Rezidivierende Harnwegsinfektionen der Frau

Urinary tract infections (UTI) are among the most frequent bacterial infections in women. Mostly young women and, to some extent, postmenopausal women are affected by recurrent UTI (rUTI), defined as >or=3 UTI/year. Modifiable predisposing factors are rare. The differential diagnosis between relapse and reinfection is decisive for therapy. Antibiotic prophylaxis has emerged as one of the most important therapeutic principles in rUTI. Depending on the drug utilized, the various modes of action are described as reducing the number of uropathogens in the gut and vaginal flora and/or in repeatedly eliminating bacteria from the urine. According to the European Association of Urology guidelines, nitrofurantoin, trimethoprim, and cotrimoxazole are available as first-line drugs. Cephalexin and the quinolones should be restricted to specific indications. Depending on the case, long-term antibiotic prophylaxis for 6 months, postcoital single dose prophylaxis, or patient-initiated self-start therapy can all be used successfully. Given the correct indications, the recurrence rate of rUTI can be reduced by 95%.

[Therapy of the acute uncomplicated urinary tract infection]

Acute uncomplicated cystitis and acute uncomplicated pyelonephritis are two frequently encountered urinary tract infections (UTI) in premenopausal, healthy females. Recent epidemiological investigations showed that the incidence of these infections is higher than expected. Surveys on healthcare practices in North America revealed a high variability in the therapy of uncomplicated UTI. Standardized criteria for diagnosis and therapy of uncomplicated UTIs therefore are important in order to achieve sufficient sensitivity and specificity in clinical practice. The Infectious Diseases Society of America (IDSA) developed evidence-based guidelines for the treatment of acute uncomplicated cystitis and acute uncomplicated pyelonephritis, which were recently updated by other expert groups.

[Incidence and significance of pathogen detection in Douglas fluid in non-inflammatory genital diseases]

Between 1976 and 1986 the secretions from the pouch of Douglas of 1,219 patients with non-inflammatory genital diseases were microbiologically studied. Microorganisms were detected in 3.4%. In the majority of cases they were physiological skin organisms, with a count of less than 10 per ml of Douglas fluid. These findings support the view, that secondary contamination of the specimens occurred during removal, transportation, or laboratory processing.

Penicillanic acid derivatives in the canine prostate

Distribution of ampicillin, amoxicillin, bacampicillin, mecillinam, pivmecillinam, carbenicillin, indanyl sodium was studied in the canine prostate, prostatic interstitial fluid, and prostatic secretion. All seven antibiotics were found in higher concentrations in the prostatic interstitial fluid than in the prostatic secretion. As expected for weak acids, drug concentrations in these fluids were always lower than the simultaneous serum concentrations. Tissue penetration was enhanced for the penicillin ester, pivmecillinam, as shown by its prostatic secretion/serum and tissue/serum ratios, which were higher than those of the other antibiotics, including the esters, bacampicillin, and carbenicillin indanyl sodium. This results may be due to pivmecillinam's long hydrolysis half-life. The concentrations for these penicillanic acid derivatives in prostatic interstitial fluid were above the minimal inhibitory concentrations for most of the commonly encountered gram-negative bacteria encountered in prostatitis. Therefore, these antibiotics should be effective in the treatment of bacterial prostatitis caused by susceptible organisms. Carbenicillin and carbenicillin indanyl sodium had the highest prostatic interstitial fluid/serum ratios of the compounds tested, and theoretically, therefore, they should be the most effective in the treatment of prostatitis. However, clinical trials should be carried out to confirm this.

Rosoxacin and cinoxacin distribution in prostate, vagina, and female urethra. An experimental study in dogs

Rosoxacin and cinoxacin, two new compounds structurally related to nalidixic acid, were investigated in dogs. Our primary interest was in the beneficial effects of the two drugs when used in the treatment of urinary tract infections. The distribution of rosoxacin and cinoxacin was investigated in prostatic tissue, prostatic interstitial fluid, and prostatic secretion, and in vaginal and female urethral secretions. Concentrations of both antibiotics were also measured in plasma, various tissues, and spinal fluid. The amounts of rosoxacin and cinoxacin in all tested tissues, fluids, and secretions were in the range of the minimal inhibitory concentrations for most Gram negative organisms found in urinary tract infections. This suggested possible beneficial effects of these drugs when the infection involves the above tissues. Rosoxacin concentration ratios were higher than those of cinoxacin relative to plasma concentration in prostatic, vaginal, and urethral secretions, as well as in prostatic and other tissue. These ratio differences were explained by the different physiochemical properties of the two drugs.

Antibiotics excretion in canine vaginal and urethral secretions

Trimethroprim, erythromycin, ampicillin, and rosamicin, a new macrolide antibiotic, were administered to dogs by constant intravenous infusion. Their concentrations in plasma, urine, vaginal and urethral secretions, saliva, and tears were determined by bioassay. Trimethoprim, rosamicin, and, to a lower degree, erythromycin were concentrated in the secretions of the vagina and the urethra whereas the ampicillin concentrations in these secretions never exceeded the simultaneous plasma concentrations. Inasmuch as rosamicin and trimethoprim have antibacterial spectra well suited for the treatment of bacterial urethritis and vaginitis they should be investigated clinically in this respect.

Cefamandole and cefazolin in the therapy of complicated urinary tract infections

The clinical efficacy and tolerance of cefamandole, a new cephalosporin antibiotic effective against indole-positive strains of Proteus, and cefazolin were studied after intramuscular administration of 500 mg of either of the two cephalosporins every 8 hr for seven days in a prospective, randomized study of 65 elderly male patients with complicated urinary tarct infections. Both antibiotics were effective in eradicating the infections, and there was no significant difference between the two groups in regard to tolerance and cure rate, as defined by a negative urine culture one week and four to six weeks following discontinuation of the treatment. Because of its broader antibacterial spectrum, cefamandole appears to represent an improvement over previously available cephalosporin antibiotics.

Rosamicin--a new drug for the treatment of bacterial prostatitis

Rosamicin, a new macrolide substance, was investigated in dogs and humans with regard to its usefulness for the treatment of bacterial prostatitis and compared with the well-known macrolide erythromycin. In dogs with normal and experimentally infected prostates, concentration ratios for rosamicin in prostatic secretion, interstitial fluid (obtained from implanted tissue chambers), and tissue were significantly higher than for erythromycin. The difference was even more pronounced in human prostatic tissue, obtained by transurethral resection. With its broad spectrum against many common urinary pathogens, rosamicin seems to be a promising drug for the treatment of acute and chronic bacterial prostatitis.

[Bacterial prostatitis--therapeutic principles]

The authors examined the possibilities of the treatment of bacterial prostatitis and yielded the following result: A medicament suited for the treatment of prostatitis must fulfil such chemical criteria, as they are at present to be found only in alkaline marcolids (e.g. erythromycin) and trimethoprim. Since trimehtoprim has a good spectre of action against gram-negative germs, it seems to be the suited remedy, for these pathogens are frequent and dominating in the pathogenesis of prostatitis. Gram-positive bacteria should be accessible to a therapy with erythromycin.

Rosamicin in urethral and vaginal secretions and tissues in dogs and rats

In animal studies we investigated the distribution of rosamicin in plasma and urethral and vaginal tissues in rats as well as in urethral and vaginal secretions in dogs. We found concentration ratios between urethral secretion and plasma of 1.9 and between vaginal secretion and plasma of 2.4. The rosamicin concentrations in urethral and vaginal tissue significantly exceeded the levels of all other tissues investigated. Because rosamicin could be valuable for the treatment of bacterial urethritis and the colonization of the vaginal introitus with fecal bacteria in women, it should be investigated clinically in this respect.