Journal article
Comparison of Ciprofloxacin (7 Days) and Trimethoprim-Sulfamethoxazole (14 Days) for Acute Uncomplicated Pyelonephritis in Women: A Randomized Trial
JAMA : the journal of the American Medical Association, Vol.283(12), pp.1583-1590
03/22/2000
DOI: 10.1001/jama.283.12.1583
PMID: 10735395
Abstract
CONTEXT The optimal antimicrobial regimen and treatment duration for acute uncomplicated
pyelonephritis are unknown. OBJECTIVE To compare the efficacy and safety of a 7-day ciprofloxacin regimen
and a 14-day trimethoprim-sulfamethoxazole regimen for the treatment of acute
pyelonephritis in women. DESIGN Randomized, double-blind comparative trial conducted from October 1994
through January 1997. SETTING Twenty-five outpatient centers in the United States. PATIENTS Of 378 enrolled premenopausal women aged at least 18 years with clinical
diagnosis of acute uncomplicated pyelonephritis, 255 were included in the
analysis. Other individuals were excluded for no baseline causative organism,
inadequate receipt of study drug, loss to follow-up, no appropriate cultures,
and other reasons. INTERVENTIONS Patients were randomized to oral ciprofloxacin, 500 mg twice per day
for 7 days (with or without an initial 400-mg intravenous dose) followed by
placebo for 7 days (n = 128 included in analysis) vs trimethoprim-sulfamethoxazole,
160/800 mg twice per day for 14 days (with or without intravenous ceftriaxone,
1 g) (n = 127 included in the analysis). MAIN OUTCOME MEASURE Continued bacteriologic and clinical cure, such that alternative antimicrobial
drugs were not required, among evaluable patients through the 4- to 11-day
posttherapy visit, compared by treatment group. RESULTS At 4 to 11 days posttherapy, bacteriologic cure rates were 99% (112
of 113) for the ciprofloxacin regimen and 89% (90 of 101) for the trimethoprim-sulfamethoxazole
regimen (95% confidence interval [CI] for difference, 0.04-0.16; P = .004). Clinical cure rates were 96% (109 of 113) for the ciprofloxacin
regimen and 83% (92 of 111) for the trimethoprim-sulfamethoxazole regimen
(95% CI, 0.06-0.22; P = .002). Escherichia coli, which caused more than 90% of infections, was more
frequently resistant to trimethoprim-sulfamethoxazole (18%) than to ciprofloxacin
(0%; P<.001). Among trimethoprim-sulfamethoxazole–treated
patients, drug resistance was associated with greater bacteriologic and clinical
failure rates (P<.001 for both). Drug-related
adverse events occurred in 24% of 191 ciprofloxacin-treated patients and in
33% of 187 trimethoprim-sulfamethoxazole–treated patients, respectively
(95% CI, −0.001 to 0.2). CONCLUSIONS In our study of outpatient treatment of acute uncomplicated pyelonephritis
in women, a 7-day ciprofloxacin regimen was associated with greater bacteriologic
and clinical cure rates than a 14-day trimethoprim-sulfamethoxazole regimen,
especially in patients infected with trimethoprim-sulfamethoxazole–resistant
strains.
Details
- Title: Subtitle
- Comparison of Ciprofloxacin (7 Days) and Trimethoprim-Sulfamethoxazole (14 Days) for Acute Uncomplicated Pyelonephritis in Women: A Randomized Trial
- Creators
- David A Talan - Olive View-UCLA Medical CenterWalter E Stamm - University of WashingtonThomas M Hooton - University of WashingtonGregory J Moran - University of California, Los AngelesThomas Burke - University of WashingtonAbdollah IravaniJonathan Reuning-Scherer - BayerDeborah A Church - Bayer
- Resource Type
- Journal article
- Publication Details
- JAMA : the journal of the American Medical Association, Vol.283(12), pp.1583-1590
- Publisher
- American Medical Association
- DOI
- 10.1001/jama.283.12.1583
- PMID
- 10735395
- ISSN
- 0098-7484
- eISSN
- 1538-3598
- Language
- English
- Date published
- 03/22/2000
- Academic Unit
- Emergency Medicine; Internal Medicine
- Record Identifier
- 9984297147902771
Metrics
8 Record Views