Efficacy of a 14-day course of oral ciprofloxacin therapy for acute uncomplicated pyelonephritis.

This study aimed to evaluate the efficacy and safety of oral antibacterial treatment with fluoroquinilone for acute uncomplicated pyelonephritis Thirteen female patients with acute uncomplicated pyelonephritis were treated with oral fluoroquinilone (ciprofloxacin; CPFX). They received 200 mg of the drug three times a day while febrile (3-5 days). Once they become afebrile, the same dose of the drug, given twice a day, was given for another 9-11 days. The mean duration of the course of CPFX was 14 days. Symptoms were evaluated, and laboratory examinations, including urine culture and measurement of the minimal inhibitory concentration (MIC) of CPFX were conducted before treatment, and 3, 7, 14, 21, and/or 28 days after the initiation of the treatment. Of the 13 patients, only 5 needed to be hospitalized, and the period of hospitalization was only a few days. On the 14th day after the commencement of treatment, bacteriologic and clinical cure rates were 100%. Escherichia coli was the most common uropathogen, being isolated from the urine of 8 patients. No clinical relapse of the disease was found during a follow-up period of up to 4 weeks. The patients tolerated the drug well without developing any serious adverse effects. Oral antimicrobial chemotherapy with fluoroquinolone, given on an outpatient or short-term hospitalization basis, achieved satisfactory bacteriological and clinical outcomes in the treatment of acute uncomplicated pyelonephritis. This treatment regimen is indicated for patients with this disease who are not in a serious condition with complications such as shock.

Biofilm in complicated urinary tract infection.

We studied the clinical efficacy of oral treatment with ciprofloxacin (CPFX) alone and combined with clarithromycin (CAM) in patients with complicated urinary tract infection with or without an indwelling catheter. Patients were randomly allocated to 600 mg CPFX (CPFX group) or to 600 mg CPFX plus 600 mg CAM (combination group) for 14 days. Evaluation was done on day 14 according to the criteria advocated by the Japanese Urinary Tract Infection Committee. In patients with a urinary catheter, the combination achieved a higher complete bacterial elimination rate (50.0%) and clinical efficacy rate (83.9%) than CPFX alone (30.0 and 61.5%, respectively). While no significant difference was found in the bacterial elimination rate between the two groups, the clinical efficacy of the combination (40.0%) was superior to that of CPFX alone (23.3%) in patients with an indwelling catheter. The better clinical efficacy of the combination may partly be attributed to the antibiofilm effect of CAM in the clinical setting. The results also indicate that difficulties still remain in the treatment of complicated urinary tract infections in patients with an indwelling catheter.