Quinolones for uncomplicated acute cystitis in women - PubMed (original) (raw)

Meta-Analysis

Quinolones for uncomplicated acute cystitis in women

V Rafalsky et al. Cochrane Database Syst Rev. 2006.

Abstract

Background: Uncomplicated acute cystitis is one of the most common bacterial infections in adults. The percentage of women who have at least one episode of acute cystitis is estimated to be between 40% to 50%. Quinolones are recommended for acute cystitis in regions where the level of resistance to other antimicrobials namely co-trimoxazole is high. However the efficacy, safety and tolerance of quinolones needs investigation.

Objectives: To compare the efficacy, safety and tolerance of different quinolones in women with uncomplicated acute cystitis.

Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, in The Cochrane Library Issue 3, 2003), MEDLINE (1966 - September 2003), EMBASE (1988 - September 2003), reference lists of articles and abstracts from conference proceedings without language restriction. Reference lists of urology, infectious diseases and nephrology textbooks, review articles and relevant studies.

Selection criteria: Randomised and quasi-randomised controlled trials comparing two or more different quinolones in women (>/= 16 years) with uncomplicated acute cystitis were selected.

Data collection and analysis: Two reviewers independently assessed trial quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) for dichotomous outcomes with 95% confidence intervals (CI).

Main results: We identified 11 studies enrolling 7535 women. There were no significant differences in clinical or microbiological efficacy between quinolones. Photosensitivity reactions were more frequently observed for sparfloxacin when compared to ofloxacin. Any adverse event, adverse events causing withdrawal, skin adverse events, photosensitivity reactions were more common for lomefloxacin when compared to norfloxacin. Any adverse event, adverse drug reactions, CNS adverse events were more common for ofloxacin when compared to ciprofloxacin. CNS adverse events and insomnia were more often reported for rufloxacin when compared to pefloxacin. Adverse drug reactions occurred frequently for ofloxacin than levofloxacin. Insomnia was reported more frequently for enoxacin than ciprofloxacin.

Authors' conclusions: We found no significant differences in clinical or microbiological efficacy between quinolones but some differences in occurrence and spectrum of quinolone safety.

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Conflict of interest statement

None known

Figures

1.1. Analysis

Comparison 1 200 mg/d sparfloxacin versus 400 mg/d ofloxacin, Outcome 1 Clinical efficacy.

1.2. Analysis

Comparison 1 200 mg/d sparfloxacin versus 400 mg/d ofloxacin, Outcome 2 Microbiological efficacy.

1.3. Analysis

Comparison 1 200 mg/d sparfloxacin versus 400 mg/d ofloxacin, Outcome 3 Clinical + microbiological efficacy.

1.4. Analysis

Comparison 1 200 mg/d sparfloxacin versus 400 mg/d ofloxacin, Outcome 4 Safety.

2.1. Analysis

Comparison 2 400 mg/d lomefloxacin versus 800 mg/d norfloxacin, Outcome 1 Clinical efficacy.

2.2. Analysis

Comparison 2 400 mg/d lomefloxacin versus 800 mg/d norfloxacin, Outcome 2 Microbiological efficacy.

2.3. Analysis

Comparison 2 400 mg/d lomefloxacin versus 800 mg/d norfloxacin, Outcome 3 Safety.

3.1. Analysis

Comparison 3 200 mg/d ciprofloxacin versus 400 mg/d ofloxacin, Outcome 1 Clinical efficacy.

3.2. Analysis

Comparison 3 200 mg/d ciprofloxacin versus 400 mg/d ofloxacin, Outcome 2 Microbiological efficacy.

3.3. Analysis

Comparison 3 200 mg/d ciprofloxacin versus 400 mg/d ofloxacin, Outcome 3 Safety.

4.1. Analysis

Comparison 4 Single dose rufloxacin 400 mg versus single dose pefloxacin 800 mg, Outcome 1 Clinical efficacy.

4.2. Analysis

Comparison 4 Single dose rufloxacin 400 mg versus single dose pefloxacin 800 mg, Outcome 2 Microbiological efficacy.

4.3. Analysis

Comparison 4 Single dose rufloxacin 400 mg versus single dose pefloxacin 800 mg, Outcome 3 Safety.

5.1. Analysis

Comparison 5 250 mg/d levofloxacin versus 400 mg/d ofloxacin, Outcome 1 Clinical efficacy.

5.2. Analysis

Comparison 5 250 mg/d levofloxacin versus 400 mg/d ofloxacin, Outcome 2 Microbiological efficacy.

5.3. Analysis

Comparison 5 250 mg/d levofloxacin versus 400 mg/d ofloxacin, Outcome 3 Safety.

6.1. Analysis

Comparison 6 400 mg/d lomefloxacin versus 800 mg/d norfloxacin, Outcome 1 Clinical efficacy.

6.2. Analysis

Comparison 6 400 mg/d lomefloxacin versus 800 mg/d norfloxacin, Outcome 2 Microbiological efficacy.

6.3. Analysis

Comparison 6 400 mg/d lomefloxacin versus 800 mg/d norfloxacin, Outcome 3 Safety.

7.1. Analysis

Comparison 7 200 mg/d gatifloxacin versus 200 mg/d ciprofloxacin, Outcome 1 Clinical efficacy.

7.2. Analysis

Comparison 7 200 mg/d gatifloxacin versus 200 mg/d ciprofloxacin, Outcome 2 Microbiological efficacy.

7.3. Analysis

Comparison 7 200 mg/d gatifloxacin versus 200 mg/d ciprofloxacin, Outcome 3 Safety.

8.1. Analysis

Comparison 8 500 mg/d ciprofloxacin versus 800 mg/d norfloxacin, Outcome 1 Clinical efficacy.

8.2. Analysis

Comparison 8 500 mg/d ciprofloxacin versus 800 mg/d norfloxacin, Outcome 2 Microbiological efficacy.

8.3. Analysis

Comparison 8 500 mg/d ciprofloxacin versus 800 mg/d norfloxacin, Outcome 3 Safety.

9.1. Analysis

Comparison 9 200 mg/d fleroxacin versus 500 mg/d ciprofloxacin, Outcome 1 Clinical efficacy.

9.2. Analysis

Comparison 9 200 mg/d fleroxacin versus 500 mg/d ciprofloxacin, Outcome 2 Microbiological efficacy.

9.3. Analysis

Comparison 9 200 mg/d fleroxacin versus 500 mg/d ciprofloxacin, Outcome 3 Safety.

10.1. Analysis

Comparison 10 320 mg/d gemifloxacin versus 500 mg/d ciprofloxacin, Outcome 1 Microbiological efficacy.

11.1. Analysis

Comparison 11 500 mg/d conventional ciprofloxacin versus 500 mg/d extended‐release ciprofloxacin, Outcome 1 Clinical efficacy.

11.2. Analysis

Comparison 11 500 mg/d conventional ciprofloxacin versus 500 mg/d extended‐release ciprofloxacin, Outcome 2 Microbiological efficacy.

11.3. Analysis

Comparison 11 500 mg/d conventional ciprofloxacin versus 500 mg/d extended‐release ciprofloxacin, Outcome 3 Safety.

References

References to studies included in this review

Henry 1998 {published data only}

1. Henry D, Ellison W, Sullivan J, Mansfield DL, Magner DJ, Dorr MB, et al. Treatment of community‐acquired acute uncomplicated urinary tract infection with sparfloxacin versus ofloxacin. The Sparfloxacin Multi Center UUTI Study Group. Antimicrobial Agents & Chemotherapy 1998;42(9):2262‐6. [MEDLINE: ] -PMC -PubMed

Henry 2002 {published data only}

1. Henry DC Jr, Bettis RB, Riffer E, Haverstock DC, Kowalsky SF, Manning K, et al. Comparison of once‐daily extended‐release ciprofloxacin and conventional twice‐daily ciprofloxacin for the treatment of uncomplicated urinary tract infection in women. Clinical Therapeutics 2002;24(12):2088‐104. [MEDLINE: ] -PubMed

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1. Iravani A, Tice AD, McCarty J, Sikes DH, Nolen T, Gallis HA, et al. Short‐course ciprofloxacin treatment of acute uncomplicated urinary tract infection in women. The minimum effective dose. The Urinary Tract Infection Study Group. Archives of Internal Medicine 1995;155(5):485‐94. [MEDLINE: ] -PubMed

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McCarty 1999 {published data only}

1. McCarty JM, Richard G, Huck W, Tucker RM, Tosiello RL, Shan M, et al. A randomized trial of short‐course ciprofloxacin, ofloxacin, or trimethoprim/sulfamethoxazole for the treatment of acute urinary tract infection in women. Ciprofloxacin Urinary Tract Infection Group. American Journal of Medicine 1999;106(3):292‐9. [MEDLINE: ] -PubMed

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References to studies excluded from this review

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Boyko 1990 {published data only}

1. Boyko EJ, Iravani A, Silverman MH, Schelling DJ, Wright RA. Randomized, controlled trial of a 10‐day course of amifloxacin versus trimethoprim‐sulfamethoxazole in the treatment of acute, uncomplicated urinary tract infection. Amifloxacin Multi‐Center Trial Group. Antimicrobial Agents & Chemotherapy 1990;34(4):665‐7. [MEDLINE: ] -PMC -PubMed

Briedigkeit 1982 {published data only}

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Bucy 1981 {published data only}

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Cortes 1992 {published data only}

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Cox 1982 {published data only}

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Dawani 1987 {published data only}

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De Miranda 1995 {published data only}

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Del Rio 1996 {published data only}

1. Rio G, Dalet F, Aguilar L, Caffaratti J, Dal‐Re R. Single‐dose rufloxacin versus 3‐day norfloxacin treatment of uncomplicated cystitis: clinical evaluation and pharmacodynamic considerations. Antimicrobial Agents & Chemotherapy 1996;40(2):408‐12. [MEDLINE: ] -PMC -PubMed

Derevianko 1996 {published data only}

1. Derevianko II, Kotliarova GA, Siniukhin VN. Outlook and experience in using ofloxacin in urology. Antibiotiki i Khimioterapiia 1996;41(9):89‐94. [MEDLINE: ] -PubMed

Drylie 1981 {published data only}

1. Drylie DM. Cinoxacin and nalidixic acid in treatment of urinary tract infections. Urology 1981;17(5):500‐1. [MEDLINE: ] -PubMed

Fujita 1993 {published data only}

1. Fujita K, Munakata A, Matsushima H, Kaneko M, Nakano M. Seven‐day treatment with Lomefloxacin for uncomplicated cystitis in women. Nishinihon Journal of Urology 1993;55(12):1685‐9. [EMBASE: 1994030009]

Gallego Gomez 1987 {published data only}

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Giamarellou 1984 {published data only}

1. Giamarellou H, Efstratiou A, Tsagarakis J, Petrikkos G, Daikos GK. Experience with ciprofloxacin in vitro and in vivo. Arzneimittel‐Forschung 1984;34(12):1775‐8. [MEDLINE: ] -PubMed

Goldstein 1987 {published data only}

1. Goldstein EJ, Kahn RM, Alpert ML, Ginsberg BP, Greenway FL, Citron DM. Ciprofloxacin versus cinoxacin in therapy of urinary tract infections. A randomized, double‐blind trial. American Journal of Medicine 1987;82(4A):284‐7. [MEDLINE: ] -PubMed

Goto 1999 {published data only}

1. Goto T, Kitagawa T, Kawahara M, Hayami H, Ohi Y. Comparative study of single‐dose and three‐day therapy for acute uncomplicated cystitis. Hinyokika Kiyo ‐ Acta Urologica Japonica 1999;45(2):85‐9. [MEDLINE: ] -PubMed

Guibert 1997 {published data only}

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Henry 1999 {published data only}

1. Henry DC, Nenad RC, Iravani A, Tice AD, Mansfield DL, Magner DJ, et al. Comparison of sparfloxacin and ciprofloxacin in the treatment of community‐acquired acute uncomplicated urinary tract infection in women. Sparfloxacin Multicenter Uncomplicated Urinary Tract Infection Study Group. Clinical Therapeutics 1999;21(6):966‐81. [MEDLINE: ] -PubMed

Hirose 1992 {published data only}

1. Hirose T, Yoshiaki K, Yokoo A, Umehara T, Miyake M, Takatsuka K, et al. Dose finding study of sparfloxacin in single‐dose therapy for female acute uncomplicated cystitis. Kansenshogaku Zasshi ‐ Journal of the Japanese Association for Infectious Diseases 1992;66(10):1462‐72. [MEDLINE: ] -PubMed

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1. Iravani A. Treatment of community‐acquired acute uncomplicated urinary tract infections (UUTI) with sparfloxacin (SPAR) and ciprofloxacin (CIP). Proceedings of the 36th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC); 1996 Sep 15‐18; New Orleans (USA). 1996:L006.

Iravani 1991 {published data only}

1. Iravani A. Treatment of uncomplicated urinary tract infections with temafloxacin. American Journal of Medicine 1991;91(6A):124S‐8S. [MEDLINE: ] -PubMed

Iravani 1992 {published data only}

1. Iravani A. Efficacy of lomefloxacin as compared to norfloxacin in the treatment of uncomplicated urinary tract infections in adults. American Journal of Medicine 1992;92(4A):75S‐81S. [MEDLINE: ] -PubMed

Ishigami 1976 {published data only}

1. Ishigami J, Mita T, Kataoka N, Miyazaki S, Kaneda K. Comparative clinical experiment by double‐blind method in acute lower urinary tract infections with pipemidic acid and piromidic acid. Japanese Journal of Antibiotics 1976;29(2):167‐77. [MEDLINE: ] -PubMed

Ishihara 1998 {published data only}

1. Ishihara S, Ban Y, Kawada Y, Ito S, Ito Y, Doi T, et al. Fleroxacin treatment for acute uncomplicated cystitis in women: comparison of 3‐day and 7‐day therapy. Hinyokika Kiyo ‐ Acta Urologica Japonica 1988;44(6):431‐6. [MEDLINE: ] -PubMed

Kadiri 1999 {published data only}

1. Kadiri S, Ajayi SO, Toki RA. Quinolones for short‐term treatment of uncomplicated urinary tract infection. East African Medical Journal 1999;76(10):587‐9. [MEDLINE: ] -PubMed

Karachalios 1991 {published data only}

1. Karachalios GN, Georgiopoulos AN, Nasopoulou‐Papadimitriou DD, Adracta DJ. Value of single‐dose ciprofloxacin in the treatment of acute uncomplicated urinary tract infection in women. Drugs Under Experimental & Clinical Research 1991;17(10‐11):521‐4. [MEDLINE: ] -PubMed

Koyama 2000 {published data only}

1. Koyama Y, Mikami O, Matsuda T, Murota T, Ohara T, Kawamura H, et al. Efficacy of single‐dose therapy with levofloxacin for acute cystitis: comparison to three‐day therapy. Hinyokika Kiyo ‐ Acta Urologica Japonica 2000;46(1):49‐52. [MEDLINE: ] -PubMed

Kumamoto 1983 {published data only}

1. Kumamoto Y, Nishio A, Ikegaki S, et al. Research on relapse and reinfection following antibiotic therapy of acute simple cystitis in women: A double‐blind study on dose response with cinoxacin. II. Chemotherapy 1983;31(6):646‐56. [EMBASE: 1983207279]

Leelarasamee 1995 {published data only}

1. Leelarasamee A, Leelarasamee I. Comparative efficacies of oral pefloxacin in uncomplicated cystitis. Single dose or 3‐day therapy. Drugs 1995;49(Suppl 2):365‐7. [MEDLINE: ] -PubMed

Leibovici 1991 {published data only}

1. Leibovici L, Wysenbeek AJ. Single‐dose antibiotic treatment for symptomatic urinary tract infections in women: a meta‐analysis of randomized trials. Quarterly Journal of Medicine 1991;78(285):43‐57. [MEDLINE: ] -PubMed

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1. Loran OB, Pushkar' DIu, Tevlin KP. Experience with the use of ciprofloxacin in patients with acute uncomplicated cystitis. Antibiotiki i Khimioterapiia 1997;42(6):42‐4. [MEDLINE: ] -PubMed

Ludwig 1996 {published data only}

1. Ludwig G. Experience with clinical use of ofloxacin in the treatment of upper and lower urinary tract infections. Demonstration of the result of four clinical trials. Antibiotiki i Khimioterapiia 1996;41(9):84‐5. -PubMed

Malinverni 1988 {published data only}

1. Malinverni R, Glauser MP. Comparative studies of fluoroquinolones in the treatment of urinary tract infections. Reviews of Infectious Diseases 1988;10 Suppl 1:S153‐63. [MEDLINE: ] -PubMed

Martorana 1988 {published data only}

1. Martorana G, Giberti C, Pizzorno R, Bonamini A, Oneto F, Curotto A, et al. Treatment of urinary tract infections with ciprofloxacin. Clinical Therapeutics 1988;10(5):516‐20. [MEDLINE: ] -PubMed

Matsuura 1985 {published data only}

1. Matsuura T, Kurita T. Clinical studies of norfloxacin in urinary tract infections. Hinyokika Kiyo ‐ Acta Urologica Japonica 1985;31(11):2085‐9. [MEDLINE: ] -PubMed

Miano 1990 {published data only}

1. Miano L, Goldoni S, Tubaro A, Paradiso Galatioto G, Gandolfi P. Review of norfloxacin in lower urinary tract infections. European Urology 1990;17 Suppl 1:13‐8. [MEDLINE: ] -PubMed

Miyata 1987 {published data only (unpublished sought but not used)}

1. Miyata M, Inagaki N, Inada F, Yachiku S, Okamura K, Osanai H, et al. Clinical study of ofloxacin (OFLX) on urinary tract infections. Hinyokika Kiyo ‐ Acta Urologica Japonica 1987;33(8):1303‐11. [MEDLINE: ] -PubMed

Naber 1994 {published data only}

1. Naber, KG, Baurecht W, Fischer M, Kresken M. Pefloxacin single‐dose in the treatment of acute uncomplicated lower urinary tract infections in women: A meta‐analysis of seven clinical trials. International Journal of Antimicrobial Agents 1994;4(3):197‐202. [EMBASE: 1994236750] -PubMed

Naber 1996 {published data only}

1. Naber KG, Silverio F, Geddes A, Guibert J. Comparative efficacy of sparfloxacin versus ciprofloxacin in the treatment of complicated urinary tract infection. Journal of Antimicrobial Chemotherapy 1996;37 Suppl A:135‐44. [MEDLINE: ] -PubMed

Nagai 1988 {published data only}

1. Nagai N, Kaneko S, Akiyama T, Kurita T, Iguchi M, Kataoka K. Clinical studies on enoxacin in urinary tract infection. Hinyokika Kiyo ‐ Acta Urologica Japonica 1988;34(7):1283‐91. [MEDLINE: ] -PubMed

Nordic 1988 {published data only}

1. The Inter‐Nordic Urinary Tract Infection Study Group. Double‐blind comparison of 3‐day versus 7‐day treatment with norfloxacin in symptomatic urinary tract infections. Scandinavian Journal of Infectious Diseases 1988;20(6):619‐24. [MEDLINE: ] -PubMed

Norrby 1990b {published data only}

1. Norrby SR. Short‐term treatment of uncomplicated lower urinary tract infections in women. Reviews of Infectious Diseases 1990;12(3):458‐67. [MEDLINE: ] -PubMed

Ohmori 1989 {published data only}

1. Ohmori H, Kumon H, Suzuki K, Kamidono S, Arakawa S, Ishigami J, et al. A comparative study on lomefloxacin and norfloxacin in the treatment of acute uncomplicated cystitis. Japanese Journal of Antibiotics 1989;42(4):1025‐50. [MEDLINE: ] -PubMed

Ohmori 1998 {published data only}

1. Ohmori H, Kumon H, Suzuki K, Kamidono S, Arakawa S, Ishigami J, et al. A comparative study on lomefloxacin and norfloxacin in the treatment of acute uncomplicated cystitis. Japanese Journal of Antibiotics 1989;42(4):1025‐50. [MEDLINE: ] -PubMed

Piipo 1990 {published data only}

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Pimentel 1998 {published data only}

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Pytel' 1996 {published data only}

1. Pytel' IuA, Volkova VS. Comprehensive treatment with ofloxacin in pyo‐inflammatory urologic diseases. Antibiotiki i Khimioterapiia 1996;41(9):86‐8. [MEDLINE: ] -PubMed

Raz 1989 {published data only}

1. Raz R, Rottensterich E, Hefter H, Kennes Y, Potasman I. Single‐dose ciprofloxacin in the treatment of uncomplicated urinary tract infection in women. European Journal Of Clinical Microbiology & Infectious Diseases 1989;8(12):1040‐2. [MEDLINE: ] -PubMed

Reeves 1984 {published data only}

1. Reeves DS, Lacey RW, Mummery RV, Mahendra M, Bint AJ, Newsom SW. Tretment of acute urinary infection by norfloxacin or nalidixic acid/citrate: a multi‐centre comparative study. Journal of Antimicrobial Chemotherapy 1984;13 Suppl B:99‐105. [MEDLINE: ] -PubMed

Rizk 1992 {published data only}

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Saginur 1992 {published data only}

1. Saginur R, Nicolle LE. Single‐dose compared with 3‐day norfloxacin treatment of uncomplicated urinary tract infection in women. Canadian Infectious Diseases Society Clinical Trials Study Group. Archives of Internal Medicine 1992;152(6):1233‐7. [MEDLINE: ] -PubMed

Schaeffer 1987 {published data only}

1. Schaeffer AJ. Multiclinic study of norfloxacin for treatment of urinary tract infections. American Journal of Medicine 1987;82(6B):53‐8. [MEDLINE: ] -PubMed

Stein 1992 {published data only}

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Trienekens 1993 {published data only}

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Rafalsky 2002

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