[Efficacy and safety of cefixim and ciprofloxacin in acute cystitis (a multicenter randomized trial)].

A prospective multicenter randomized trial enrolled 104 females aged 18-55 years with acute un-complicated cystitis. The patients were randomized into two groups: 49 patients of group 1 received cefixim in a single dose 400 mg/day for 5 days; 55 patients of group 2 were given ciprofloxacin in a dose 250-500 mg twice a day for 5 days. Clinical and microbiological assessment of efficacy and safety was made before treatment and on treatment day 8 and 28. Significant differences were found between groups 1 and 2 in parameters of bacteriological and clinical efficacy. Eradication of the agent and persistent bacteriological response was seen in 95.9 and 100% patients of group 1, 66 and 100% patients of group 2, respectively. Complete and partial response was observed in 55.1 and 75.5% patients of group 1, 37.3 and 58.1% patients of group 2, respectively. Thus, cefixim in a single dose 400 mg/day for 5 days has a higher microbiological efficacy than ciprofloxacin in a dose 250-500 mg twice a day. Side effects occurred less frequently in the treatment with cefixim.

[Norfloxacine efficacy in acute cystitis in the region with 10% resistance of E. coli to fluoroquinolones: a comparative randomized study].

We have conducted a clinicomicrobiological study the first stage of which consisted in collection of information on uropathogens resistance to fluoroquinolones in 89 females with uncomplicated urinary infections (UI). Sensitivity to antibacterial drugs was determined by the agar dilution test (CLSI, 2007). At stage two of the study we made a prospective multicenter randomized trial including 108 females aged 18-55 years with acute uncomplicated cystitis. The patients were randomized into two groups: group 1 (n = 55) received norfloxacin (400 mg twice a day for 3 days); group 2 (n = 53) received phosphomycin (a single 3.0 g dose). Clinical and microbiological assessment of efficacy and safety was performed before the treatment, on treatment day 5, 10 and 28. Isolation of E. coli strains in the region highly and moderately resistant to cyprofloxacine was rather high--10 and 1.1%, respectively. Before the treatment E. coli was isolated from the urine in 82.4% cases, E. faecalis--5.9%, S. saprophyticus--3.9%, Staphylococcus spp--2.0%, others--< 1%. No significant differences by bacteriological and clinical efficacy were found between the groups. Eradication of the agent and persistent bacteriological response were seen in 100 and 95.2%, 95.8 and 100% patients of groups 1 and 2, respectively. Complete and partial responses were registered in 68.5 and 76%, 76 and 98% patients of groups 1 and 2, respectively. Thus, treatment with norfloxacin in a dose 400 mg twice a day for 3 days and with phosphomycin in a 3.0 g single dose have high clinical and microbiological efficacy in uncomplicated cystitis. Norfloxacin retains clinical and microbiological efficacy in acute uncomplicated cystitis even in conditions of 10% prevalence of fluoroquinolone-resistant strains. We think that there are reasons for revision of criteria of interpretation of uropathogens sensitivity to fluoroquinolones in the treatment of uncomplicated UI.

[Resistance of causative agents of uncomplicated urinary tract infections in Russia].

A prospective epidemiological study of the spectrum of causative agents (CA) of uncomplicated urinary tract infections (UTI) in adult patients and CA resistance to antimicrobial drugs was conducted in nine cities of the Russian Federation in 2004-2005. Minimum inhibiting concentrations were ascertained by dilution in agar according to NCCLS (2000-2002) recommendations. The study has found that uncomplicated UTI are most frequently caused by E.coli (73.9%). Other CA occur much less frequently: K.pneumoniae--6.4%, E. faecalis--4.4%, S. epidermidis--4.1%, Staphylococcus spp--3.4%, others--2% patients. E. coli demonstrated high resistance to ampicilline (33.1%), co-trimoxasol (19.4%). Most active against E. coli were fluoroquinolones (norfloxacin, ciprofloxacin, levofloxacine), the resistance being 4.8%; cefalosporins of the second and third generation (cefuroxim, ceftibuten), nitrofurantoin, no resistant strains were found.