Clinical Briefs

By Louis Kuritzky, MD

Ciprofloxacin and Trimethoprim-Sulfamethoxazole for Acute Uncomplicated Pyelonephritis in Women

Randomized trials were able to establish that the traditional 10- to 14-day therapy used for lower urinary tract infection (i.e., uncomplicated cystitis in women) may be safely accomplished with as little as three days of appropriate therapy. Pyelonephritis is responsible for a substantial number of hospitalizations, with the traditional regimen being 14 days, with no randomized trials confirming efficacy of shorter regimens. Increasingly complex patterns of antimicrobial resistance, hospital use patterns, and cost efficacy monitoring support a trial to compare therapies for acute uncomplicated pyelonephritis (APN).

Subjects with APN (n = 378) were randomly assigned to treatment with either one week of ciprofloxacin 500 mg b.i.d. or two weeks trimethoprim-sulfamethoxazole 160/800 mg b.i.d.

The clinical cure rate for ciprofloxacin was statistically superior to that of trimethoprim-sulfamethoxazole (96% vs 83%). Adverse drug effects occurred to a similar degree among both groups, though there was a trend to more adverse effects among trimethoprim-sulfamethoxazole recipients. This study demonstrates the superiority of seven days of ciprofloxacin for APN, but results must be viewed as only applicable to women, since no men were included in the trial, and the pathology of APN in men may reflect both different pathogens and different etiologic factors resulting in APN.

Talan DA, et al. JAMA 2000;283: 1583-1590.