trimethoprim--sulfamethoxazole-drug-combination and lomefloxacin

Urinary tract infections (UTIs) are very common in medical practice. Women have a high prevalence of UTIs, approximately 50 times higher than men. A large proportion of this prevalence is probably caused by anatomic and physical factors Chemical analysis of urine composition, examination of the urinary sediment and the bacterial colony counts are of great value for diagnosis and therapy. The patients may be benefit from antibiotic doses. In addition to trimethoprimsulfamethoxazole (TMP/SMZ), amoxicillin and cephalosporins, the authors observed a new drug: fluoroquinolones. These drugs derived by nalidixic acid and included: ciprofloxacin, enoxacin, lomefloxacin, norfloxacin, pefloxacin and rufloxacin. They are sinergistic against most Gram positives and negatives including Pseudomonas aeruginosa and Proteus mirabilis. Fluoroquinolone is an antibacterial agent that is effective in treating urinary tract infections. It is usually administered orally and is well absorbed after oral ingestion. Quinolones are preferable to TMP/SMZ because of their greater antibacterial activity that occurred in about 82% of women. A dose of quinolones (400 mg daily for 3 days) has been particularly effective in the treatment of UTIs. The amoxicillin-clavulanic acid can be used for treatment even if increased antibiotic resistance. The efficacy, relative safety and low cost of quinolones predispose to utilize its like the first treatment choice.

Topics: Anti-Infective Agents; Anti-Infective Agents, Urinary; Female; Fluoroquinolones; Humans; Male; Quinolones; Risk Factors; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The efficacy of lomefloxacin given at 400 mg once daily for 14 days compared with that of trimethoprim-sulfamethoxazole at 160 and 800 mg, respectively, given twice daily for 14 days in the treatment of symptomatic complicated urinary tract infections was studied in a prospective, randomized, single-blind multicenter study. A total of 133 subjects presenting with signs and symptoms of urinary tract infection and an underlying abnormality consistent with complicated urinary tract infection were enrolled in the study. Bacteriologic cure was significantly better in 68 subjects randomized to lomefloxacin than in 65 subjects randomized to trimethoprim-sulfamethoxazole at short-term follow-up (88 versus 52%; 95% confidence intervals [CIs] 77 and 94% and 39 and 65%, respectively) this difference was no longer significant at long-term follow-up (64 versus 47%; CIs, 52 and 75% and 32 and 57%, respectively). Clinical outcomes were similar for both therapeutic regimens at short- and long-term follow-ups. The organisms that infected the subjects pretherapy were more frequently resistant to trimethoprim-sulfamethoxazole, and drug therapy was discontinued more frequently in subjects treated with trimethoprim-sulfamethoxazole because of adverse antimicrobial effects. In secondary analyses, outcomes did not differ with age or underlying genitourinary abnormality.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Female; Fluoroquinolones; Humans; Male; Middle Aged; Prospective Studies; Quinolones; Single-Blind Method; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Lomefloxacin, a new difluorinated quinolone, and trimethoprim/sulfamethoxazole (TMP/SMX) were compared in the treatment of adults with uncomplicated urinary tract infections. The study was conducted as a multicenter, controlled, prospectively randomized, single-blind study in five countries (Argentina, Belgium, Brazil, Mexico, and Venezuela). A total of 254 patients were enrolled: 129 in the lomefloxacin group and 125 in the TMP/SMX group. Patients received either 400 mg lomefloxacin orally once daily or 160 mg/800 mg TMP/SMX orally twice daily for 7-10 days. Escherichia coli and Proteus mirabilis were the pathogens most frequently isolated. At 5-9 days post-therapy, satisfactory bacteriologic results were noted in 98.4% of patients treated with lomefloxacin and in 95.8% of patients in the TMP/SMX group (p = 0.2153). Clinical success 5-9 days post-therapy was noted in 99.2% of patients in the lomefloxacin group and in 98.3% of patients in the TMP/SMX group (p = 0.5138). Adverse events probably related to treatment occurred in 6% of those treated with lomefloxacin and in 7% of patients treated with TMP/SMX. Once-daily oral lomefloxacin is a well-tolerated and effective treatment of uncomplicated urinary tract infections caused by susceptible pathogens.

Topics: Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Female; Fluoroquinolones; Humans; Male; Middle Aged; Prospective Studies; Quinolones; Single-Blind Method; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A total of 63 adult patients with uncomplicated acute pyelonephritis were enrolled in a multicenter, randomized comparison of lomefloxacin (400 mg orally once daily for 14 days) and trimethoprim/sulfamethoxazole (TMP/SMX, 160/800 mg orally twice daily for 14 days). Study participants were predominantly female (70% in the lomefloxacin group and 80% in the TMP/SMX group). Escherichia coli was isolated from pretreatment urine cultures in 87.5% of the lomefloxacin group and 80.0% of the TMP/SMX group. Baseline pathogens were eradicated in 100% of evaluable patients in the lomefloxacin group 5-9 days after the end of therapy and in 88.9% of patients in the TMP/SMX group (p = 0.05). The clinical cure rate 5-9 days after therapy with lomefloxacin was 65.0% and for TMP/SMX was 68.4%. At the 4-6 week follow-up in the lomefloxacin group, nine pathogens remained eradicated, one E. coli was isolated, and the results for 14 pathogens were unknown or unevaluable. In the TMP/SMX group, 12 pathogens remained eradicated, three E. coli and one Group D Streptococcus were isolated, and the results for nine pathogens were unknown or unevaluable. Both treatment regimens were well tolerated; adverse events occurred in 12% of patients in the lomefloxacin group and in 17% in the TMP/SMX group. Events considered by the investigators to be probably related to treatment occurred in three patients in each group. In conclusion, once-daily lomefloxacin (400 mg) was a well tolerated and effective alternative to twice-daily TMP/SMX (160/800 mg) for the treatment of adults with uncomplicated acute pyelonephritis.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Escherichia coli Infections; Female; Fluoroquinolones; Humans; Male; Middle Aged; Pyelonephritis; Quinolones; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Data were collected from 14 French centres which participated in a randomized study to compare the safety and efficacy of 400 mg lomefloxacin taken orally once daily by 62 patients with 160/800 mg trimethoprim/sulphamethoxazole (TMP/SMX) taken orally twice daily by 64 patients with uncomplicated urinary tract infections. Most patients were infected with Escherichia coli at baseline (72.4% in the lomefloxacin group and 69.0% in the TMP/SMX group) and all patients were treated for 5 days. At 5-9 days post-treatment, lomefloxacin had eradicated the causative organism of infection in 100% of evaluable patients treated with lomefloxacin compared with 86.7% of those treated with TMP/SMX. At 4-6 weeks post-treatment, there were no marked differences in eradication rates between the two treatment groups: 83.3% and 80.0% for the lomefloxacin and TMP/SMX groups, respectively. Clinical cure rates showed no marked differences between treatment groups at 5-9 days or at 4-6 weeks post-treatment. At 5-9 days post-treatment, lomefloxacin achieved a clinical cure rate of 78.6% compared with 86.7% for TMP/SMX evaluable patients. At 4-6 weeks post-treatment, the clinical cure rates were 66.7% and 86.7% for the evaluable lomefloxacin- and TMP/SMX-treated patients, respectively. Both treatment regimens were well tolerated with a low incidence of adverse events. In conclusion, once-daily oral dosing with lomefloxacin is a safe and efficacious alternative to twice-daily dosing with TMP/SMX in the treatment of uncomplicated urinary tract infections.

Topics: Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Drug Administration Schedule; Enterobacteriaceae Infections; Escherichia coli Infections; Female; Fluoroquinolones; Humans; Male; Middle Aged; Prospective Studies; Quinolones; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The in vitro activities of enoxacin, lomefloxacin, norfloxacin, ofloxacin, and pefloxacin against 274 strains of Salmonella typhi isolated from suspected typhoid fever patients (137 multi-resistant strains and 137 strains sensitive to chloramphenicol, ampicillin and/or co-trimoxazole) were determined using disk diffusion and agar dilution techniques. In vitro, enoxacin was active against all tested strains with a MIC90 and inhibition zone size against multi-resistant strains of 0.12 mg/l and 34 mm diameter, respectively. Similar results were found with the other fluoroquinolones. Enoxacin and other fluoroquinolones may be the therapy of choice in cases of typhoid fever caused by organisms resistant to the standard therapy, chloramphenicol.

Topics: Ampicillin; Anti-Infective Agents; Chloramphenicol; Drug Resistance, Microbial; Enoxacin; Fluoroquinolones; Humans; Microbial Sensitivity Tests; Norfloxacin; Pefloxacin; Quinolones; Salmonella typhi; Species Specificity; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

The activity of lomefloxacin, a new difluorinated quinolone, was tested against 190 Enterobacteriaceae strains (belonging to 23 different species), 70 enterococci and 70 staphylococci. As regards Enterobacteriaceae, the activity of lomefloxacin was the same as that of norfloxacin in 9 out of the 23 species tested, and only slightly lower in further 8 species. Minimum inhibitory concentrations (MIC) values for 90% of strains were 0.5 microgram/ml in 2 species, 0.25 microgram/ml in 6, 0.125 microgram/ml in 4, and lower than 0.125 microgram/ml in 8. Slightly higher values were obtained for Serratia marcescens (2 micrograms/ml), whilst, as already reported for the other new quinolones, the susceptibility of the Providencia genus was very poor, with MIC values up to 128 micrograms/ml for the vast majority of strains. Lomefloxacin proved bactericidal at the MIC in all the Enterobacteriaceae strains tested but 20. In the latter strains, however, bactericidal activity could be appreciated at values slightly exceeding MIC. As regards enterococci, the MIC for 90% of strains was 32 micrograms/ml. Minimum bactericidal concentration (MBC) was the same as the MIC for 78% of the strains tested and was only twofold higher in all the others. The new drug was also active against staphylococci having an MIC50 and MIC90 of 0.5 and 2 micrograms/ml, respectively. It was bactericidal at the MIC for 62% of the strains and at twofold the MIC for all the others.

Topics: 4-Quinolones; Anti-Bacterial Agents; Anti-Infective Agents; Drug Combinations; Enterobacteriaceae; Fluoroquinolones; Lactams; Leucomycins; Microbial Sensitivity Tests; Miocamycin; Netilmicin; Quinolones; Staphylococcus; Streptococcus; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination