Treatment for 7 days with the antibiotic ciprofloxacin is as effective at treating acute pyelonephritis in women as a 14-day regimen of the fluoroquinolone, with a similar safety profile, report Swedish researchers.
Both the clinical and bacteriologic cure rates were high at short- and long-term follow up in patients who received both treatment regimens, show the study findings.
There is concern about the emerging resistance of such infections to antibiotics, and "an important way to tackle antibiotic resistance is to reduce antibiotic consumption - eg, by shortening the duration of treatment," say Torsten Sandberg (Sahlgrenska University, Gothenburg) and colleagues in The Lancet.
Therefore, "if the use of ciprofloxacin can be restricted to febrile or complicated urinary tract infections and if the length of treatment is reduced as shown in this study, the trends in increasing resistance might be impeded," they add.
The team randomly assigned 156 women with acute pyelonephritis to either ciprofloxacin 500 mg twice daily for 7 days (n=73, mean age 46 years), or 14 days (n=83, mean age 41 years), and followed the groups up 17-21 days and 24-28 days after treatment cessation, respectively.
A total of 71 (97%) and 80 (96%) women in the 7- and 14-day groups achieved a clinical cure at follow up - defined as complete resolution of symptoms during treatment with no recurrence or sign of urinary tract infection during follow up - indicating the non-inferiority of the shorter regimen, note Sandberg et al.
At a later, 42-63-day post-treatment follow up, the researchers observed that three patients on the 7-day regimen had an episode of acute cystitis, while one patient in the 14-day regimen group had an additional episode of acute pyelonephritis and two patients had an episode of acute cystitis; a nonsignificant difference.
In all, just 5% and 6% of the 7- and 14-day regimen groups reported an adverse event after the first week of treatment. At this same time point, no patients in the 7-day ciprofloxacin group had mucosal candida, while marginally significantly more (n=5) in the 14-day group had the infection.
"The findings should not be extrapolated to other classes of antibiotics," conclude Sandberg and co-workers.
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