Fluoroquinolones in urinary tract infections. Proper and improper use

Treatment of chronic prostatitis: an etiologicaly based approach

The therapeutics of chronic prostatitis remain as enigmatic as the disease. In light of the recent guidelines from the National Institutes of Health, there may finally be satisfactory evaluation of efficacy.

Safety of fluoroquinolones: An update

The fluoroquinolone class of antimicrobials has been in clinical use for over 13 years. During that period, some representatives of the class have been extensively prescribed, such as ciprofloxacin and levofloxacin, while others have seen minimal use and have been restricted or withdrawn, namely, trovafloxacin and grepafloxacin. Manipulation of the fluoroquinolone structure by substituting a range of moieties around the core has yielded enhanced antibacterial activity, but in some cases this has come at a price. Specific substitutions are discussed in relation to particular recognized adverse events. In the present paper, newly introduced fluoroquinolones, such as moxifloxacin and gatifloxacin, are examined in terms of anticipated class effects and recent clinical experience. These antimicrobials are associated with reactions such as diarrhea, nausea, headache and other typical antimicrobial phenomena at rates less than 5%. New fluoroquinolone agents should be examined carefully in light of structural findings until adequate clinical data are amassed.

An evidence-based approach to the treatment of prostatitis: is it possible?

The classification of prostatitis has been re-evaluated, and the National Institutes of Health (NIH) has defined the separate groups more thoroughly. Furthermore, the development of the NIH chronic prostatitis symptom index (CPSI) has allowed the symptoms to be measured and the effect of interventions calculated. A search of the literature finds that the quality of treatment trials in prostatitis is poor and the level of evidence for many of the existing strategies is lacking; there is a total absence of any meta-analyses of randomized controlled trials (level 1a). The bulk of literature consists of small descriptive studies (level III) or opinions from respected authorities (level IV). The advent of the NIH-CPSI has provided the opportunity for well-designed trials to be performed where the symptom outcomes can be quantified. This opportunity will be of greatest value in type III prostatitis where symptom amelioration is the main target of therapy and a number of treatment options abound.

Ciprofloxacin once versus twice daily in the treatment of complicated urinary tract infections. German Ciprofloxacin UTI Study Group

Ciprofloxacin is considered to be the standard treatment for patients with complicated urinary tract infections (UTI). This multicentre, randomized clinical study was designed to compare a once-daily regimen with 500 mg to the usual twice-daily regimen with 250 mg orally for 7-20 days. A total of 215 patients with significant bacteriuria (> or = 10(5) c.f.u./ml for females and > or = 10(4) c.f.u./ml for males) were included in the study. Eradication of bacteriuria was shown in 84.0% of patients treated with 500 mg q.i.d. and in 90.9% of patients treated with 250 mg b.i.d. Clinical cure or improvement was achieved in 97.3% of those treated with 500 mg q.i.d. versus 95.5% of those treated with 250 mg b.i.d. More superinfections occurred in patients treated with 500 mg q.i.d., mostly caused by gram-positive cocci. The statistical analysis concerning the elimination of bacteriuria using the 95% confidence interval showed a difference of up to 18.4% between the two treatment groups in favour of the 250-mg b.i.d. regimen. Ciprofloxacin was well tolerated with only mild to moderate side-effects (mostly gastrointestinal) in 8% of the patients. When using ciprofloxacin in patients with complicated UTI, its administration in two divided doses can be further recommended as a standard regimen.