Antimicrobial Selection in the Treatment of Pyelonephritis

Ciprofloxacin for the management of urinary tract infection

Urinary tract infections are common, especially among women. A number of agents are available for the treatment of urinary tract infections but emerging resistance to commonly used first-line therapies has impacted the selection of empirical therapy. Ciprofloxacin was the first member of the fluoroquinolone class of antibiotics to be widely available and is effective for the management of urinary tract infections. An extended-release formulation has recently become available that allows once-daily dosing, which may improve patient adherence and convenience. Clinical trials have demonstrated that the extended-release formulation is as effective as the standard formulation in the management of acute uncomplicated cystitis, complicated urinary tract infections and acute uncomplicated pyelonephritis. The pharmacokinetics of the extended-release formulation may offer potential advantages in terms of microbial eradication and clinical response; however, this has yet to be demonstrated in clinical trials. In the USA and western Europe, overall rates of quinolone resistance among common uropathogens have remained low; however, reports of increasing resistance from certain geographical areas are of great concern. Risk factors for resistance are currently poorly defined.