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C l a i r E . C o x , S u s a n V. C a l l e r y , K. J. T a c k
Infection 14 (1986) Suppl. 4 © MMV Medizin Verlag GmbH Mtinchen, M0nchen 1986 S 303
C. E. Cox et al.: Ofloxacin in UTI
Table t : Demographics, pathogens, and results, uncompli- co-trimoxazole treatment group. Both complained of diz-
cated UTI study. ziness.
For the complicated UTI study, a total of 71 patients
were entered. On admission, all patients h a d underlying
disease of the urinary tract, and all pathogens were sus-
ceptible to both study drugs. Pathogen identity and sus-
Patients 69 67 73 ceptibility data are shown in Table 2. Efficacy results are
Male 19 12 14 shown in Table 3. All patients in the ofloxacin treatment
Escherichia coli 45 49 57 group were cured microbiologically. One patient in the
Klebsiella spp. 10 4 5 co-trimoxazole group, with a Klebsiella pneumoniae in-
Staphylococcus saplvphyticus 4 5 2 fection failed. Her organism became resistant during ther-
Proteus mirabilis 3 2 2 apy, with a pretreatment MIC of 2.0 mg/l, and a post-
Citrobacter spp. 2 3 4 treatment MIC of > 256 rag/1. Three superinfections also
Enterobacter spp. 3 2 3 occurred in the co-trimoxazole group. Two were due to
Enterococcus 0 1 0
co-trimoxazole-resistant but ofloxacin-susceptible Pseu-
Streptococcus agalactiae 1 0 0
Staphylococcus aureus 1 1 0 domonas aeruginosa, and one due to co-trimoxazole-sus-
ceptible Acinetobacter anitratus.
Failures 1 l 0 Evaluation of the complicated UTI patients four t o six
Relapses at 4 to 6 weeks 3 2 2 weeks post-therapy showed no relapses in the ofloxacin
Superinfections 2 2 1 group, but two relapses in the co-trimoxazole group, both
due to co-trimoxazole-susceptible E. coli. There was also
one reinfection in the co-trimoxazole group, due to an E.
coli isolate with an MIC for co-trimoxazole of > 256 mg/1.
Table 2: Susceptibility data on 71 pathogens* from the One patient dropped out of each study arm in the compli-
complicated urinary tract study. cated UTI study due to adverse drug reactions, both rash-
es. There were no other clinical adverse effects of the
drugs.
Discussion
A variety of antimicrobial agents can be used for the
treatment of urinary tract infections. Increasing antimi-
* 30 Escherichia coli, 10 Klebsiella pneumoniae, 10 Proteus mi- crobial resistance, however, has led to a tendency to treat
rabilis, 3 each of Enterobacter aerogenes, Enterobacter cloa- with intrinsically more active agents such as co-trimox-
cae, Citrobacter freundii, Proteus vulgaris, Proteus rettgeri, azole rather than sulfonamides alone or ampicillin.
and Serratia marscescens, 2 Citrobacter diversus and 1 entero- The data presented here show that treatment of uncom-
COCCUS.
plicated U T I ' s with ofloxacin is as effective as treatment
with co-trimoxazole, with a high cure rate (98.5 to 100%)
in each of the three treatment groups. Superinfection
rates and relapses were also comparable in ofloxacin and
Table 3: Microbiological results in complicated urinary co-trimoxazole treated groups.
tract infection
In UTI's in patients with underlying abnormalities of the
urinary tract, a more resistant group of infecting agents
i!ii iill¸!i!i!i!iiiii!ii!i!ii!!i!!li
iii was seen, as expected. Again, ofloxacin and co-trimoxa-
zole cure rates were essentially equivalent, 97 to 100% in
each group. Of note is the development of resistance to
Patients entered 36 35
co-trimoxazote in one isolate of K. pneumoniae during
Patients evaluable therapy in the co-trimoxazole treatment group, and
5 to 9 days post-therapy 35 34 superinfection due to co-trimoxazole-resistant organisms
Microbiological cure 35 30 (P. aeruginosa) in the same group.
Microbiological failure 0 1
Both ofloxacin and co-trimoxazole appeared to be well
Superinfections 0 3
tolerated, with similar drop-out rates due to adverse drug
Patients evaluable reactions. Rashes and dizziness were responsible for pa-
4 to 6 weeks post-therapy 32 29 tients discontinuing therapy.
Microbiological relapses 0 2 In conclusion, based on the data available for analysis at
Microbiological 0 1 this time, ofloxacin is a safe and effective agent for the
re-infections treatment of both uncomplicated and complicated urinary
tract infections.
S 304 Infection 14 (1986) Suppl. 4 © MMV Medizin Verlag GmbH Mtinchen, Mtinchen 1986