Ciprofloxacin in Management of Urinary Tract Infection

URINARY TRACT INFECTION

no conclusive data on 1u,,1cc,,_,u,1uv1ca1e treatment of UTI in patients with renal failure. Emergence of resistant pathogens during therapy with fluoroquinolones has been infrequent but might be more frequent in complicated UTI caused by P. aeruginosa.

Ciprofkrn:acin in Management of Urinary Tract Infection N. E. TOLKOFF-RUBIN AND R. H. RUBIN, Medical Service, Renal and Infectious Disease Units, Massachusetts General Hospital and Department of Medicine, Harvard Medical School, Boston, Massachusetts Urology, 31: 359-367, 1988

Editorial Comment: The fluoroquinolones are a major advance i:n treatment of urinary tract i!'.lfections because of their intense microbiological activity against most Enterobacteriaceae (minimal inhibitory concentration usually less than 0,1 µg,/ml.) and Psemfomrnnas aeruginosa (minimal inhibitory concentration 0,5 µ.g,/ml. or less). A high urinary concentration of nmrfloxacin, cip~ ro:l:1oxacin, anoxacin and ofloxacin against almmit all urinary pathogens has led to a large l.mmber of clinical studies of the§e drugs, They are not nephrotoxic and are structurali.y distinct, and, therefore, safe in _patients with ,B~lactam (fo:r example, penicillin) alle:rgy, As noted in these selected abstracts the fluoroquinolones are highly effective in the treatment of complicated and uncomplicated urina:ry tract infectioxi.s. Since most uncomplicated infections can be cured readily less expensive, olde:r agents, such as trimethop:rim-suifamet:11oxazole, cephalospo:rins o:r nitrofuTantoi:n, it would seem :rea§onahle to iimit the use of flu.o:roquinofones for tR.""eatment of :more complicated infections, ,mch as in patients with uTinary tract ob§t:ruction, the elderly, and i:nfectiom, ca.:rned multhJle-re§istant Ente:rnbacte:riaceae and Pseudomonas aeruginoSllL Prelimina:ry !llomparative t:dal,; :m..1ggest that these drugs have similar efficacy. Howeveit, some differences a:re apparent already. For example, ofloxacin (200 mg. once a day) is as effective as norflmrncin (400 mg. twice a day) for treatment of ch1·onic complicated udna:ry tract infections, Emergence of resistant bacteria has been infrequent but it has been reported after long-term therapy of Pseudomonas infections and warrants careful monitoring, Anthony J, Schaeffer, M.D. Enoxacin in the Treatment of Sexually Transmitted Diseases 8IBOULET, J. M. BOHBOT Fournier, Paris, France

Jo Antimicrob. Chemother., suppl. B, 21: 119-124, 1988 Enoxacin was evaluated in two double-blind comparative trials in a total of 200 male and female patients with urethral and/or endocervical gonorrhoea. Single 400-mg doses were effective in eradicating Neisseria gonorrhoeae (including penicillinase-producing strains) from patients. Enoxacin was as effective as the parenteral drugs approved for treatment. Adverse events occurred in 3% of patients. Enoxacin has been shown to be an effective well tolerated and convenient treatment for gonorrhoea.

Single Doses of Ofloxacin in Uncomplicated Gonorrhoea J. AZNAR, R. PRADOS, A. HERRERA, A. RODRIGUEZ-PICHARDO

Ciprofloxacin is a new quinolone derivative which is particularly well adapted for the treatment of bacterial urinary tract infection. Virtually all uropathogens are susceptible, and the development of resistance is uncommon. Its pharmacokinetic characteristics reveal that effective concentrations of the drug are easily achieved with twice a day oral therapy in the blood, urine, kidneys, and prostate-even in advanced renal failure. The drug is well tolerated, even with prolonged courses of therapy. It will be particularly useful in the treatment of antibiotic-resistant, complicated, and/or prostatic infection.

A.

225

AND

F.

CATALAN,

lnstitut Alfred

E. J. PEREA, Departments of Microbiology and Dermatology, STD Clinic, University of Seville, School of Medicine, Seville, Spain AND

Drugs, suppl. 1, 34: 107-110, 1987 The clinical efficacies of 2 different single-dose oral treatments of ofloxacin were evaluated in a double-blind, randomised study of 60 males with gonococcal urethritis. 30 patients received a single dose of ofloxacin 100 mg and 30 received a single dose of ofloxacin 200 mg. The minimal inhibitory concentrations of ofloxacin against all isolates were less than or equal to 0.25 mg/L. Neisseria gonorrhoeae was eradicated from all 50 patients evaluated and clinical cure was achieved in 84%. In total, 8 patients developed post-gonococcal urethritis, although there was a significantly (p less than 0.05) lower rate of post-gonococcal urethritis in the group treated with ofloxacin 200 mg. In conclusion, a single oral dose of ofloxacin 100 mg could be an alternative treatment for uncomplicated gonorrhoea.

Editorial Comment: The studies indicate that the fluoroquinolones are effective in vitro against Neisseiria gonorrhoeae and in the treatment of uncomplicated uretli:rai or endocervical gonorrhea. A single dose of enoxaci:n (400 mgo) o:r ofloxacin (100 (])Jr' 200 mg,) is as effective as parenteral therapy, including infections caused by penicillinase-producing strains. Ciprofloxacfo (100 to 500 mg,) and norfloxacin (400 mg,) also a:1:e effective, The fluo:rroqui.nolones are well tolerated a:nd an attractive alternative treatment foi· uncomplicated go:no:r:r he:a. Anthony J, Schaeffer, MJJ. Pedneph:ric Ab§ces§: Modern Diagnosis and Treatment in 47 Cases H. EDELSTEIN AND R. E. McCABE, Section of Infectious Diseases, Veterans Administration Medical Center, Martinez, California Medicine, 67: 118-131, 1988 The records of 47 patients with a perinephric abscess diagnosed from 1975 to 1986 at 8 San Francisco Bay Area hospitals were reviewed. The mean age was 51 years. Fifty-five percent were females and 45%, males. The left kidney was affected in 47% of cases, the right kidney in 40%, both in 4%, and a transplanted pelvic kidney in 9%. Fever (55% ), chills or diaphoresis (4 7%), flank pain (40%), abdominal- pain (40%), and nausea or vomiting (32%) were the most common presenting