Oral vs Intravenous Ciprofloxacin in the Initial Empirical Management of Severe Pyelonephritis or Complicated Urinary Tract Infections: A Prospective Randomized Clinical Trial

Mombelli, G; Pezzoli, Romina; Pinoja-Lutz, G.; Monotti, R.; Marone, Claudio; Franciolli, M.; Walsh, Patrick C.

doi:10.1016/s0022-5347(05)68396-6

Cited by 5 publications

(8 citation statements)

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“…Patients with symptomatic infection can usually be treated with oral therapy (85). Patients who are hemodynamically unstable, unable to tolerate oral medication, or in whom gastrointestinal absorption is impaired, require parenteral therapy.…”

Section: Continued On Next Pagementioning

confidence: 99%

“…Clinical trials of parenteral therapy for complicated urinary infection have reported efficacy for a wide variety of agents, but there are limited comparative studies. Aminoglycosides (79,83,86), fluoroquinolones (74,79,85,87), piperacillin/ tazobactam (64,88,89), ceftazidime (74,78,80,82) and carbapenems (61,64,71,82) have all been reported to achieve high rates of clinical and microbiological cure. Duration of therapy: The optimal duration of antimicrobial therapy for the treatment of acute symptomatic episodes has not been systematically studied.…”

Section: Continued On Next Pagementioning

confidence: 99%

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Complicated Urinary Tract Infection in Adults

Nicolle¹

2005

Canadian Journal of Infectious Diseases and Medical Microbiolog

216

156

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OBJECTIVE: To review current knowledge relevant to complicated urinary tract infection, and to provide evidence-based recommendations for management. METHODS: The literature was reviewed through a PubMed search, and additional articles were identified by journal reference review. A draft guideline was prepared and critically reviewed by members of the Association of Medical Microbiology and Infectious Disease Canada Guidelines Committee, with modifications incorporated following the review. RESULTS: Many urological abnormalities may be associated with complicated urinary infection. There is a wide spectrum of potential infecting organisms, and isolated bacteria tend to be more resistant to antimicrobial therapy. Morbidity and infection outcomes in subjects with complicated urinary infection are principally determined by the underlying abnormality rather than the infection. Principles of management include uniform collection of a urine specimen for culture before antimicrobial therapy, characterization of the underlying genitourinary abnormality, and nontreatment of asymptomatic bacteriuria except before an invasive genitourinary procedure. The antimicrobial regimen is determined by clinical presentation, patient tolerance, renal function and known or anticipated infecting organisms. If the underlying abnormality contributing to the urinary infection cannot be corrected, then early post-treatment recurrence of infection is anticipated. CONCLUSIONS: The management of complicated urinary infection is individualized depending on patient variables and the infecting organism. Further clinical investigations are necessary to assist in determining optimal antimicrobial regimens.

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Section: Continued On Next Pagementioning

confidence: 99%

Section: Continued On Next Pagementioning

confidence: 99%

Complicated Urinary Tract Infection in Adults

Nicolle¹

2005

Canadian Journal of Infectious Diseases and Medical Microbiolog

216

156

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“…A limited number of US and international clinical trials have been published, and provide evidence to support the effectiveness of the fluoroquinolones in the treatment of complicated and hospital‐acquired UTIs [52–75]. However, the findings of these trials are often difficult to compare or interpret because of differing or incomplete definitions of the ‘complicated’ aspect.…”

Section: Fluoroquinolone Clinical Studies In Patients With Complicatementioning

confidence: 99%

“…However, the findings of these trials are often difficult to compare or interpret because of differing or incomplete definitions of the ‘complicated’ aspect. Although these trials vary in their study design, many support the use of fluoroquinolones in the treatment of serious or complicated UTIs; the most experience has been garnered with ciprofloxacin [52–64]. Several contemporary and key ciprofloxacin studies are described in more detail below.…”

Section: Fluoroquinolone Clinical Studies In Patients With Complicatementioning

confidence: 99%

Current challenges in the treatment of complicated urinary tract infections and prostatitis

Wagenlehner

Naber

2006

Clinical Microbiology and Infection

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Serious urinary tract infections (UTIs) and acute bacterial prostatitis in adults cause significant morbidity and economic burden. Chronic bacterial prostatitis is a rather rare condition seen in urological practice, however, in certain occasions difficult to treat. In this paper, we review the bacterial etiologies and the resistance patterns found in adults with serious UTIs and bacterial prostatitis, and discuss considerations for selecting optimal antimicrobial therapy. The role of fluoroquinolones as targeted therapy for serious UTIs is highlighted. The use of effective antimicrobial therapy is the foundation of management of serious UTIs and bacterial prostatitis. Selection of the optimal antimicrobial agent must take into account patient-specific factors; infection characteristics (e.g., severity, community- vs. institutional- or hospital-acquired, need for IV agent, UTI, prostatitis); local resistance pattern; pharmacokinetic and pharmacodynamic principles; and cost. Fluoroquinolones are among the alternatives for empirical antibiotic treatment of serious UTIs and acute bacterial prostatitis. In serious UTIs activity of the antimicrobial agent against Pseudomonas aeruginosa needs to be taken into account. In chronic bacterial prostatitis fluoroquinolones are the first choice because of their favourable pharmacokinetic properties at the site of infection. Targeted antimicrobial therapy--emphasising the correct antibacterial spectrum and correct dosage--is likely to provide important benefits, such as reduced morbidity and associated costs, reduced emergence of resistance and maintenance of class efficacy.

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“…Empirical antibiotic treatment was considered concordant if the patient was treated intravenously with an antibiotic to which the bacteraemia organism was phenotypically sensitive and discordant if they were treated with an antibiotic to which it was phenotypically resistant or intermediately resistant. Oral/ enteral antibiotic treatment was considered discordant even if the organism was phenotypically sensitive, unless the antibiotic prescribed was ciprofloxacin, as a number of studies have found oral therapy to be equivalent to intravenous [19][20][21].…”

Section: Data Sourcesmentioning

confidence: 99%