Levofloxacin Versus Ciprofloxacin in the Treatment of Urinary Tract Infections: Evidence-Based Analysis

Urinary tract infections (UTIs) are one of the most common bacterial infections acquired both in community and hospital. Fluoroquinolones, represented by levofloxacin and ciprofloxacin, are widely used for treatment of UTIs. However, it remains controversial for the comparison between the 2 drugs, which propelled us to conduct the first evidence-based research on this topic. To establish their relative efficacy and safety, we searched Pubmed, embase, and Web of Science for randomized controlled trials (RCTs) for UTIs. A total of 5 RCTs were finally included, involving 2,352 patients and a systematic review and meta-analysis were performed to compare the end-of-therapy and posttherapy clinical success rate, microbial eradication rate and adverse event rate. Jadad score and Review Manager 5.3.0 version were applied respectively to evaluate the study quality and heterogeneity. There was no significant difference between levofloxacin and ciprofloxacin group in end-of-therapy or posttherapy clinical success rate and microbial eradication rate (p > 0.05). As for adverse event rate, the 2 drugs were comparable and both safe for clinical use. Based on one included trial and pharmacological research, we raised hypothesis that levofloxacin was superior to ciprofloxacin for treatment of E. coli-induced chronic bacterial prostatitis (CBP) and it required a further study to prove it.

Download Full-text

1114. Oral β-lactams for the Treatment of Escherichia coli Bacteremia Secondary to Complicated Urinary Tract Infections Including Pyelonephritis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.978 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S396-S396

Author(s):

Nicole Harrington ◽

Megan Doran ◽

Stephen May ◽

Julianne Care ◽

Jillian Laude ◽

...

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Clinical Success ◽

Clinical Success Rate ◽

Bloodstream Infections ◽

E Coli ◽

Definitive Therapy ◽

Days Of Therapy ◽

Step Down ◽

Tract Infections

Abstract Background Complicated urinary tract infections (cUTI) including pyelonephritis may result in bacteremia, increasing the rate of morbidity and mortality. The Infectious Diseases Society of America recommends a fluoroquinolone as empiric therapy or trimethoprim/sulfamethoxazole as definitive therapy for acute pyelonephritis (AP). Oral β-lactams (BL) are considered sub-optimal based on historical efficacy data with aminopenicillins and variable bioavailability. Increasing resistance and toxicity with preferred agents, justifies further evaluation of oral BL for E. coli bacteremia secondary to urinary source. Methods This was a single-center, retrospective cohort study of patients with E. coli bacteremia secondary to AP or cUTI who received oral step-down therapy with a BL or non-BL. The primary outcome was the rate of clinical success defined by microbiological cure, clinical cure, and infection-related readmission. Secondary outcomes were time to oral step-down, total days of therapy, length of hospital stay, incidence of therapy escalation, 30-day readmissions, and antibiotic-associated adverse events. Results A total of 46 patients were included, with 23 patients in each group. The difference in clinical success between the BL and non-BL groups was not statistically significant (91.3% vs. 100%, P = 0.489). The most frequent oral step-down agents prescribed were cephalexin and ciprofloxacin. The median time to oral step-down was significantly lower in the non-BL group (4.39 vs. 3.41 days, P = 0.038), and the median duration of therapy in each group was 15 days. No patients required therapy escalation after oral step-down or had infection-related readmission within 30 days of discharge. Conclusion The observed clinical success rate of 91.3% remains consistent with previous studies evaluating oral BL as step-down therapy for Enterobacteriaceae bloodstream infections. The results of this study support the safety and efficacy of oral BL as step-down therapy for E. coli bacteremia due to cUTI, although larger studies may be beneficial. Disclosures All authors: No reported disclosures.

Download Full-text

ICNA regional workshops — using national evidence-based guidelines to reduce the risk of catheter-related urinary tract infections: report of post-workshop activities and outcomes

British Journal of Infection Control ◽

10.1177/14690446040050040501 ◽

2004 ◽

Vol 5 (4) ◽

pp. 23-25 ◽

Cited By ~ 2

Author(s):

C.M. Pellowe ◽

R.J. Pratt

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Evidence Based ◽

Tract Infections ◽

Evidence Based Guidelines

Download Full-text

The Implementation of Evidence-Based Nursing Measures to Reduce Catheter-associated Urinary Tract Infections (CAUTIs)

American Journal of Infection Control ◽

10.1016/j.ajic.2013.03.190 ◽

2013 ◽

Vol 41 (6) ◽

pp. S90-S91

Author(s):

Theresa L. Houston ◽

Donna Anderson ◽

Denise Larson

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Evidence Based ◽

Tract Infections ◽

Evidence Based Nursing

Download Full-text

SINGLE-DOSE PRULIFLOXACIN VERSUS SINGLE-DOSE PEFLOXACIN IN THE TREATMENT OF ACUTE UNCOMPLICATED URINARY TRACT INFECTION IN WOMEN

Urogynaecologia ◽

10.4081/uij.2004.5 ◽

2010 ◽

Vol 18 (3) ◽

pp. 5

Author(s):

M. CERVIGNI ◽

G. ORTICELLI ◽

M. BOLOGNA ◽

F. NATALE ◽

E. SALVATORI ◽

...

Keyword(s):

Single Dose ◽

Urinary Tract ◽

Eradication Rate ◽

Clinical Success ◽

Therapeutic Option ◽

Uncomplicated Urinary Tract Infection ◽

Efficacy And Safety ◽

Success Rates ◽

The One ◽

Tract Infections

The aim of the study was to compare the efficacy and safety of singledose prulifloxacin vs. single-dose pefloxacin in the treatment of patients with acute uncomplicated urinary tract infections. Two hundred and thirty-one female out-patients were considered microbiologically evaluable and randomly treated with 600 mg prulifloxacin (116 patients) or 800 mg pefloxacin (115 patients). The most commonly isolated uropathogen at baseline was Escherichia coli (71.4%), followed by Proteus mirabilis (10.8%) and Klebsiella pneumoniae (7.8%). Five-seven days posttreatment, the eradication rate was 97.4% and 92.2% in the prulifloxacin and pefloxacin group, respectively. The one-tailed 95% confidence interval analysis showed the equivalence of treatments. Four weeks from treatment no relapses, reinfections or superinfections were observed. The clinical success rates were 92.2% in the prulifloxacin and 84.3% pefloxacin groups. The safety profile was very good with both drugs. The results of the study make it possible to consider prulifloxacin a possible therapeutic option in patients with acute uncomplicated UTIs.

Download Full-text

Assessment of Fosfomycin for Complicated or Multidrug-Resistant Urinary Tract Infections: Patient Characteristics and Outcomes

Chemotherapy ◽

10.1159/000449422 ◽

2016 ◽

Vol 62 (2) ◽

pp. 100-104 ◽

Cited By ~ 18

Author(s):

Stephanie E. Giancola ◽

Monica V. Mahoney ◽

Michael D. Hogan ◽

Brian R. Raux ◽

Christopher McCoy ◽

...

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Bacterial Resistance ◽

Clinical Success ◽

Patient Characteristics ◽

Multidrug Resistant ◽

Enterococcus Spp ◽

Tract Infections ◽

Microbiological Cure

Background: Bacterial resistance among uropathogens is on the rise and has led to a decreased effectiveness of oral therapies. Fosfomycin tromethamine (fosfomycin) is indicated for uncomplicated urinary tract infections (UTIs) and displays in vitro activity against multidrug-resistant (MDR) isolates; however, clinical data assessing fosfomycin for the treatment of complicated or MDR UTIs are limited. Methods: We conducted a retrospective evaluation of patients who received ≥1 dose of fosfomycin between January 2009 and September 2015 for treatment of a UTI. Patients were included if they had a positive urine culture and documented signs/symptoms of a UTI. Results: Fifty-seven patients were included; 44 (77.2%) had complicated UTIs, 36 (63.2%) had MDR UTIs, and a total of 23 (40.4%) patients had a UTI that was both complicated and MDR. The majority of patients were female (66.7%) and elderly (median age, 79 years). Overall, the most common pathogens isolated were Escherichia coli (n = 28), Enterococcus spp. (n = 22), and Pseudomonas aeruginosa (n = 8). Twenty-eight patients (49.1%) were clinically evaluable; the preponderance achieved clinical success (96.4%). Fifteen out of 20 (75%) patients with repeat urine cultures had a microbiological cure. Conclusions: This retrospective study adds to the limited literature exploring alternative therapies for complicated and MDR UTIs with results providing additional evidence that fosfomycin may be an effective oral option.

Download Full-text

Fosfomycin versus Ertapenem for Outpatient Treatment of Complicated Urinary Tract Infections: A Multicenter, Retrospective Cohort Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab620 ◽

2021 ◽

Author(s):

Noah Wald-Dickler ◽

Todd C Lee ◽

Soodtida Tangpraphaphorn ◽

Susan M Butler-Wu ◽

Nina Wang ◽

...

Keyword(s):

Cohort Study ◽

Urinary Tract ◽

Los Angeles ◽

Urinary Tract Infections ◽

Retrospective Cohort Study ◽

Outpatient Treatment ◽

Retrospective Cohort ◽

Clinical Success ◽

Public Hospitals ◽

Tract Infections

Abstract Objectives We sought to determine the comparative efficacy of fosfomycin vs. ertapenem for outpatient treatment of complicated urinary tract infections (cUTI). Methods We conducted a multi-centered, retrospective cohort study involving patients with cUTI treated with outpatient oral fosfomycin vs. intravenous ertapenem at three public hospitals in Los Angeles County between January 2018 and September 2020. The primary outcome was resolution of clinical symptoms 30 days after diagnosis. Results We identified 322 patients with cUTI treated with fosfomycin (n = 110) or ertapenem (n = 212) meeting study criteria. Study arms had similar demographics, although patients treated with ertapenem more frequently had pyelonephritis or bacteremia while fosfomycin-treated patients had more retained catheters, nephrolithiasis, or urinary obstruction. Most infections were due to extended-spectrum β-lactamase-producing E. coli and Klebsiella pneumoniae; 80-90% of which were resistant to other oral options. Adjusted odds ratios for clinical success at 30 days, clinical success at last follow up, and relapse were 1.21 (0.68 to 2.16), 0.84 (0.46 to 1.52), and 0.94 (0.52 to 1.70), for fosfomycin vs. ertapenem, respectively. Patients treated with fosfomycin had significant reductions in length of hospital stay and length of antimicrobial therapy, and fewer adverse events (1 vs. 10). Fosfomycin outcomes were similar irrespective of duration of lead-in IV therapy or fosfomycin dosing interval (daily, every other day, every third day). Conclusion These results would support the conduct of a randomized controlled trial to verify efficacy. In the meantime, they suggest fosfomycin may be a reasonable stepdown from IV antibiotics for cUTI.

Download Full-text