Skip to main content
Log in

Optimal characteristics of agents to treat uncomplicated urinary tract infections

Optimale Eigenschaften antimikrobieller Substanzen für die Behandlung unkomplizierter Harnwegsinfektionen

  • Published:
Infection Aims and scope Submit manuscript

Summary

The optimal characteristics of agents to treat uncomplicated urinary tract infection must include activity against the major pathogens involved in these infections as well as a low potential for development of bacterial resistance. High urinary levels should be present for an adequate period to eliminate the organisms. Side effects should be minimal with minimal effect on the bacterial flora of the community. Treatment programs of single-dose, three days, or five days can be developed depending upon the agent.

Zusammenfassung

Optimale Substanzen für die Behandlung unkomplizierter Harnwegsinfektionen sollten wirksam gegen die wichtigsten Erreger sein und ein geringes Potential zur Resistenzentwicklung von Bakterien aufweisen. Für die Elimination der Erreger sind hohe Urinspiegel für einen adäquaten Zeitraum erforderlich. Die Nebenwirkungen sollten möglichst gering sein, und die Therapie sollte auf die bakterielle Flora der Allgemeinbevölkerung möglichst wenig Einfluß haben. Abhängig von der Substanz können Therapieregime für eine Einmaldosis-Behandlung, drei- oder fünf-Tagestherapien entwickelt werden.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Neu, H. C., Parry, M. F. Urinary tract infections — 1982. Use of new concepts to guide therapy. Bull. N. Y. Acad. Med. 59 (1983) 283–300.

    Google Scholar 

  2. Hooton, T. M. Epidemiology, definitions, and terminology in urinary tract infections. In:Neu, H. C., Williams, J. D. (eds): New Trends in Urinary Tract Infections. Karger, Basel 1990, pp. 1–8.

    Google Scholar 

  3. Fihn, S. D., Stamm, W. E. Interpretation and comparison of treatment studies for uncomplicated urinary tract infections in women. Rev. Infect. Dis. 7 (1985) 468–478.

    Google Scholar 

  4. Norrby, S. R. Short-term treatment of uncomplicated lower urinary tract infections in women. Rev. Infect. Dis. 12 (1990) 458–467.

    Google Scholar 

  5. Rubin, R. H. Infections of the urinary tract. Sci. Am. Med. 23 (1984) 1–12.

    Google Scholar 

  6. Kass, E. H. Chemotherapeutic and antibiotic drugs in the management of infections of the urinary tract. Am. J. Med. 18 (1955) 764–781.

    Google Scholar 

  7. Stamm, W. E. Quantitative urine cultures revisited. Eur. J. Clin. Microbiol. Infect. Dis. 3 (1984) 279–281.

    Google Scholar 

  8. Stamm, W. E. Criteria for the evaluation of antimicrobial drug efficacy in uncomplicated UTI — a problem of definitions and individualization. In:Ohkoshi, M., Kawada, Y. (eds): Clinical Evaluation of Drug Efficacy in UTI. Excerpta Medica, Amsterdam 1990, pp. 157–172.

    Google Scholar 

  9. Stamm, W. E., Counts, G. W., Running, K. R., Finn, S., Turck, M., Holmes, K. K. Diagnosis of coliform infections in acutely dysuric women. N. Engl. J. Med. 303 (1980) 409–415.

    Google Scholar 

  10. Fihn, S. D., Johnson, C., Roberts, P. L., Running, K., Stamm, W. E. Trimethoprim-sulfamethoxazole for acute dysuria in women: a single-dose or 10- day course. A double-blind randomized trial. Ann. Intern. Med. 108 (1988) 350–357.

    Google Scholar 

  11. Stamey, T. A., Govan, D. E., Palmer, J. M. The localization and treatment of urinary tract infections: the role of bactericidal urine levels as opposed to serum levels. Medicine 44 (1965): 1–36.

    Google Scholar 

  12. Neu, H. C. Single-dose treatment of urinary tract infections. A pharmacologist's view. In:Bailey, R. (ed.): Single-dose therapy of urinary tract infection. ADIS Health Sci. Press, Auckland 1983, pp. 92–97.

    Google Scholar 

  13. Stamey, T. A. The role of introital enterobacteria in recurrent urinary infections. J. Urol. 109 (1973) 467–472.

    Google Scholar 

  14. Stamey, T. A., Condy, M., Mihara, G. Prophylactic efficacy of nitrofurantoin macrocrystals and trimethoprim-sulfamethoxazole in urinary tract infections: biological effects on the vaginal and rectal flora. N. Engl. J. Med. 296 (1977) 780–782.

    Google Scholar 

  15. Neu, H. C. Contribution of beta-lactamases to bacerial resistance and mechanism to inhibit beta-lactamases. Am. J. Med. 79 Suppl. 5B (1985) 2–11.

    Google Scholar 

  16. Towner, K. J., Wise, P. J. Transferable resistance plasmids as a contributory cause of increasing trimethoprim resistance in general practice. J. Antimicrob. Chemother. 11 (1983) 33–39.

    Google Scholar 

  17. Murray, B. E., Alvarado, T., Kim, K. H. Increasing resistance to trimethoprim-sulfamethoxazole among isolates ofEscherichia coli in developing countries. J. Infect. Dis. 152 (1985) 1107–1113.

    Google Scholar 

  18. Andriole, V. T. Use of quinolones in treatment of prostatitis and lower urinary tract infections. Eur. J. Clin. Microbiol. Infect. Dis. 10 (1991) 342–350.

    Google Scholar 

  19. Neu, H. C. Penicillins. In:Mandell, G., Douglas, G., Bennett, J. (eds): Principles and Practice of Infectious Diseases. 3rd ed. Churchill Livingstone, New York 1990, pp. 230–246.

    Google Scholar 

  20. Fang, L. S. T., Tolkoff-Rubin, N. E., Rubin, P. H. Efficacy of single-dose and conventional amoxicillin therapy in urinary tract infections localized by the antibody-coated bacteria technique. N. Engl. J. Med. 298 (1978) 413–416.

    Google Scholar 

  21. Harbord, R. B., Grüneberg, R. N. Treatment of urinary tract infection with a single-dose of amoxycillin, co-trimoxazole, or trimethoprim. Br. Med. J. 283 (1981) 1301–1302.

    Google Scholar 

  22. Bailey, R. R. Review of the published studies on single-dose therapy of urinary tract infections. Infection 18 Suppl. 2 (1990) 853–856.

    Google Scholar 

  23. Savard-Fenton, M., Fenton, B. W., Reller, L. B., Lauer, B. A., Byny, R. L. Single-dose amoxicillin therapy with follow-up urine cultures. Effective initial management for acute uncomplicated urinary tract infections. Am. J. Med. 73 (1982) 808–813.

    Google Scholar 

  24. Sandberg, T., Henning, C., Iwarson, S., Paulson, O. Cefadroxil once daily for three or seven days versus amoxycillin for seven days in uncomplicated urinary tract infections in women. Scand. J. Infect. Dis. 17 (1985) 83–87.

    Google Scholar 

  25. Neu, H. C. The pharmacokinetics of bacampicillin. Rev. Infect. Dis. 3 (1981) 117–120.

    Google Scholar 

  26. Hooton, T. M., Running, K., Stamm, W. Single-dose therapy of cystitis in women. A comparison of trimethoprim-sulfamethoxazole, amoxicillin, and cyclacillin. JAMA 253 (1985) 387–390.

    Google Scholar 

  27. Neu, H. C. Mecillinam, a novel penicillanic acid derivative with unusual activity against gram-negative bacteria. Antimicrob. Agents Chemother. 9 (1976) 793–799.

    Google Scholar 

  28. Marsh, B. T., Obst, D., Menday, A. P. Comparative efficacy of 3-day and 7-day chemotherapy with pivmecillinam in urinary tract infections in general practice. J. Int. Med. Res. 8 (1980) 105–111.

    Google Scholar 

  29. Gordon, A., Kalima, S., Mäkälä, P., Antikainen, R. Comparison of three day and ten day regimen with sulfadiazine-trimethoprim combination and pivmecillinam in acute lower urinary tract infections. Scand. J. Infect. Dis. 19 (1987) 97–102.

    Google Scholar 

  30. Greenberg, R. N., Reilly, P. M., Luppen, K. L., Keinnadt, W. J., Ellington, L. I., Bollinger, M. R. Randomized study of single-dose, three day, and seven day treatment of cystitis in women. J. Infect. Dis. 153 (1986) 277–282.

    Google Scholar 

  31. Brumfitt, W., Hamilton-Miller, J. M. T., Smith, G. W. Comparative trial of cefuroxime axetil in recurrent urinary tract infections. Antimicrob. Agents Chemother. 31 (1987) 1442–1443.

    Google Scholar 

  32. Brogden, R. N., Campoli-Richards, D. M. Cefixime: a review of its antibacterial activity, pharmacokinetic properties and therapeutic potential. Drugs 38 (1989) 524–550.

    Google Scholar 

  33. Brittain, D. C., Scully, B. E., Hirose, T., Neu, H. C. The pharmacokinetic and bactericidal characteristics of oral cefixime. Clin. Pharm. Ther. 38 (1985) 590–594.

    Google Scholar 

  34. Bailey, R. B., Peddie, B. A. Comparison of single-dose netilmicin with a five-day course of co-trimoxazole for uncomplicated urinary tract infection. NZ Med. J. 97 (1984) 262–264.

    Google Scholar 

  35. Gossius, G., Vorland, L. Randomized comparison of single-dose vs. three-day and ten-day therapy with trimethoprim-sulphamethoxazole for acute cystitis in women. Scand. J. Infect. Dis. 16 (1984) 373–379.

    Google Scholar 

  36. Fihn, S. D., Johnson, C., Roberts, P. L., Running, K., Stamm, W. E. Trimethoprim-sulfamethoxazole for acute dysuria in women, a single-dose or 10-day course. A double-blind randomized study. Ann. Intern. Med. 108 (1988) 350–357.

    Google Scholar 

  37. Neu, H. C. The quinolones. Infect. Dis. Clin. N. Am. 3 (1989) 625–640.

    Google Scholar 

  38. Naber, K. G. Use of quinolones in urinary tract infections and prostatitis. Rev. Infect. Dis. 11 Suppl. (1989) 1321–1337.

    Google Scholar 

  39. Kosmidis, J., Gargalianos, P., Adamis, G., Petropoulou, D., Markis, D. Fleroxacin in single-dose oral therapy of uncomplicated urinary tract infection. J. Antimicrob. Chemother. 22 Suppl. D (1988) 219–221.

    Google Scholar 

  40. Ode, B., Walder, M., Forsgren, A. Failure of a single-dose of 100 mg ofloxacin in lower urinary tract infections in females. Scand. J. Infect. Dis. 19 (1987) 677–679.

    Google Scholar 

  41. Naber, K. G., Thyroff-Friesinger, U. Fosfomycin trometamol versus ofloxacin/co-trimoxazole as single dose therapy of acute uncomplicated urinary tract infection in females: a multicentre study. Infection 17 Suppl. 2 (1990) S 70-S 76.

    Google Scholar 

  42. Neu, H. C. Fosfomycin trometamol — management of lower urinary tract infections. Chemotherapy 36 Suppl. 1 (1990) 53–55.

    Google Scholar 

  43. Segre, G., Bianchi, E., Cataldi, A., Zannini, G. Pharmacokinetic profile of fosfomycin trometamol (Monuril). Eur. Urol. 13 Suppl. (1987) 56–63.

    Google Scholar 

  44. Carlae, N. A., Borsotto, M., Cuffini, A. M., Savoia, D. Effect of fosfomycin trometamol on bacterial adhesion in comparison with other chemotherapeutic agents. Eur. Urol. 13 Suppl. 1 (1987) 86–91.

    Google Scholar 

  45. Neu, H. C. Fosfomycin trometamol versus amoxycillin single-dose multicenter study of urinary tract infections. Chemotherapy 36 Suppl. 1 (1990) 10–18.

    Google Scholar 

  46. Crocchiolo, P. Single-dose fosfomycin trometamol versus multiple-dose co-trimoxazole in the treatment of lower urinary tract infections in general practice. Chemotherapy 36 Suppl. 2 (1990) 37–40.

    Google Scholar 

  47. Jardin, A. A general practitioner multicenter study: fosfomycin trometamol single-dose versus pipemidic acid multiple dose. Infection 18 Suppl. 2 (1990) 89–93.

    Google Scholar 

  48. Boerema, J. B. J., Willems, F. T. C. Fosfomycin trometamol in a single-dose versus norfloxacin for seven days in the treatment of uncomplicated urinary infections in general practice. Infection 18 Suppl. 2 (1990) 80–87.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Neu, H.C. Optimal characteristics of agents to treat uncomplicated urinary tract infections. Infection 20 (Suppl 4), S266–S271 (1992). https://doi.org/10.1007/BF01710012

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01710012

Keywords

Navigation