Randomized Study of Single-Dose, Three-Day, and Seven-Day Treatment of Cystitis in Women

Abstract

We evaluated the following five treatment regimens for acute cystitis in nonpregnant women: cefadroxil, 1,000 mg single-dose; cefadroxil, 500 mg twice a day for three days; cefadroxil, 500 mg twice a day for seven days; trimethoprim-sulfamethoxazole (TMP-SMZ), 320-1,600 mg single-dose, and TMP-SMZ, 160-800 mg twice a day for three days. At four weeks after the end of treatment, 25%, 58%, 70%, 65%, and 88% of patients, respectively, remained cured of infection. The results indicated that three-day treatment (1) might improve cure rates (over single-dose), (2) would reduce incidence of relapse (vs. single-dose), and (3) may be as curative as seven-day treatment. The results of the antibody-coated bacteria test did not predict treatment failure or relapse.

Treatment of acute uncomplicated urinary tract infections with 3 days of lomefloxacin compared with treatment with 3 days of norfloxacin

“…The outcomes with 3 days of norfloxacin therapy in this study are consistent with the results with this same therapeutic regimen in a previous multicenter Canadian study of uncomplicated urinary tract infections (17). The reported success rates of more than 90% are also consistent with those from other reports of short-term therapy with quinolones or trimethoprim-sulfamethoxazole in the treatment of acute uncomplicated urinary tract infections (4,8 from outcome analysis (6,9,16). Since such subjects would frequently not be identified or excluded in usual clinical practice, the study observations from such trials may not be relevant to actual clinical use of the antimicrobial agent.…”

“…For trimethoprim-sulfamethoxazole, single-dose therapy is likely optimal (4,12,15). For other antimicrobial agents effective as short courses of therapy, 3 days of therapy has been suggested to be appropriate (6,8,9,16). For the fluoroquinolone antimicrobial agents, in particular, 3 days of therapy seems necessary because of the high failure rates of single-dose therapy of infection with Staphylococcus saprophyticus, the second most frequent infecting organism in this syndrome (5,8,17).…”

Cefpodoxime-Proxetil versus Trimethoprim-Sulfamethoxazole for Short-Term Therapy of Uncomplicated Acute Cystitis in Women

“…These results were almost the same as those obtained with TMP-SMX for the treatment of acute cystitis (1,22). However, single-dose regimens with the newer quinolones as well as with fosfomycin trometamol had failure rates slightly higher than those obtained with the 3-day regimens (8,16). On the other hand, the increasing rates of resistance of E. coli to quinolones in European countries (6, 7) as well as the increasing rates of resistance of E. coli isolates from urine in the Greek community, which exceeds 15% among strains derived from infectious disease outpatient clinics in the Athens area (H. Giamarellou, personal communication), necessitate the evaluation of shortterm regimens with advanced cephalosporins.…”

Treatment duration for urinary tract infections in adults

“…After the introduction of the 3-day course of antibacterial therapy, numerous investigators endorsed this treatment program for women with acute bacterial cystitis (13,27,30). These researchers supported their position by publishing data indicating that the 3-day treatment course was as therapeutically effective as the more traditional 10-day therapy and that the short-duration treatment was associated with a reduced incidence of adverse drug reactions (25).…”

“…Some studies included patients with asymptomatic bacteriuria, as well as acute pyelonephritis (13). Some studies enrolled patients with bacteria resistant to the prescribed drug treatment (27). Some studies failed to randomly allocate patients to the treatment programs being compared (10).…”