[New fluoroquinolones in urology]. / Primenenie novykh ftorkhinolonov v urologii.

The authors review the practice of using fluoroquinolones (FQ) of the second generation in urology: levofloxacine, sparfloxacine, moxifloxacine. Details are given on chemical structure of FQ, their antimicrobial spectrum, indications for FQ administration, pharmacokinetics, efficacy in complicated infections of the urinary tracts. Treatment with new FQ demonstrated a good effect: high clinical and bacteriological responses (100 and 98.5%; 88.7 and 78.1%, 95.7 and 85.7% in the treatment with levofloxacine, sparfloxacine, moxifloxacine, respectively). The area of clinical application of FQ is urinary infection, urogenital infections, sexually transmitted diseases.

[Cefepime (maxipime) in the treatment of severe urinary tract infection]. / Primenenie tsefepima (maxipim) pri lechenii tiazhelykh infektsii mochevyvodiashchikh putei.

Comparative susceptibility of microflora isolates from patients with complicated urinary tract infections to cefepime, other cephalosporins, amikacin, ciprofloxacin and ofloxacin was studied. Isolates in the diagnostic titers (5 x 10(4)-5 x 10(8)) from the patients treated with cefepime as etiotropic monotherapy were identified. The treatment course was 7 to 14 days. The daily dose was 1 to 2 g. The clinical and bacteriological efficacies of the cefepime therapy equaled to 93.2 and 85.4% respectively.

[Experience in using the new drug moxifloxacin (Avelox, "Bayer", Germaniia) in urologic practice]. / Opyt primeneniia novogo lekarstvennogo preparata moksifloksatsina (Avelox, "Bayer", Germaniia) v urologicheskoi praktike.

Fluoroquinolones (ciprofloxacine, ofloxacin, pefloxacin, lomefloxacin, etc.) have a long and successful history of application in the treatment of urinary infection. They are the first-line drugs in the above nosological entity. Fluoroquinolones of a new generation including moxifloxacin demonstrate a wider spectrum of antimicrobial activity, updated pharmacokinetic properties, low resistance that is are promising in the treatment of urinary infection. We tried moxifloxacin in the treatment of both complicated and uncomplicated infections of the urinary tracts. The response reached 95.7%, bacteriological effectiveness 85.7%. The drug is well tolerated, side effects were not observed. Thus, moxifloxacin can be used in the treatment of urinary and urogenital infections.

[Effectiveness of imipenem/cilastatin (Tienam, MSD) in treating complicated infections in urology]. / Effektivnost' imipenem/tsilastatina (tienam, MSD) pri lechenii oslozhennykh infektsii v urologii.

Complicated urinary infections tend to eventuate in severe pyoseptic complications--bacteriuria, sepsis. The search for methods of fighting agents of urinary infections goes in the direction of perfection of already existing methods and in the direction of design of novel antibacterial drugs. In the middle 1980s the first carbapenem drug-imipenem--was proposed for urological clinical practice. Mechanism of its action as that of the other beta-lactam antibiotics consists in impairment of synthesis of bacterial cell wall as a result of the drug penetration through the surface membrane and irreversible binding with penicillin-binding proteins. Imipenem is active against most gram-positive and gram-negative aerobic and anaerobic microorganisms which cause severe urological infections. The article presents the results of treatment of 45 patients with severe urological infections with multiple resistance of the causing agent and failure of previous treatment. Imipenem was given in a daily dose 1.5-2.0 g. Sometimes a stepwise regimen was used: 500 mg 4 times a day intravenously for the first 3-4 days, then 500 mg twice a day intramuscularly for the following 3-4 days. In detection of highly sensitive bacteria (E. coli, Proteus mirabilis) daily doses were reduced to 1 g. In long standing infection caused by Pseudomonas aeruginosa imipenem was combined with amicacin. In high surgical risk of postoperative period imipenem was given prior to surgery and continued after it for 5 to 14 days. Good therapeutic results were achieved: clinical effect reached 95.5%, antibacterial efficiency was 87.8%. Thus, imipenem is antibiotic of the first line in empirical therapy of severe bacterial infections in urology as it has a wide spectrum of antibacterial action. We believe that this drug should not be left as a reserve but used for a starting empirical therapy of severe infections in urological hospital.

[Sparfloxacin (Sparflo) in the treatment of urological infections]. / Sparfloksatsin (sparflo) pri lechenii infektsii v urologii.

Sparfloxacin efficacy evaluation for the treatment of urogenital tract infections is presented. The trial was performed on 43 patients with chronic complicated infections of urogenital tract (pyelonephritis, prostatitis). Sparfloxacin (once daily for 7-14 days) was highly effective in the infection management according to clinical and bacteriological results (83.7 per cent and 78.1 per cent subsequently).

[Effectiveness of sparfloxacin (sparflo) in the treatment of complicated forms of pyelonephritis and prostatitis]. / Effektivnost' sparfloksatsina (sparflo) pri lechenii oslozhnennykh form pielonefrita i prostatita.

A novel difluoroquinolone drug sparfloxacine has a wide antibacterial spectrum. It is active both against gram-negative and gram-positive flora. Sparfloxacine was tried in 43 patients with pyelonephritis and prostatitis complicated with urolithiasis, diabetes mellitus, nephroptosis, anomalous kidneys, etc. The drug was given according to its pharmacokinetics for 7-14 days in a daily dose 400 mg (day 1) then 200 mg/day. The effectiveness of sparfloxacine in complicated pyelonephritis and prostatitis was rather high: clinical response reached 83.7%, bacteriological one--78.7%.

[Clinical significance of infection pathogen resistance in a urological clinic for selection of antibacterial therapy regimes for the treatment of complicated urinary infections]. / Klinicheskoe znachenie rezistentnosti vozbuditelei infektsii v urologicheskom statsionare dlia vybora rezhimov antibakterial'noi terapii oslozhnennykh infektsii mochevyvodiashchikh putei.

Data on changes of etiological structure of the complicated urinary tract infections treated at the Research Institute of Urology and Hospital No. 47 at the 5-year period (1996-2000) are given. It was shown that the most important microorganisms were the following: Enterobacter spp., E. coli, Proteus spp., Staphylococcus spp., Enterococcus faecalis. The correlation between frequency of the microorganisms isolation and their susceptibility to antimicrobial agents at different periods was analysed. The results of analysis allowed to elaborate algorithm of etiotropic therapy. Choice of the drug depends on pathogen susceptibility to antibiotics, bacteriuria level and clinical symptoms severity.

[Clinical significance of microbiological monitoring of infective agents in an urological hospital in the selection of antibacterial therapy regimens]. / Klinicheskoe znachenie mikrobiologicheskogo monitoringa vozbuditelei infektsii v urologicheskom statsionae dlia vybora rezhimov antibakterial'noi terapii.

Individual microbiological examination of each patient can improve significantly the response of urological patients to antibacterial therapy. 6000 cultures of opportunistic microorganisms isolated from patients with various infectious-inflammatory diseases were studied. Most of them were gram-negative: P. aeruginosa, E. coli, Enterobacter spp., Proteus spp. Of gram-positive most frequently occurred Staphylococcus spp and Enterococcus faecalis. The cultures showed different spectrum of the sensitivity to antibacterial drugs used in urological practice. The choice of etiotropic therapy was the easiest in E. coli infection, the hardest in P. aeruginosa and Enterobacter pylori infection. Combined treatment of complicated urological infections with gentamycin, ampicillin, carbnicilline, azlocillin is much more effective than monotherapy. P. aeruginosa is more sensitive to cephalosporins, fluoroquinolins, carbapenems and combination of aminoglycosides with betalactame drugs.

[Efficacy of meropenem in the treatment of severe complicated urinary tract infections]. / Effektivnost' meropenema pri lechenii tiazhelykh oslozhnennykh infektsii mochevyvodiashchikh putei.

The clinical and bacteriological efficacies of meropenem in the treatment of 12 patients with urinary tract infection were studied. In 8 patients the drug was administered intravenously in a dose of 1 g every 8 hours and in 4 patients with the creatinine clearance below 50 ml/min it was administered in a dose of 1 g every 12 hours (the treatment course of 7 to 10 days). Meropenem was used in the monotherapy. Severe complicated urinary tract infections were mainly observed in the patients with long-term urolithiasis, subjected to repeated surgical interventions and isolating as a rule polyresistant strains of Pseudomonas aeruginosa and E.agglomerans as the pyelonephritis pathogens at a titre of 5 x 10(5)-5 x 10(8) microbial cells per 1 ml of the urine susceptible to meropenem in 80 to 96 per cent of the cases. The clinical efficacy of the drug was stated in all the patients while the bacteriological efficacy amounted to 88.9 per cent.

[Efficacy of lomefloxacin in treatment of nonspecific inflammatory diseases and in prophylaxis of postoperative complications in urology]. / Effektivnost' lomefloksatsina v lechenii nespetsificheskikh vospalitel'nykh zabolevanii i profilaktike oslozhnenii posle operativnykh vmeshatel'stv v urologii.

Clinical and bacteriological efficacies of lomefloxacin and ofloxacin were comparatively estimated in the treatment of 104 urologic patients with nonspecific inflammatory diseases and in 36 urologic patients for prophylaxis of inflammatory complications after surgical interventions. The majority of the urinary tract pathogens i.e. Enterobacteriaceae spp. and gramnegative nonfermenting bacteria were highly susceptible to both the fluoroquinolones. The clinical and bacteriological efficacies of lomefloxacin amounted to 94.4 and 80.7 per cent and those of ofloxacin to 92 and 79.2 per cent respectively. The prophylactic use of lomefloxacin and ofloxacin was efficient in 94.7 and 94.1 per cent of the cases respectively. The antibacterial prophylaxis in urologic patients should be applied not only at the period of surgical interventions but also during the early postoperative period.

[Multicenter open randomized trial of meropenem in comparison to ceftazidime and amikacin used in combination in severe hospital infections]. / Mnogotsentrovoe otkrytoe randomizirovannoe issledovanie meropenema v sravnenii s kombinatsiei tseftazidima i i amikatsina pri tiazhelykh gospital'nykh infektsiiakh.

Clinical efficacy and tolerance of meropenem were estimated by comparison with those of ceftazidime and amikacin used in combination in the therapy of hospital infections of the lower respiratory tract, skin and soft tissues, intraabdominal and gynecologic infections, urinary tract infection and sepsis. 48 patients were given meropenem in a dose of 1 g every 8 hours for 3-14 days (the average of 9 days). 47 patients were subjected to the routine combined therapy: ceftazidime in a dose of 1 g every 8 hours and amikacin in a dose of 0.5 g every 12 hours for 2-14 days (the average of 9 days). The patient groups were comparable by the age, nature and severity of the infection and the condition (the mean APACHE II of 9.1 and 8.9). By the end of the treatment a positive clinical effect (recovery and improvement) was observed in 47 patients (97.9 per cent) treated with meropenem and in 41 patients (89.1 per cent) subjected to the combined therapy. The infection relapse within 4 weeks after the treatment completion was recorded in 3 patients in every group. Before the treatment 133 microbial strains were isolated from the patients. 121 of them were susceptible to meropenem (91.1 per cent), 111 to amikacin (83.4 per cent) and 90 to ceftazidime (67.7 per cent). The difference between meropenem and ceftazidime was significant (p = 0.0005). Eradication of the primary pathogens at the background of the meropenem therapy was stated in 41 out of 44 patients (93.2 per cent) and that of the combined therapy in 38 out of 43 patients (88.4 per cent). The microbiological relapse after the treatment completion was recorded in 3 and 2 patients, respectively. Side effects were observed in 8.3 per cent of the patients treated with meropenem and in 10.6 per cent of the patients subjected to the combined therapy. The trial results were indicative of the meropenem high efficacy and good tolerance and of the possible use of the drug in the monotherapy as an alternative of the routine combined therapy of severe hospital infections.

[Urotractin in the treatment of an infection of the kidneys, urinary tract and prostate]. / Urotraktin v lechenii infektsii pochek, mochevykh putei i predstatel'noi zhelezy.

Clinical and bacteriological effects of urotractin are analysed for 60 patients with infectious-inflammatory diseases of the kidney, urinary tracts and prostate treated in 3 urological clinics of Moscow. The drug was given 10 days in a dose 400 mg twice a day. Urotractin demonstrated high efficacy against both gram-negative and gram-positive bacteria. The results were the same in in- and outpatients.

[Analysis of the etiologic structure of urinary tract infection and antibiotic-resistance of its pathogens]. / Analiz étiologicheskoi struktury mochevoi infektsii i antibiotikorezistentnosti ee vozbuditelei.

The main pathogens of inflammatory diseases of the kidneys and upper urinary tracts in inpatients of an urological unit were gramnegative organisms of the family Enterobacteriaceae while the pathogens of the infection of the lower urinary tracts (nonspecific urethritis) and male genitalia were grampositive cocci. Pseudomonas aeruginosa, Enterobacter agglomerans and Proteus spp. (indole positive) were the chief causative agents of the hospital infections. The analysis of the materials revealed a tendency towards an increase in the microflora resistance to the most widely used antibiotics: aminoglycosides, cephalosporins and fluoroquinolones. This especially applied to the "problem" pathogen P.aeruginosa. Thus, in 1987 the portion of the P.aeruginosa gentamicin susceptible strains amounted to 52 per cent whereas in 1996 it was 13 per cent. The strains susceptible to ofloxacin equaled 79 per cent in 1988 and 44 per cent in 1995. At present the drugs of choice in the treatment of urinary tract infections due to P.aeruginosa are ceftazidime, cefpirome and amikacin (65, 64 and 62 per cent of the susceptible strains respectively). The importance of permanent microbiological monitoring and the respective correction of the therapy are indicated.