[Comparison of efficacy and tolerability among 3 quinolones in the treatment of lower urinary tract infections (cinoxacin versus ciprofloxacin and pefloxacin]

A clinical trial was carried out in 150 patients with lower urinary tract infections in order to compare the efficacy and tolerability of three quinolone drugs (cinoxacin, ciprofloxacin, pefloxacin). The satisfactory therapeutic efficacy of all three drugs is underlined, as is the excellent tolerability of cinoxacin.

[Therapy of urinary tract infections. Clinical experience comparing norfloxacin to other quinolones]

The paper examines to treatment of 40 cases of urinary infections and compares the efficacy of pipemidic acid, norfloxacin, cinoxacin and ofloxacin. All these compounds demonstrated a good level of therapeutic efficacy, both in terms of management and effectiveness; in particular, norfloxacin and ofloxacin were preferable to the other compounds since they caused fewer side-effects.

[Chronic prophylaxis of urinary tract infections in diabetic patients]

A mass screening of 600 diabetic revealed 240 (190 female and 50 male) with urinary infections. The comparative antibiotic efficacy (elimination) and tolerability of Cinoxacin and Norfloxacin were assessed in the treatment of these patients. The traditional protocol (2 daily doses for 10-20 days) was supplemented in every case by chronic prophylaxis (a single daily dose for 10 days each month for 6 months) that was designed to prevent recurrences and the development of chronic urinary infections. Cinoxacin was always found to be faster acting in antibacterial terms than Norfloxacin (at 10 days x2 = p less than 0.01; at 2 degrees, 4 degrees, and 6 degrees month x2 = p less than 0.05) providing a more complete and faster remission of the subjective symptoms, as well as being considerably better tolerated a both locally and systematically than Norfloxacin.

[Early antibiotic therapy following urodynamic examination. Results of a randomized, controlled study]

Forty-three young men from the Italian army underwent urodynamic tests following the diagnosis of enuresis. Of these, 37 were included in an assessment trial to define the rationale for early anti-bacterial therapy following the test. The subjects were subdivided into two groups: one group received 500 mg Cinoxacin b.i.d. for 5 days, and the other group was not treated. The comparison of results revealed a high incidence of irritative disorders in both groups (78.9% of treated subjects and 88.9% of untreated subjects) but the most significant complications were observed in the untreated group (feveret in 27.7% and one case of septic fever). Early anti-bacterial therapy following standard urodynamic tests therefore seems to be a ration tool in urological practice.

[Comparative evaluation of norfloxacin and cinoxacin in the therapy of complicated infections of the urinary tract]

A randomized clinical study was conducted in order to compare the effectiveness of norfloxacin and cinoxacin in complicated urinary tract infections. Norfloxacin proved effective in 80% of the 40 patients treated, cinoxacin in only 60%.

Prevention of recurrent urinary tract infections in premenopausal women by post-coital administration of cinoxacin

A total of 21 sexually active premenopausal women, prone to recurrent urinary tract infections but who otherwise were healthy, underwent post-coital prophylaxis consisting of bladder voiding and a single 250 mg. tablet of cinoxacin. While 94 urinary tract infections occurred during a mean of 7.5 months before treatment, only 8 occurred during a mean of 12.5 months after prophylaxis. This difference was statistically highly significant. A mean of 106 cinoxacin tablets per patient were administered during post-coital prophylaxis. Cinoxacin represents an additional valuable and effective antibacterial in post-coital prophylaxis of recurrent urinary tract infection in otherwise healthy premenopausal women, although it is slightly less effective than cotrimoxazole or nitrofurantoin. Effective post-coital prophylaxis requires the use of much smaller quantities of antibacterial agents than the daily use of a single tablet and in women with a high incidence of recurrent urinary tract infections it is superior to intermittent self-administered antibacterial therapy.

[Cinoxacin in infections of the lower urinary tract]

The results obtained in 15 patients with infections of the lower urinary tract given 500 mg cinoxacin in two daily doses for 10 days are reported. A positive response was obtained in 13 of the 15 cases. Cinoxacin is easily managed, produces no side effects and can be administered orally, all of which makes it a drug of first choice in the treatment of prophylaxis of lower urinary infections.

[Study of clinical efficacy and safety of long-term cinoxacin therapy of chronic urogenital organ infection]

Thirty-five patients with chronic simple and complicated urogenital organ infections were treated with 400 mg/day Cinoxacin for 60 to 284 days. The effects were judged according to improvements of subjective symptoms, bacteriuria and pyuria before and after the complete administration. Overall clinical efficacy in 35 cases with urogenital organ infections was estimated as excellent: 54%, good: 26%, poor: 17%, and effectiveness rate: 80%. The clinical effectiveness rate in 12 cases of chronic simple urinary tract infection was 100%, and in 14 cases of chronic complicated urinary tract infections was 64%, and in 6 cases of chronic prostatitis the rate of effectiveness was 83%. No recurrence was observed during the treatment. No side-effects or toxicity were seen. Accordingly long-term Cinoxacin therapy seems to be useful in preventing recurrence in chronic infections encountered in the department of urology.

Ciprofloxacin versus cinoxacin in therapy of urinary tract infections. A randomized, double-blind trial

In a prospective, randomized, double-blind trial, ciprofloxacin (250 mg orally, twice daily) was compared with cinoxacin (500 mg orally, twice daily) in 60 patients with urinary tract infections. Most patients were women with uncomplicated urinary tract infections. Escherichia coli was the most common isolate (36 patients). Clinical and microbiologic cure occurred in 20 of 24 (83 percent) evaluable patients treated with ciprofloxacin, compared with 15 of 21 (71 percent) evaluable patients treated with cinoxacin. Ciprofloxacin was well tolerated and had a low incidence of minor side effects that included Candida vaginitis, headache, and gastrointestinal intolerance. Relapse or failed therapy was not associated with the development of resistance.

Treatment of urinary infections: clinical perspectives

The present study was carried out with the aim of comparing the microbiological and clinical efficacy of norfloxacin, cinoxacin and aztreonam in urinary tract infections. Patients were tested who had infections of the higher and/or lower urinary tracts associated with complicating factors. The microorganism most frequently isolated in these individuals was Escherichia coli. The assays carried out with the aim of testing the in vitro antibacterial activity (agar diffusion method and minimum inhibitory concentration) on the microorganisms responsible for the infections, as well as the evaluation of clinical efficacy, showed that norfloxacin has a wider antibacterial spectrum of action and inhibitory activity greater than the other two drugs tested.

Pharmacokinetics of cinoxacin in elderly patients following repeated oral administration

Cinoxacin is an antibacterial drug belonging to the quinolone class used in the treatment of urinary tract infections due to common gram-negative pathogens. Considering the high frequency of urinary tract infections in elderly people where aging represents a physiopathological condition frequently requiring an adjustment of the dosage regimen, the pharmacokinetic behaviour of cinoxacin (500 mg/12 h) in aged patients was investigated to find out if age-dependent differences may be established. The main differences detected were a shift to 4 h of the Tmax and a partly reduced clearance in comparison with data referred to younger people. On the other hand the findings showed that no accumulation occurred. High urinary concentrations of cinoxacin, exceeding the MICs for most urinary tract pathogens were found up to the 12th hour after administration.

[Clinical study of cinoxacin in acute simple cystitis]

Cinoxacin (CINX) was administered twice a day for 7 consecutive days (400 mg X 2/day) to 34 female patients suffering from acute simple cystitis. The overall clinical efficacy was excellent in 15 cases (94%) and moderate in one case (6%) according to the criteria for clinical evaluation by the UTI committee. The efficacy was not determined in 18 cases. Bacteriological examination revealed 11 cases of single infection by E. coli, 2 cases of single infection by P. cepacia and S. epidermidis and one case of single infection by S. sunguis. MIC of E. coli ranged from 3.13 to 6.25 micrograms/ml. MIC of P. cepacia was 3.13 micrograms/ml and MIC of S. epidermidis more than 100 micrograms/ml. All the strains were eradicated with the efficacy of 100%. There was no relapse of acute simple cystitis in 16 cases after 7 days treatment of CINX. No serious side effects were recognized except for slight general fatigue and heart burn in 2 cases. It was thus concluded that CINX is clinically effective and safe for acute simple cystitis caused by E. coli and P. cepacia.

Successful use of reduced dosage of cinoxacin in the treatment of recurrent urinary infection

Ninety-seven patients with a history of recurrent bacteriuria were treated with cinoxacin in a dosage of either 250 mg (48 patients) or 500 mg (49 patients) 12-hourly for seven days. Both regimens had a success rate in excess of 85% one week after the end of treatment, and only 15% of the patients rendered abacteriuric had relapsed four weeks later. Both dosage regimens of cinoxacin were very well tolerated. Our results show that in patients with recurrent urinary infections the conventional dosage of cinoxacin (500 mg) can be reduced to 250 mg 12-hourly without any loss of efficacy. Consequently patients seen in family practice with uncomplicated lower tract urinary infection can confidently be expected to respond equally well to a dose of 250 mg 12-hourly with the obvious advantages of less toxicity, less chance of producing resistance in the bowel flora and lower cost.

[Clinical study on long-term cinoxacin therapy for outpatients with chronic complicated urinary tract infections]

Cinoxacin was administered to 30 outpatients with chronic complicated urinary tract infection for 57.3 days (average) and the following results were obtained. Clinical efficacy based on decrease of pyuria were "excellent" in 44.8%, "good" in 31.0%, "fair" in 24.1%, and "poor" in 0%; and, overall effectiveness rate reached 75.9%. As for side effect, diarrhea and nausea were observed in 2 and 1 patients, respectively. GOT and GPT elevation was also seen in one case. Cinoxacin long term therapy seems to be effective and useful to chronic complicated urinary tract infections.

Experiences on the efficacy and safety of nalidixic acid, oxolinic acid, cinoxacin and norfloxacin in the treatment of urinary tract infections (UTI)

The purpose of this study was to determine the effectiveness and tolerability of norfloxacin, cinoxacin and oxolinic acid in the treatment of urinary tract infections (UTI) in comparison to nalidixic acid. 125 patients were given the drugs in the appropriate doses for 10-14 days and 30 patients were treated for six weeks. Clinical, bacteriological, hematological and chemical checks were made on all patients before and after treatment. It was found that norfloxacin, cinoxacin and oxolinic acid are safe and effective against Escherichia coli, Klebsiella and Proteus, the commonly encountered organisms in urinary tract infections. The cure rate for norfloxacin was 93%, for cinoxacin 83%, for oxolinic acid 80% and for nalidixic acid 70% in the short course. However, these differences were not statistically significant. Oxolinic acid, cinoxacin and norfloxacin have the advantage over nalidixic acid of being administered only twice daily.

[Long-term cinoxacin therapy for chronic complicated urinary tract infection]

Twenty-two patients with chronic complicated urinary tract infections were treated with 400 to 1,200 mg/day cinoxacin for 2 to 12 months. Assessment of drug efficacy was based on monthly urinalysis. Clinical response rates were "excellent" in 32.3%, "good" in 27.9%, and "poor" in 39.8% of the participants. Overall effective rate reached 60.2%. No cases of side-effects or toxicity were seen. Long-term cinoxacin therapy is both safe and effective in the treatment of chronic complicated urinary tract infections.

Comparative study using norfloxacin and amoxycillin in the treatment of complicated urinary tract infections in geriatric patients

Norfloxacin, a new oral quinolone antimicrobial agent, was shown to have considerably greater activity than nalidixic acid and cinoxacin against sensitive and resistant strains of Enterobacteriaceae. A clinical trial was carried out comparing norfloxacin with amoxycillin in two groups of 20 geriatric patients with complicated urinary tract infection. The cure rate was 95% with norfloxacin and 75% with amoxycillin. Failures of treatment were due to increased bacterial resistance in most cases. Norfloxacin was well tolerated by all patients and no changes were noted in the toxicological assessment. Norfloxacin is a valuable addition to the oral antimicrobial agents available for the treatment of urinary tract infection.

Cinoxacin. A review of its pharmacological properties and therapeutic efficacy in the treatment of urinary tract infections

Cinoxacin is a urinary antibacterial drug closely related structurally to nalidixic acid. It has a spectrum of in vitro antibacterial activity which qualitatively resembles that of the latter agent, covering most common Gram-negative pathogens, excluding Pseudomonas. In acute or recurrent urinary tract infections it has been shown to be at least as effective as nalidixic acid or co-trimoxazole, and in a few studies was as effective as amoxycillin or nitrofurantoin. Cinoxacin appears to be well tolerated and may have a low propensity to induce bacterial resistance during clinical use, although the latter needs further confirmation. Thus, cinoxacin is an effective alternative for treating urinary tract infections due to common Gram-negative pathogens, and its apparently low incidence of adverse effects may offer worthwhile advantages over the related compounds nalidixic and oxolinic acids. Its use as prophylactic therapy in patients with recurrent urinary tract infections is not yet well established, although this appears a worthwhile area for further study.

Cinoxacin (Cinobac, Eli Lilly & Co.)

Cinoxacin, a synthetic organic acid antibacterial agent, related structurally to nalidixic and oxolinic acid, has been approved for the treatment of initial and recurrent urinary tract infections (UTIs) caused by susceptible gram-negative microorganisms. The role of cinoxacin in the treatment of UTIs, compared with the usual first-line agents, is uncertain at this time. The efficacy of cinoxacin in the treatment of pyelonephritis, compared with these proven agents, has been examined in only small numbers of patients, and cinoxacin is more expensive than these agents. Cinoxacin may prove valuable in the treatment of prostatitis and in the prophylaxis of recurrent UTIs; further study in these areas is warranted. In the routine treatment of acute UTIs, cinoxacin perhaps should be reserved only for those patients with organisms resistant to usual first-line agents or those who fail to respond to therapy with these agents. In this respect, cinoxacin may, in the future, replace nalidixic acid.

Comparison of low-dose cinoxacin therapy and placebo in the prevention of recurrent urinary tract infections

Fifty-nine female patients with a history of at least three episodes of urinary tract infection in the preceding year were enrolled in a two-center, double-blind study comparing cinoxacin and placebo as preventive therapy. Evaluation of efficacy was based on the results from 41 patients for whom complete data were available. In the cinoxacin-treated group, 18 of 20 patients remained asymptomatic during the study, compared with 11 of 21 patients in the placebo group. This difference between the two treatment groups was significant (P = 0.031). One patient in the cinoxacin group and eight patients in the placebo group developed an infection during the study. This difference was also significant (P = 0.045). Nine patients spontaneously reported adverse reactions, four in the cinoxacin group and five in the placebo group. In four instances, these were sufficiently severe for the treatment to be withdrawn from one patient who received cinoxacin and three patients who received placebo. The results of this study have shown that cinoxacin was significantly more effective than placebo in preventing urinary tract infection in patients with a history of frequent recurrent infections.

Cinoxacin: mechanism of action, spectrum of activity, pharmacokinetics, adverse reactions, and therapeutic indications

Cinoxacin, a chemotherapeutic agent that inhibits bacterial DNA synthesis, has recently been approved for the treatment of initial and recurrent bacterial urinary tract infections. Although closely related to nalidixic acid, cinoxacin possesses some distinct characteristics: rapid attainment of therapeutic urinary concentrations and greater activity against strains of Enterobacteriaceae that cause urinary tract infections. Biopharmaceutical properties include serum protein binding of approximately 70%, 50-60% excretion of intact drug in the urine of patients with normal renal function, and an elimination half-life of approximately one hour. The elimination half-life is increased in patients with decreased renal function and when probenecid is coadministered. Adverse events occur infrequently and consist of nausea, vomiting, headache, dizziness, and hypersensitivity reactions. The drug compares favorably with standard therapies for the treatment of bacterial cystitis and recurrent urinary tract infections. Initial studies demonstrate that cinoxacin has substantial efficacy as a prophylactic agent for those women who experience recurrent, symptomatic urinary tract infections.

Comparison of cinoxacin and nalidixic acid in patients with cystitis

A single-blind comparative study was undertaken in 95 patients with cystitis. Each patient received either cinoxacin. 250 mg. qid or nalidixic acid, 1 Gm. qid for seven to fourteen days. Fifty-five patients fulfilled all the criteria for efficacy evaluations; in the cinoxacin-treated group, 26 patients (93 per cent) had a satisfactory symptomatic response, and in the nalidixic acid group there were 25 patients (93 per cent) with a satisfactory symptomatic response. The bacteriologic response was also similar in both groups. One patient in each group became reinfected with a new pathogen and in 1 patient, who received conoxacin, the causative pathogen was not eliminated. four female patients in the cinoxacin group had seven adverse drug reactions, compared with 9 patients in the nalidixic acid group who had 18 adverse reactions. It is concluded that cinoxacin has advantages over nalidixic acid for the treatment of patients with cystitis due to susceptible organisms.

[A comparison of cinoxacin and nalidixic acid in the treatment of chronic urinary tract infections]

A total of 60 patients with chronic urinary tract infections were included in this comparative study. 29 patients received cinoxacin and 31 nalidixic acid for a period of ten days. There were five therapy failures in the cinoxacin group and nine in the nalidixic acid group. Drug-related side-effects were reported by 11 patients in the cinoxacin group and by 13 patients in the nalidixic acid group. Gastrointestinal and central nervous disturbances were the adverse reactions which occurred most frequently. In all cases side-effects disappeared quickly after therapy was discontinued.

Cinoxacin therapy for urinary tract infections: therapeutic safety and efficacy

We gave cinoxacin to 125 patients with initial and recurrent urinary tract infections to investigate the safety and efficacy of this new antimicrobial agent. Patients ranging in age from 18 to 92 were treated with 500 mg twice daily for nine days. Analysis showed a satisfactory symptomatic response rate of 96% and a bacteriologic cure rate of 92%, with mild side effects observed in 6% of the participants.

Comparison of cinoxacin and co-trimoxazole in the treatment of urinary tract infections

A randomised single-blind clinical trial compared cinoxacin (500 mg every 12 hours) to co-trimoxazole (160 mg trimethoprim, 800 mg sulphamethoxazole every 12 hours) in the treatment of 63 patients with urinary tract infections. The symptomatic response was 73% for both drugs. Bacterial eradication was achieved in 81% and 100% of patients receiving cinoxacin and co-trimoxazole respectively. Three patients receiving co-trimoxazole stopped treatment because of adverse reactions. We conclude that cinoxacin is an effective and safe antibacterial agent in the treatment of urinary tract infections.

Comparison of cinoxacin and trimethoprim-sulfamethoxazole in the treatment of urinary tract infections

Forty women with uncomplicated urinary tract infections owing to susceptible organisms were assigned randomly to 500 mg. cinoxacin or 160--800 mg. trimethoprim-sulfamethoxazole twice daily for 10 days. Of 20 patients receiving cinoxacin none had bacteriuria during or 7 days after therapy, and 2 of 15 (13 per cent) were reinfected within 30 days. Of 20 patients receiving trimethoprim-sulfamethoxazole 1 (5 per cent) had bacteriuria during therapy, 19 were uninfected during and 7 days after therapy, and 3 of 15 (20 per cent) were reinfected within 30 days. Adverse reactions occurred in 2 patients (10 per cent) in each group. Anal and vaginal Enterobacteriaceae maintained their sensitivity to cinoxacin. Three patients (20 per cent) on trimethoprim-sulfamethoxazole presented with and 3 acquired anal Enterobacteriaceae resistant to the drug and 2 (13 per cent) acquired vaginal Enterobacteriaceae that were resistant. Cinoxacin was as effective as trimethoprim-sulfamethoxazole without the emergence of resistant bacteria associated with trimethoprim-sulfamethoxazole.

A clinical comparison of cinoxacin and nalidixic acid in the treatment of urinary tract infection

In a single blind clinical study of 50 patients with urinary tract infections 250 mg. cinoxacin were compared to 1 g. nalidixic acid 4 times daily. Both drugs produced similar improvement in symptomatic response during therapy and were equally effective in eradicating the causative pathogens. In the 5 of 9-day post-therapy followup 4 patients from the cinoxacin group became reinfected compared to 1 from the nalidixic acid group. Side effects were reported by twice as many patients in the nalidixic acid group. It is concluded that cinoxacin is an effective drug for the treatment of uncomplicated urinary tract infections.

Cinoxacin for treatment and prevention of recurrent urinary tract infection

Cinoxacin, an orally administered synthetic antimicrobial agent, is highly effective in the treatment of urinary tract caused by most urinary tract pathogens. Its high prolonged urinary concentration, low incidence of adverse reactions, low fecal concentration, infrequent induction of resistant bacterial strains, and broad antimicrobial spectrum are valuable attributes. Its efficacy for prolonged low-dose preventive therapy of frequently recurring infections adds to this new drug's importance.

Cinoxacin in urinary tract infections. Theoretical and practical considerations

In dogs we found that cinoxacin concentrations in prostatic tissue, secretion, and interstitial fluid always were lower than the simultaneous serum concentrations, during constant infusion experiments. The cinoxacin concentrations in urethral and vaginal secretions were similar to those found in prostatic interstitial fluid, approximately one third to one fourth of the simultaneous serum concentrations. The concentrations of cinoxacin in human prostatic tissue after single or multiple doses of 500 mg. were found to be in the range of minimum inhibitory concentrations for most microorganisms found in urinary tract infections. Cinoxacin was found to have a half-life of 2.7 hours in patients with normal renal function, but increased to 8.5 hours in patients with impaired renal function. We found little or no drug accumulation during a seven-day treatment of patients with impaired renal function.

A comparative drug study of lower urinary tract infections in elderly patients

The urinary antibacterial drugs cinoxacin (Cinobac) and nitrofurantoin (Macrodantin) were compared for efficacy and side effects in the treatment of uncomplicated lower urinary tract infections occurring in elderly patients admitted to a rehabilitation hospital. Twenty-five patients received cinoxacin and 27 received nitrofurantoin for an average of thirteen days' treatment. The antibacterial spectrum of cinoxacin was noted to be better than that of nitrofurantoin, but both drugs performed well in clearing the infections caused by susceptible organisms. There were no side effects from cinoxacin therapy, but 15 per cent of patients receiving the nitrofurantoin experienced anorexia and nausea, in some cases sufficiently severe to require early termination of therapy.

Treatment of outpatient urinary tract infections with cinoxacin

This paper describes an open assessment of cinoxacin in the treatment of 30 outpatients with symptomatic urinary tract infections caused by Escherichia coli, Klebsiella, Proteus mirabilis, and Enterobacter. Twenty-seven patients (90 percent) had a satisfactory clinical response and in 26 patients, there was a satisfactory microbiological response with elimination of the pathogen. Mild side effects were reported by three patients, none of whom stopped therapy. It is concluded that cinoxacin will be useful in the treatment of urinary tract disease because of the high urinary antibacterial activity produced. The relatively low incidence of side effects and convenience of twice-daily dosage should encourage good compliance by patients treated outside the hospital setting.