[The efficacy and safety of cefixime and amoxicillin/clavulanate in the treatment of asymptomatic bacteriuria in pregnant women: a randomized, prospective, multicenter study].

The study was aimed to the evaluation of efficacy and safety of cefixime and amoxicillin/clavulanate in the treatment of asymptomatic bacteriuria in pregnant women. A prospective, multicenter, randomized study that included 112 pregnant women with asymptomatic bacteriuria was performed. 58 women were randomized in group 1 (cefixime [suprax solutab] 400 mg 1 time a day, 7 days), 54 women were included in group 2 (amoxicillin/clavulanate [amoksiklav] 625 mg 3 times a day, 7 days). The average age of the patients in group 1 was 25.2 +/- 6.6; in group 2--26.6 +/- 5.8 years. Physical examination, evaluation of complaints, collection of data on adverse reactions, and bacteriological analysis of urine were performed after enrollment in the study at visit 2 (day 10 +/- 1) and 3 (day 35 +/- 2). Comparable effectiveness of cefixime and amoxicillin/clavulanate in the treatment of asymptomatic bacteriuria in pregnant women was found. Eradication of the pathogen and sustained bacteriological response were observed in 94.8 and 92.7% of women treated with cefixime, and in 98.2 and 92.5% of women treated with amoxicillin/clavulanate, respectively (P > 0.05). At the same time, the use of amoxicillin/clavulanate compared with cefixime significantly higher was followed by the development of adverse reactions (13% and 1.7; respectively; P = 0.02). Seven-day courses of cefixime at a dose 400 mg 1 time a day and amoxicillin/clavulanate at a dose of 625 mg 3 times a day are high-effective treatment regimens for asymptomatic bacteriuria in pregnant women in Russia. The use of amoxicillin/clavulanate is significantly more often accompanied by the development of adverse reactions compared with cefixime.

[The value of compliance during chronic administration of acetylsalicylic acid in patients with acute coronary syndrome: results of the study FORPOST].

Found low compliance of admission to long-term acetylsalicylic acid (ASA) in patients with acute coronary syndrome (ACS): 74.9% of patients reported that the suspended or completely stopped taking the drug, and only 16.2% were fully committed to the long-term therapy with ASA. Patients are significantly more likely to discontinue conventional and buffered forms of ASA compared with intestinal-soluble forms of the drug (odds ratio - OR=1.81, 95% confidence interval - CI: 1.20 to 2.72; p=0,0027). The most common causes of low noncompliance were to receive ASA or the development of fear of adverse drug reactions (ADRs) - 47.1%, and the forgetfulness of the patients taking the drug regularly (25.4%). When receiving enteric forms of ASA NLR developed significantly less than in the case of buffered (OR 0.49, 95% CI, 0.35 to 0,69; p=0,00002) and "ordinary" (OR 0.21, 95 % CI 0.13 to 0,33; p=0,00001) forms of ASA. Compliance of the highest among all the drugs ASA, according to estimates by using a 10-point visual analog scale, were observed in enteric-coated forms of ASA (average score of 8.3+/-1.4). Some of the lowest noncompliance were noted to receive the "regular" aspirin tablet (6.9+/-1.4 points).

[Cefixim: clinical pharmacology and role in therapy of urogenital infections].

Cefixim belongs to oral cephalosporins of the third generation and has the longest half-life period among all oral cephalosporins and, therefore can be taken once a day. Moreover, cefixim presents in high concentrations in the urine, kidneys and urinary tract. In vitro, this drug has high activity against basic pathogens of urogenital infection. A randomized clinical trial has found that cefixim has higher clinical and microbiological efficacy than ciprofloxacin in patients with acute uncomplicated cystitis.

[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.

[Present-day beta-lactame antibiotics in the treatment of urinary infections in pregnant women].

A multicenter trial of the prevalence and spectrum of urinary infection agents, their resistance to beta-lactame antibiotics in pregnant women in Russia was conducted in two stages. Stage 1 (2001) included microbiological studies, stage 2 (2005-2006)--pharmacoepidemiological ones. Most frequent uropathogens in the examinees were E. coli (62.9%) and Klebsiella spp (9.7%). Their most common strains were often resistant to ampicillin, amoxicillin. Therefore, these drugs are often ineffective against urinary infections in pregnant women. Drugs of choice are oral cephalosporines of the third generation (cephoxim), inhibitor-protected aminopenicillines, for parenteral administration-parenteral cephotaxim, cephtriaxon followed by oral (cephisim) cephalosporins of the second-third generation.

[Resistance of uropathogens and outcomes of antibacterial therapy of urinary infections].

The results of 5 prospective trials were studied with metaanalysis. The trials investigated correlations between uropathogens resistance in vitro to sulphomethoxasol/trimethoprim or trimethoprim and clinical/bacterial efficacy of these drugs. In detection of a resistant uropathogen the rate of eradication of uropathogens decreases 1.81 fold (CI 1.55-2.12; p < 0.00001), of a persistent bacteriological response 1.29 fold (CI 1.12-1.49; p = 0.0004), of recovery--1.65 fold (CI 1.44-1.89; p < 0.00001), persistent clinical response--1.42 fold (CI 1.16-1.74; p < 0.0005). At present, correlation between uropathogens resistance in vitro and efficacy of antibacterial treatment of urinary infection can be estimated only for co-trimoxasol the efficacy of which in urinary infections caused by resistant uropathogens falls 1.2-1.8 fold while 45.3% patients demonstrate bacteriological and 53.2%--clinical response to therapy. Further studies are needed for estimation of the above correlations for other groups of antibacterial drugs.

[Clinicomicrobiological characteristics of community-acquired infections of the urinary tracts in Moscow].

The structure and sensitivity of the agents of community-aquired urinary infections (CUI) in Moscow were studied in a prospective clinicomicrobiological trial carried out in 2005 with participation of 8 Moscow outpatient clinics. Minimal inhibitory concentration (MIC) of antimicrobial drugs was estimated using agar dilution test according to NCCLS recommendations (2000-2002). Acute and chronic cystitis, chronic pyelonephritis and acute pyelonephritis were most frequent CUI (49.1, 39.8 and 5.3%, respectively, while among complicating factors most frequently occurred urolithiasis (48.5%), diabetes mellitus (24.2%), renal cysts (7.6%), infravesical obstruction (6,1%). CUI in Moscow were primarily caused by E.coli (72.5%). Compared to complicated CUI, uncomplicated ones were characterized by less frequent E. coli isolation (53 and 80.9%, respectively), but significantly more frequent isolation of P.aeruginosa (4.5 and 0%) and E. faecalis (9.1 and 4.2% isolation. High resistance of E.coli isolated from patients with uncomplicated CUI was seen to cotrimoxasol (28.7%) and ampicillin (39.1%), low resistance--to amoxicilline/ clavulanate (6.3%), fluoroquinolones (6.3%), nitrofurantoin (0%), cefuroxime (6.3%), cefotaxime (0%), phosphomicine (0%). Patients with complicated CUI compared to uncomplicated CUI significantly more often had E.coli strains nonsensitive to amoxicilline/clavulanate (14 and 6.3%), cotrimoxasol (25.6 and 18.8%), nalidixic acid (18.6 and 6.3%, respectively). Polyresistant E. coli strains were significantly more prevalent in complicated CUI than in uncomplicated CUI (45.4 and 25.1%, respectively). Thus, E. coli, a main causing agent of uncomplicated CUI, demonstrates high resistance to ampicilline and cotrimoxasol. High microbiological activity is shown byfluoroquinolones, nitrofurantoin, oral cephalosporines of the second-third generation.

[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.

[Efficacy of ciprofloxacine antibiotic prophylaxis of infectious complications after TUR of the prostate].

We compared efficacy of preoperative prophylactic antibiotic treatment (PPAT) with cyprofloxacine used orally (0.5 g), intravenously (0.4 g) and routine antibiotics in TUR of the prostate. A multicenter open randomized study covered 120 patients. PPAT efficacy was estimated by the rate of urinary infection (UI), frequency and duration of antibiotic treatment in the postoperative period, hospitalization duration. All the patients were divided into three groups: 39 patients of group 1 received oral cyprofloxacine 90-120 min before TUR of the prostate, 38 patients of group 2 received intravenous cyprofloxacine 30-60 min before TUR, 43 patients of group 3 (control) received routine antibiotic prophylaxis. The following results were obtained: 24-48 hours after the operation no cases of UI in group 1, 11.5 and 11.6% in groups 2 and 3, respectively, (p = 0.048); 7 days after TUR--UI in all the groups (2.6, 20, 23.3%, respectively); 14 days after TUR--UI in 5.1, 28.6, 27.9% patients, respectively. Mean duration of hospital stay was 11.7 +/- 7.6 days in group 1, 12.1 +/- 8.1 days in group 2, 12.5 +/- 7.8 days in group C (p > 0.05). Postoperative antibiotics were given to 16.7, 34.1 and 68.9% patients, respectively. Thus, cyprofloxacine in group 1 lowered UI risk and postoperative antibiotics significantly, in group 2 it had no influence on UI rate but reduced postoperative antibiotics significantly.

[Antibacterial therapy of complicated urinary infections in outpatients]. / Antibacterial'naia terapiia oslozhnennykh infektsii mochevyvodiashchikh putei.

The term complicated urinary infections (CUIs) includes infections developing in the presence of anatomic anomalies, metabolic or hormonal disorders, immunodeficiency or infection with atypical microorganisms. Complicating factors diminish efficiency of antibiotic treatment, raise probability of recurrence. CUIs account for 45.2% of all cases of outpatient urinary infections in adults in Russia. Nephroliths, diabetes mellitus and renal cysts are most prevalent complicating factors. CUIs causative agents' spectrum is wider and resistance bacteria isolation is more frequent compared to uncomplicated urinary infections. In addition to antibiotic therapy, CUIs treatment should be focused on detection and elimination of the complicating factor. If complicating factors are unremovable, antibiotic therapy should be directed to management of clinical symptoms of urinary infection, prevention of complications and damage to renal parenchyma. CUIs demand longer courses of antibiotics than uncomplicated urinary infections: 7-14 days in infection of the lower urinary tracts, at least 14 days in infection of the upper urinary tracts and 4-6 weeks in failure of the standard course. Fluoroquinolones are drugs of choice in adults.

[Microbiological characteristics and clinical efficacy of phosphomycin]. / Microbiologicheskaia kharakteristika i klinicheskaia éffektivnost' fosfomitsina.

E. coli is the most frequent agent causing urinary infection (UI) both in adults and children. E. coli of UI outpatients is often resistant to ampicilline, amoxicilline and co-trimoxasol. The study of phosphomycin in UI outpatients showed its highest efficacy against E. coli. Phosphomycin in a single daily dose of 3 g is a drug of choice in acute uncomplicated cystitis. The results of the study also demonstrate that phosphomycin can be used for prevention of pyoinflammatory complications before endoscopic manipulations and operations as well as open operations on the lower urinary tracts and genital organs.

[Resistance of ambulatory urinary infection pathogens according to the data of multicenter microbiological studies UTIAP-I and UTIAP-II]. / Rezistentnost' vozbuditelei ambulatornykh infektsii mochevyvodiashchikh putei po dannym mnogotsentrovykh mikrobiologicheskikh issledovanii UTIAP-I i UTIAP-II.

AIM: To study causative agents and sensitivity of E-coli strains isolated from adult outpatients with uncomplicated urinary infection (UI) in different regions of Russia. MATERIAL AND METHODS: A multicenter prospective epidemiological study included adult patients with uncomplicated infections of the upper or lower urinary tracts. MPK of antibiotics was established by dilution in agar according to NCCLS recommendations, 2000-2002. RESULTS: Among UI causative agents, E. coli was most frequent (85.9%). K. Pneumoniae, Proteus spp., Staphylococcus spp., P. Aeruginosa, Enterococcus spp. occurred much less frequently (6, 1.8, 1.6, 1.2, and 1.0%, respectively). E. Coli UI was highly resistant to ampicilline (37.1%), cotrimoxasol (21%), maximal resistance being in St-Petersburg (51.9 and 31.5%, respectively). Such oral antibiotics as norfloxacin and ciprofloxacin, cefuroxim, amoxicillin/clavulanat, nitrofurantoin were maximally active against E. Coli (4.3, 2.4, 2.6 and 1.2%, respectively). CONCLUSION: High resistance of E. coli, which is the chief causative agent of uncomplicated UI, to ampicillin, cotrimoxasol was detected. Fluoroquinolones, amoxicillin/clavulanat, nitrofurantoin, cefuroxim have high microbiological activity. On the basis of the pharmacokinetic, safety and other evidence it is concluded that drugs of choice for therapy of uncomplicated UI in Russia are oral fluoroquinolones.

[Practical approaches of antibiotics choice in uncomplicated urinary tract infections]. / Prakticheskie podkhody k vyboru antibiotikov pri neoslozhnennykh infektsiiakh mochevyvodiashchikh putei.

Infections of the urinary tract (IUT) belong to the most prevalent infectious diseases. Acute cystitis is the most frequent symptom of uncomplicated IUT. The main agents of IUT are gram-negative enterobacteria, mainly Escherichia coli (80%). The agents of uncomplicated IUT are the least resistant (5%) to fluoroquinolones (norfloxacin and ciprofloxacin). The duration of antibiotic therapy for acute cystitis is determined predominantly by risk factors: a 7-day course is recommended for cases with risk factors and a 3-day one for cases without risk factors. In acute pyelonephritis antibiotic therapy should be longer (10-14 days). Preventive therapy is recommended for patients with frequent relapses of IUT.