Infectious human adenoviruses are shed in urine even after disappearance of urethral symptoms.

BACKGROUND: Urethritis is a common sexually transmitted disease, and human adenoviruses (HAdVs) have been found to be associated with nonchlamydial nongonococcal urethritis. However, the level and viability of HAdV in the urine of patients with urethritis remain unclear. METHODS: Male patients with urethritis and an asymptomatic group were screened using their First-void urine (FVU) for urethritis-related pathogens to identify those with HAdV DNA. FVU and gargle fluid were collected from all patients including from those in the asymptomatic group. A swab of eye discharge was also collected from patients with eye symptoms. The pharyngeal and/ or ocular fluid was also screened only in cases in which FVU was positive for HAdV DNA. HAdVs were isolated using A549 cell lines and typed by sequencing, and viral shedding during 2 years was quantified using real-time PCR. The prevalence of HAdV was assessed in the urethritis and asymptomatic groups, and viral load, isolated HAdV types, and urethral symptoms were compared between the groups. RESULTS: The positive detection rate of HAdV DNA was significantly higher in the urethritis group than in the asymptomatic group. Of 398 patients with urethritis, HAdV was isolated in all 32 cases (23 cases in which only HAdV DNA was detected with a mean of 2 × 109 copies/mL in urine samples). Of 124 control cases, one had HAdV monoinfection. The most frequently detected HAdV type was 56, followed by types 37 and 64. Regarding the relationship between symptoms and isolated HAdVs, the virus was isolated for up to 12 days after urethritis symptoms disappeared. CONCLUSIONS: HAdVs were significantly detected and isolated from the FVU of patients with urethritis. Furthermore, high levels of infectious HAdVs are excreted in urine for a long period even after urethritis symptoms disappear.

The bacterial microbiota in first-void urine from men with and without idiopathic urethritis.

BACKGROUND: Non-gonococcal urethritis (NGU) is a common syndrome in men. NGU may have several causes, but many cases are caused by sexually transmitted infections that may also cause complications in their female partners. Chlamydia trachomatis and Mycoplasma genitalium are the most common causes of NGU, but in up to 35% of the cases, none of the known viral or bacterial causes are found. Traditionally, pathogens have been detected using various culture techniques that may not identify all species present in the urethra. To address this, we used culture-independent methods for analysis of the male urethral microbiota. METHODS: This case-control study analysed first void urine samples, collected at STD clinics in Stockholm, Sweden from men with idiopathic urethritis (IU), i.e. negative for Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Ureaplasma urealyticum, Trichomonas vaginalis, adenovirus, and herpes simplex virus type 1 and -2 together with samples from men without urethritis. Forty-six controls and 39 idiopathic urethritis patients were analysed. RESULTS: The microbiota was highly diverse: None of the 302 operational taxonomic units (OTUs) found in negative controls and IU patients were found in all of the samples or even in all of the samples in one group. More than 50% of the OTUs were only found in one or two of the total of 85 samples. Still the most dominant 1/6 of the genera constituted 79% of the sequences. Hierarchical clustering in a heatmap showed no specific clustering of patients or controls. A number of IU patient samples were dominated by a single genus previously related to urethritis (Gardnerella, Haemophilus, Ureaplasma). CONCLUSION: The male urethra contain a very diverse composition of bacteria, even in healthy controls. NGU may be caused by a number of different bacteria but more studies including a higher number of samples are needed for elucidation of the role of each species.

Risk factors for human papillomavirus detection in urine samples of heterosexual men visiting urological clinics in Japan.

OBJECTIVE: The present study aimed to investigate human papillomavirus (HPV) prevalence and identify risk factors for HPV detection in urine samples among heterosexual men attending urological clinics. MATERIALS AND METHODS: Spot urine samples including initial stream were collected from 845 participants, and the cell pellets were preserved into liquid-based cytological solution. After DNA extraction from each sample, HPV-DNA amplification and genotyping were performed using Luminex multiplex polymerase chain reaction. Participants completed a questionnaire on their age, education, smoking status, sexuality, age of sexual debut, marital status, and present history of sexually transmitted infections. RESULTS: Data from 803 patients were included in the analysis. Overall HPV and high-risk (HR)HPV prevalence in urine samples were 6.2% and 3.1%, respectively. HPV and HR-HPV prevalences were the highest in men with urethritis, and were significantly higher than those without urethritis. HPV detection was the most common in men aged 40-49 years, although significant detection differences were not age-related. Urethritis was an independent risk factor for HPV detection from urine samples, with an odds ratio (OR) of 4.548 (95%CI; 1.802-11.476) (p = 0.001). On the other hand, a sub-analysis excluding men with urethritis demonstrated that prostate cancer was a significant risk factor for HPV detection, with OR of 2.844 (95%CI; 1.046-7.732) (p = 0.0410), whereas was not a significant risk for HR-HPV detection in urine samples. CONCLUSION: Prostate cancer may represent a risk factor for HPV detection in the urine of men without urethritis. REGISTRATION OF CLINICAL TRIALS: The authors did not register to Clinical Trial because this is observational and cross-sectional study.

Sensitivity of 20-minute voiding intervals in men testing for Chlamydia trachomatis.

BACKGROUND: Men are recommended to not urinate for at least 1 hour before urine testing for Chlamydia trachomatis, but some studies have shown that recent urination does not impact test sensitivity for nucleic acid amplification tests. The objective of this study was to estimate the sensitivity of chlamydia testing using samples obtained 20-minutes post void. METHODS: We recruited men returning to Sydney Sexual Health Centre for treatment of urethral Chlamydia trachomatis infection between July 2009 and February 2011. A short questionnaire was used to elicit symptoms, and 2 first-void urine samples were collected-the first after the standard 1 hour minimum and the second 20 minutes later. Men with clinical or microbiologic evidence of urethritis, men receiving antibiotic treatment, and those who had urinated within the last hour were excluded. Samples were tested using Roche COBAS Amplicor PCR. The proportion of samples testing positive at 20 minutes post void was determined using the 1-hour post void sample as a gold standard. RESULTS: Thirty-one men with confirmed chlamydia infection were included in the analysis. Of these, 29 of 31 (93.5%) were positive at 20 minutes (95% CI: 78.6%-99.2%). CONCLUSIONS: The sensitivity of 20-minute voiding intervals in asymptomatic men remains reasonably high relative to standard voiding intervals. Removing the barrier of a 1-hour voiding interval should be considered during opportunistic screening.

[Prevalence and determining factors of acquiring C. trachomatis infection among adolescents and young adults in Catalonia]. / Prevalencia de la infección por C. trachomatis y N. gonhorroeae y determinantes para su adquisición en jóvenes y adultos-jóvenes en Cataluña.

OBJECTIVE: To determine the prevalence of Chlamydia trachomatis (C. trachomatis) and Neisseria gonorrhoeae (N. gonhorroeae) infections and the risk factors for acquiring them in individuals under 35 years-old attending sexual health clinics in Barcelona province in 2006. METHODS: Cross-sectional study of a convenience sample of 500 adolescents and young adults aged between 16 and 35 years. A total of 423 samples were analysed using real-time PCR. A standardised questionnaire was used to collect clinical, epidemiological, and behavioural data on the participants. Significant differences were analysed in the descriptive study using Pearson's ((2). The association between C. trachomatis infection and its determining factors was analysed using the Mantel-Haenszel test and a multivariate logistic regression model. RESULTS: The overall prevalence of C. trachomatis was 4%, and was significantly higher in those under 25 years of age. The overall prevalence of N. gonhorroeae was 0.2%. The independent risk factors for infection by C. trachomatis were as follows: foreign origin (OR: 3.74; CI 95%: 1.10-12.72), having had a sexual partner in the last 3 months (OR 3.91; CI 95%: 1.30-11.81), and tobacco use the last 12 months (OR: 4.99; CI 95%: 1.34-18.59). CONCLUSIONS: This is the first study performed in Catalonia that shows high prevalence of C. trachomatis in young people, thus confirming trends in the rest of Europe. Systematic monitoring of C. trachomatis infection in sentinel populations will provide valid information allowing us to assess the relevance of proposing targeted screening programs in our setting.

Impact of urine collection order on the ability of assays to identify Chlamydia trachomatis infections in men.

BACKGROUND: Noninvasive urine samples have been used to diagnose Chlamydia trachomatis infections, with the assumption that the first-void urine (FVU), defined as the first 20 to 30 ml at any micturition, would be the optimal collection. We compared testing technologies on first, second, and third volumes for diagnosis. GOAL: The goal was to test in nonculture assays three sequential volumes of urine from men also undergoing urethral swabbing for C trachomatis culture specimens. STUDY DESIGN: A total of 237 men attending an STD clinic (C trachomatis prevalence, 11%) collected three containers of urine (each containing 20-30 mL) for testing in four nonculture assays. A urethral swab specimen was tested in cell culture. RESULTS: The numbers of men positive by testing of FVU with nucleic acid amplification (LCx chlamydia), nucleic acid hybridization (PACE 2), enzyme immunoassay (Chlamydiazyme), and a leukocyte esterase dipstick were 26, 7, 14, and 11, respectively; urethral culture identified 6 of the infected men. Comparative testing of all voids from the 26 men positive by the FVU assays demonstrated a reduction of LCx-positives. Non-amplified-test positivity declined precipitously in subsequent voids, approaching zero in the third void. The presence of symptoms and time of last void up to 8 hours had little effect on the number of positives detected by LCx of FVU. CONCLUSION: Amplified testing of FVU was most effective for diagnosing infection in these men.

Use of ligase chain reaction and polymerase chain reaction on urine specimens to detect Chlamydia trachomatis infections in a sexually transmitted diseases clinic in Singapore.

This study was done to assess the specificity and sensitivity of the DNA amplification assays of ligase chain reaction (LCR) and polymerase chain reaction (PCR) on urine specimens to detect Chlamydia trachomatis infections in both male and female patients seen at a sexually transmitted diseases (STD) clinic in Singapore, compared with other diagnostic methods currently in use. A total of 100 patients were selected; 50 male patients diagnosed with non-gonococcal urethritis based on symptoms and a positive Gram-stained urethral smear and 50 female asymptomatic sex workers were assessed. Automated assays using LCR and PCR were used, and compared to enzyme immunoassays, chlamydial cell cultures and PCR of urethral and endocervical swab specimens. In male patients, LCR and PCR of urine specimens had sensitivities of 100%, compared to 87.0% for PCR of urethral swab specimen, 82.6% for enzyme immunoassay (EIA) and 91.3% for cell cultures. In female patients, LCR and PCR of urine samples achieved sensitivities of 77.8% and 88.9% respectively, compared with 55.6% for PCR of endocervical swab specimens, 22.2% for EIA and 66.7% for cell cultures. LCR and PCR of urine samples provided higher sensitivity compared to cell cultures, EIA and PCR of urethral and endocervical swab specimens. The use of LCR and PCR on urine as a non-invasive means of detecting chlamydial infections is viable, and may have a role to play in population-based screening programmes.

Detection of Chlamydia trachomatis antigens in male urethral swabs and urines with a microparticle enzyme immunoassay.

BACKGROUND AND OBJECTIVES: More information is needed on the natural history of Chlamydia trachomatis urethral infections in men. Newer assays for detecting antigens in male first void urine and urethral swabs identify patients for control programs. A new microparticle enzyme immunoassay from Abbott Laboratories called IMX Select Chlamydia was evaluated and compared with culture and an expanded gold standard for sensitivity and specificity. STUDY DESIGN: Paired samples of first void urine and two urethral swabs were tested from 230 men, 73% of whom had symptoms of urethritis. Both specimen types were tested with IMX Select, the other swab was cultured, and a part of the first void urine was tested by Chlamydiazyme enzyme immunoassay. Performance calculations were made against urethral culture and an expanded gold standard that included direct fluorescent staining of discordant specimens by Microtrak. RESULTS: Compared with urethral swab culture, the IMX Select test performed on urethral swabs and first void urine had sensitivities of 93.8% and 81.3%, and specificities of 95.2% and 95.7%, respectively. Calculations of sensitivity and specificity based on the expanded gold standard were: IMX Select on urethral swabs, 88.5% and 99.4%; IMX Select on first void urine, 80.8% and 100%; Chlamydiazyme after blocking confirmation on first void urine, 73.1% and 100%; culture on urethral swabs, 61.5% and 100%. CONCLUSION: This IMX Select Chlamydia enzyme immunoassay, which generates laboratory results within 2 hours, performed better than culture and an established enzyme immunoassay on male urethral swabs. The experimental first void urine protocol showed promise for noninvasive male testing.

Diagnosis of male Chlamydia trachomatis urethritis by polymerase chain reaction.

BACKGROUND AND OBJECTIVES: A quick and highly sensitive diagnostic test would be valuable in the diagnosis of Chlamydia trachomatis. GOAL OF THIS STUDY: We compared a new polymerase chain reaction (PCR) technique to Chlamydiazyme (Abbott, North Chicago, IL) in the detection of male chlamydial urethritis, and evaluated the performance of PCR on urine samples. STUDY DESIGN: Urethral samples for analysis by PCR and Chlamydiazyme were obtained from 474 unselected patients attending a sexually transmitted diseases (STD) clinic. Urine samples were analyzed by PCR from 362 of these patients. RESULTS: Twenty seven (5.7%) urethral samples were positive by Chlamydiazyme, while 64 (13.5%) were positive by PCR. After resolution of discrepant results, the sensitivity of PCR on urethral swabs was 98.4% and the specificity was 99.0%, with positive and negative predictive values of 93.8% and 99.8%, respectively. These same measures for Chlamydiazyme were 43.5%, 100%, 100%, and 92.2%, respectively. The sensitivity of PCR on urine samples was 87.1%, the specificity was 98.0%, and the positive and negative predictive values were 90.0% and 97.4%, respectively. CONCLUSIONS: This PCR test is more sensitive than Chlamydiazyme in detecting male urethral chlamydial infections in an STD clinic population, and appears to be equally efficacious on urethral swabs and urine samples.

Factors affecting urine EIA sensitivity in the detection of Chlamydia trachomatis in men.

OBJECTIVE: This study examined the effects of four variables on the detection of Chlamydia trachomatis in urine from men by enzyme immunoassay (EIA). These variables were: symptoms and signs of urethritis, urine polymorphonuclear leucocytes (PMN), inclusion counts from urethral chlamydia cell cultures and the time between testing and last voiding. METHODS: Included were patients with and without symptoms and/or signs of urethritis attending the Edmonton Sexually Transmitted Disease Clinic. Men were asked to submit a 20 ml volume urine sample. Urethral swabs were collected for gram stain, chlamydia and gonorrhea culture. RESULTS: A total of 318 men were evaluated of whom 47 had chlamydia. Excluding six men who were coinfected with gonorrhoea, sensitivities and specificities of the Microtrak, Chlamydiazyme and IDEIA systems were 78.1% and 99.6%, 75.6% and 100%, and 80.5% and 97.8% respectively. Last void time did not affect the sensitivity. However, sensitivity was best when applied to men with severe evidence of urethritis. CONCLUSION: There is evidence that urine EIA could be used to detect chlamydia in men with acute urethritis but not in those without signs of urethritis.

Non-invasive sampling for detection of genital infection with Chlamydia trachomatis in males utilising urinary leukocyte esterase tests and immunoassays.

First-void urine specimens from 224 male recruits and 443 patients of venereal disease clinics without complaints of symptoms of urethritis were collected. Urinary leukocyte esterase test, two enzyme immunoassays (EIAs: Syva MicroTrak and Orion), a chemiluminometric assay (Magic Lite) and Syva's MicroTrak direct immunofluorescence test were used. The prevalence of chlamydial urethritis in the study population as determined by direct immunofluorescence test of first-void urine in the military recruits and venereal disease patients was 1.3% and 6.3%, respectively. The denominator used for calculation of sensitivities was the sum of patients with positive test results in at least two of the different test systems used. The sensitivities of first-void urine were 100% for Syva EIA, 96.7% for Orion EIA and 86.7% for the chemiluminometric assay. All assays proved highly specific (99.5-99.7%). Compared with direct immunofluorescence test of first-void urine, the urine leukocyte esterase test had a sensitivity of 93.6% and a specificity of 94.3%. The study showed that the urine leukocyte esterase test is an effective method to detect males infected by Chlamydia trachomatis.

The value of urine specimens in screening for male urethritis and its microbial aetiologies in Tanzania.

OBJECTIVE: To evaluate the first void urine (FVU) specimen in screening for urethritis and its microbial aetiologies in a male African population in which urinary schistosomiasis is also prevalent. PATIENTS AND METHODS: Two hundred and forty eight males aged 15-54 years provided FVU specimens: 55 patients from a clinic for sexually transmitted diseases (STD), 151 patients from a medical outpatient clinic and 42 villagers from an area of high endemicity for S haematobium. Specimens were tested for leucocyte esterase (LE) using a dipstick (Nephur-Test+Leuco, Boehringer-Mannheim France SA). Ova of S haematobium were sought in terminal urine samples from all subjects. For all STD patients, and all medical outpatients with a positive LE test, urine and urethral swabs were tested for Chlamydia trachomatis antigen, and urethral swabs were tested for Neisseria gonorrhoeae by gram stain and isolation. RESULTS: The prevalence of LE positivity was 38/41 in STD patients with urethral signs or symptoms (93%), 5/14 among other STD patients (36%), 21/151 among medical outpatients (15%) and 13/42 among villagers (31%). As a screening test for urethral infection (detection of gonorrhoea or chlamydia and/or > or = 5 polymorphs per high power field on gram stain) the LE test had a sensitivity of 94% and a specificity of 53% among STD patients. Of 24 STD patients with gonococcal or chlamydial infection, 23 had a positive LE test (96%). Among general medical outpatients, 12 of 22 with a positive LE test had either conventionally defined urethritis or gonococcal or chlamydial infection, giving a positive predictive value of 55% for the LE test in this group. Of 18 subjects in all groups with urinary schistosomiasis nine had a positive LE test (50%), although three of these also had gonorrhoea. Chlamydial antigen was detected in the FVU specimen of all six subjects in whom it was detected in a urethral swab, and in an additional three subjects in the outpatient group. CONCLUSIONS: The FVU, which is an easily collected and non-invasive specimen, can provide valuable information on the prevalence of urethritis and on its microbial aetiology among the general male population in African countries.

Urinary type IV collagenase: elevated levels are associated with bladder transitional cell carcinoma.

Accumulating experimental evidence has linked the overproduction of extracellular matrix-degrading metalloproteinases with tumor cell invasion. In the present study one member of the metalloproteinase family, type IV collagenase (M(r) 72,000 gelatinase), is shown to be elevated in the urine of patients with transitional cell carcinoma of the bladder. The form of the enzyme in the urine was studied by three independent methods: enzyme-linked immunosorbent assay, Western immunoblotting; and gelatin zymography. Immunoblotting revealed that the enzyme was present as a series of fragments, each retaining the amino terminus of the mature proenzyme. A prominent M(r) 43,000 fragment was associated with the transitional cell carcinoma cases. Zymography demonstrated that multiple enzyme species with gelatinase activity were present in urine and that high-molecular-weight bands of substrate lysis corresponded to complexes between type IV collagenase and tissue inhibitor of metalloproteinases 2. The total amount of type IV collagenase antigen was significantly elevated in the urine of 37 transitional cell carcinoma patients (range, 0-1081 ng/ml; mean, 318.4 +/- 147.3) compared to 19 normal controls (P < or = 0.004) and 17 inflammatory disease controls (P < or = 0.011). Immunohistochemical staining of bladder tumor biopsies verified that the transitional cell carcinoma cells were producing the M(r) 72,000 enzyme. Thus, M(r) 72,000 type IV collagenase, which is present in the urine in many forms including fragments and complexes with inhibitors, may be a useful marker for bladder cancer diagnosis or prognosis.

Detection of Chlamydia trachomatis antigens in first-void urine to identify asymptomatic male carriers.

Early morning first-void urine collected from 279 sexually active Swedish male recruits (mean age 19.5 years) was tested by two commercial enzyme immunoassay (EIA) kits, MicroTrak and IDEIA III, and by MicroTrak direct fluorescence assay (DFA), to detect Chlamydia trachomatis antigens. A result was assumed to be true-positive when any of the two non-culture tests were positive for the same specimen. In one case where only DFA was positive, confirmatory chlamydial testing was performed by isolating the organism from a urethral swab. On these premises, the number of true-positive men was 26 (9.3% of all men studied). The sensitivity, specificity, positive predictive value and negative predictive value for MicroTrak EIA were 85%, 98%, 85%, and 98%, respectively. IDEIA III was less sensitive than MicroTrak EIA (42% vs 85%). In conclusion, the diagnosis of asymptomatic chlamydial infections in men can be established with reasonable accuracy by the detection of Chlamydia antigens in urine samples using MicroTrak EIA.

Use of a urine enzyme immunoassay as a diagnostic tool for Chlamydia trachomatis urethritis in men.

We collected first-voided urine specimens from 659 males attending a sexually transmitted disease clinic and performed both enzyme immunoassay (EIA) for detection of chlamydial antigen and leukocyte esterase testing on these urine samples. The overall prevalence of chlamydial urethritis in the study population as determined by culture of urethral swabs was 11%. However, 46% of all men in the study had no symptoms of urethritis. Compared with urethral cultures for chlamydiae, the urine EIA had a sensitivity of 42% and a specificity of 99%. The sensitivity of the EIA strongly correlated with the amount of antigen present in culture as assessed by numbers of inclusion-forming units. The sensitivity of the leukocyte esterase test compared with that of chlamydia culture was 88%. We conclude that in this population of men, which included many patients without symptoms of urethritis, the urine EIA was a relatively insensitive means of screening for chlamydial infection.

Factors associated with leukocyturia in asymptomatic pilots.

We attempted to relate the prevalence of leukocyturia during annual examinations to recent activities and history data in 923 pilots. Urinary analysis was done and the results cross-tabulated with answers from a questionnaire and with a past history of leukocyturia obtained from the pilot's chart. The prevalence of 4 to 6 or more white blood cells (WBCs) in the urinary sediment was 5.3%. Leukocyturia was 35.7 times more common (odds ratio) in those with a previous history of leukocyturia and a concomitant history of urethritis (p less than 0.0001). Yet, a history of leukocyturia accounted for only 18.1% of the cases of leukocyturia. There was a trend for an association between jogging and leukocyturia. The prevalence of leukocyturia was not affected by smoking, other physical exercise, a history of nephrolithiasis, air duty in the preceding 24 h or a history of transient illness during the last 2 weeks. We conclude that there is an association between a history of both leukocyturia and urethritis and leukocyturia. In most cases, however none of the variables tested were found to be associated with leukocyturia.

Simplification of procedures used to test urine samples for Chlamydia trachomatis.

Two methods of simplifying the procedure for examining urine samples for Chlamydia trachomatis were investigated. When 73 urine samples from 56 men with acute non-gonococcal urethritis were examined by direct immunofluorescence (MicroTrak), centrifuging 1 ml volumes of urine at 13,000 rpm for five minutes was at least as efficient for detecting C trachomatis as centrifuging larger volumes at 3000 rpm for 30 minutes. Furthermore, examination of urine produced during a visit to a sexually transmitted disease clinic was at least as efficient as examination of early morning urine for detecting C trachomatis by MicroTrak, or by an enzyme immunoassay (IDEIA). Both modifications have practical advantages and should encourage the use of urine samples for diagnosing chlamydial infections in men.

Chlamydia trachomatis antigen can be detected in the urine sample of men with non-gonococcal urethritis.

We tested the first portion of voided urine (FVU) and urethral swab from 80 patients with non-gonococcal urethritis (NGU) using a novel enzyme-amplified immunoassay (IDEIA) for the detection of Chlamydia trachomatis antigen. Urine specimens were positive in all patients with positive urethral swabs (positive coincidence ratio, 100%) and in 6 of 54 patients with negative swabs (negative coincidence ratio, 88.9%). Our data suggest that FVU is suitable for the detection of Chlamydia trachomatis antigen using the IDEIA test in patients with NGU.

Diagnosing Chlamydia trachomatis urethritis by first-catch urine enzyme immunoassay in adolescent males.

This study evaluates a first-catch urine sediment enzyme immunoassay (EIA) to diagnose Chlamydia trachomatis urethritis in symptomatic adolescent males. Seven of 23 patients evaluated were diagnosed with sexually transmitted urethritis, five caused by C. trachomatis. First-catch urine sediment was accurate in diagnosing C. trachomatis urethritis when compared to urethral swab EIA (p less than 0.003). First-catch urine pyuria was also highly correlated with urethritis (p less than 0.05). First-catch urine testing is a simple, nonpainful method of screening adolescent males for urethritis, and first-catch urine sediment EIA for C. trachomatis is a rapid, painless method of diagnosis. A method for screening and diagnosis with these techniques is described.

Pharmacokinetics of cinoxacin in elderly patients following repeated oral administration.

Cinoxacin is an antibacterial drug belonging to the quinolone class used in the treatment of urinary tract infections due to common gram-negative pathogens. Considering the high frequency of urinary tract infections in elderly people where aging represents a physiopathological condition frequently requiring an adjustment of the dosage regimen, the pharmacokinetic behaviour of cinoxacin (500 mg/12 h) in aged patients was investigated to find out if age-dependent differences may be established. The main differences detected were a shift to 4 h of the Tmax and a partly reduced clearance in comparison with data referred to younger people. On the other hand the findings showed that no accumulation occurred. High urinary concentrations of cinoxacin, exceeding the MICs for most urinary tract pathogens were found up to the 12th hour after administration.