Ofloxacin versus trimethoprim-sulfamethoxazole for treatment of acute cystitis

Abstract

We compared the safety and efficacies of ofloxacin and trimethoprim-sulfamethoxazole for the treatment of acute uncomplicated cystitis in women enrolled in a multicenter study. Data from three centers were combined for this report because the study design and study populations were identical, and patients were enrolled within an 18-month period. Cure rates for evaluable patients 4 weeks after treatment were high for all regimens: ofloxacin (200 mg) twice daily for 3 days, 22 of 25 (88%) cured; ofloxacin (200 mg) twice daily for 7 days, 42 of 49 (86%) cured; ofloxacin (300 mg) twice daily for 7 days, 25 of 25 (100%) cured; and trimethoprimsulfamethoxazole (160/800 mg) twice daily for 7 days, 46 of 52 (88%) cured. Ofloxacin was more effective than trimethoprim-sulfamethoxazole in eradicating Escherichia coli from rectal cultures during and 1 week after treatment. Both ofloxacin and trimethoprim-sulfamethoxazole markedly reduced vaginal colonization with E. coli during and 4 weeks after therapy. Emergence of resistant coliforms in rectal flora was found in 5 (19%) of 27 patients treated with trimethoprim-sulfamethoxazole but none of 50 ofloxacin-treated patients who were studied (P = 0.004). Adverse effects were equally common among the four treatment groups. We conclude that 3 to 7 days of ofloxacin is as safe and effective as trimethoprim-sulfamethoxazole for treatment of uncomplicated cystitis in women and that ofloxacin effectively reduces the fecal and vaginal reservoirs of coliforms in such patients.Urinary tract infections (UTIs) are among the most common problems for which women see private physicians in the United States, accounting for over 5 million office visits annually (22 We report data from three collaborating centers comparing the safety and efficacies of ofloxacin and trimethoprimsulfamethoxazole in the treatment of acute uncomplicated UTI in women. We also studied the effects of these regimens on rectal and perineal colonization with coliforms, as well as the propensity of each regimen to select for resistant aerobic gram-negative bacilli in fecal flora. twice daily in a 3-day regimen (OFL 200-3). Combined for this report are data from the first study from the University of Washington, Seattle; the University of Utah, Salt Lake City; and the Medical College of Virginia, Richmond, and data from the second study from the Seattle and Salt Lake City sites. Identical protocols were used at all three study sites, and the study populations were very similar in that all three centers enrolled women at their respective university student health services.Patient selection and evaluation. Women were eligible for enrollment in both studies if they were between the ages of 18 and 75 and had symptoms of acute cystitis, including dysuria, frequent urination, urgency, or subprapubic pain. Patients were ineligible if they were pregnant or not using a reliable contraceptive method or if they had evidence of upper urinary tract infection, such as temperature greater than 37.5°C or flank pain or tenderness; history ...

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

“…We found in the current study, as we found in our previous study (9), that ofloxacin was initially more effective than trimethoprim-sulfamethoxazole in eradicating E. coli from the rectum, but colonization was high in all treatment groups several weeks after treatment. Other investigators have demonstrated a dramatic but transient effect of ofloxacin against rectal coliforms (11,21).…”

“…In another study with an unstated follow-up interval, the cure rate in women treated with a 100-mg single-dose regimen of ofloxacin was significantly lower (73%) than that in the comparison group treated with a longer regimen of trimethoprim-sulfamethoxazole (93%) (16). While these observed cure rates are similar to those in our single-dose ofloxacin group, they are inferior to cure rates we have observed with short or conventional regimens of trimethoprim-sulfamethoxazole for uncomplicated cystitis (5,9). Our data show that a single 400-mg dose of ofloxacin was highly effective in the initial eradication of bacteriuria but was more likely to be followed by a recurrent symptomatic UTI requiring retreatment, compared with a conventional regimen of trimethoprim-sulfamethoxazole.…”

“…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. Recent studies and reviews suggest that single-dose therapy with trimethoprim-sulfamethoxazole and especially 13-lactams may be less effective than 7 days of therapy with these drugs (10,15).…”

“…Our data show that a single 400-mg dose of ofloxacin was highly effective in the initial eradication of bacteriuria but was more likely to be followed by a recurrent symptomatic UTI requiring retreatment, compared with a conventional regimen of trimethoprim-sulfamethoxazole. Norfloxacin (6) and ofloxacin (3,9) have previously been shown to be effective in 3-day regimens with twice-daily dosing for treatment of uncomplicated cystitis. Women treated with a once-daily 200-mg dose of ofloxacin for 3 days in this study had significantly more posttreatment recurrences of significant bacteriuria than those treated with trimethoprim-sulfamethoxazole, but most of the recurrences were asymptomatic and resolved spontaneously.…”

Comparative, double-blind, prospective, multicenter trial of temafloxacin versus trimethoprim-sulfamethoxazole in uncomplicated urinary tract infections in women

“…The in vitro activity of temafloxacin is comparable to those of ofloxacin and ciprofloxacin (13,14). Pharmacokinetic studies indicate that temafloxacin has good gastrointestinal absorption, with complete dose linearity and a half-life in plasma of approximately 8 h (23).…”