. Malinverni, Medizinische Universitatsklinik, Inselspital, CH-3010 Bern, Switzerland. follow-up urine cultures 4-6 weeks after the end of treatment (unless otherwise mentioned). In this evaluation, bacteriologic cure (sterile urine) was considered as the end point of antibiotic treatment since the definitions of clinical response, when stated, varied from one study to another and symptoms may disappear in the absence of bacteriologic cure. In table 1, which outlines the efficacy of fluoroquinolone treatment of UTI by infecting organism, only data from studies (noncomparative and comparative) that provided sufficient information to permit a clear classification of UTI...

Clinical experience with pefloxacin in patients with urinary tract infections

“…New fluoroquinolones have emerged as effective antimicrobial agents in the treatment of both complicated and non‐complicated urinary tract infections (UTI). Comparative trials by our unit and other centres have recently demonstrated that norfloxacin, ciprofloxacin and ofloxacin 1,2 are at least as efficacious as trimethoprim‐sulfamethoxazole and amoxycillin in the treatment of these infections.…”

The Role of the Fluoroquinolones

“…39 ofloxacin 100 mg,40-46 fleroxacin 200, 400, or 600 mg,47-50 and pefloxacin 800 mgsl have been highly effective in women with uncomplicated lower urinary tract infections caused by Enterobacteriaceae, but may be less effective against Staphylococcus saprophyticus. 52 Bact e r i o I og i c c u re rates we re 87% (40/46) for high-dose n o r f l o x a~i n ,~~. 37 82% (59/72) for low-dose c i p r o f l~x a c i n ,~* * 39 80% (1 68/21 1 ) for o f l~x a c i n ,~~-~~ 90% (57/63) for f l e r~x a c i n ,~~-~~ and 83% (55/66) for pefloxa~in.~' The overall bacteriologic cure rate for single-dose quinolone therapy was 83% (379/458), which was at least comparable to that for TMP-SMX and other agents.…”