Clinical Uses Urinary Tract Infections

The fluoroquinolones are highly effective in uncomplicated urinary tract infection and are drugs of choice where bacterial resistance compromises routine P-lactam therapy (Chapter 6). Fluoroquinolone efficacy is augmented by their ability to eliminate carriage of uropathogenic E. coli in the intestine [45]. Excellent results follow standard short-course and single-dose regimens [46,47].

In complicated infections and in the elderly, these agents are as or more effective than P-lactams, amoxicillin-clavulanate, nitrofurantoin, and trimethoprim-sulfamethoxazole [46,47]. Ciprofloxacin is effective in many patients with chronic infections caused by P. aeruginosa, including pyelonephritis, and in patients with neurologically impaired bladders. For example, oral ciprofloxacin was as effective clinically, and more so in terms of bacterial eradication, as parenteral aminoglycoside therapy in catheterized patients with multiresistant organisms causing ascending infection [48]. However, resistance in common urinary pathogens is regrettably no longer a rarity and may compromise empirical quinolone monotherapy [28].

Bacterial prostatitis is a problem to both define and treat, poor results being obtained with tetracyclines, cephalosporins, and trimethoprim-sulfamethoxazole. Oral fluoroquinolone therapy for extended periods in chronic or pseudomonal infection with adequate follow-up has given cure rates of 50-90% depending on disease and pathogen [46,47]. Failures and relapse are most likely to occur with enterococci or P. aeruginosa infections, but coliform prostatitis responds in 80% or more of cases.

Ciprofloxacin, pefloxacin, and ofloxacin have also been found effective in continuous ambulatory peritoneal dialysis (CAPD) infections, but their usefulness has been curtailed by the emergence of resistance in or failure to eradicate staphylococci [16,49,50].

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