Skip to main content

The efficacy of sequential therapy using pazufloxacin followed by oral fluoroquinolones for treatment of pyelonephritis


The efficacy of sequential therapy of pazufloxacin (PZFX), which is a parenteral fluoroquinolone, followed by oral fluoroquinolones [tosufloxacin tosilate (TFLX) or levofloxacin (LVFX)] for treatment of pyelonephritis, was evaluated. Patients with pyelonephritis who had fever (≥37.5 °C), pyuria (≥10 white blood cells/high-power field), and bacteriuria (≥104 colony-forming units/ml) were eligible for this study. PZFX (500 mg) was given intravenously twice a day for at least 3 days. If the patients were clinically improved, TFLX (150 mg) or LVFX (100 mg) was then administered orally three times a day for at least 5 days. Patients underwent clinical and microbiological evaluation at 5–9 days after final drug administration. Clinical and microbiological efficacy could be assessed in 21 of 25 cases enrolled. Both clinical and microbiological efficacy rates were 81.0 % (17/21 cases). In the effective cases, the mean administration time was 4.2 days for PZFX and 6.0 days for oral fluoroquinolones. The mean time to defervescence was 3.4 days for the effective cases. In the four treatment failure cases, three quinolone-resistant Escherichia coli and a quinolone-resistant Enterococcus faecalis were isolated. This sequential therapy seemed to be clinically effective in the treatment of pyelonephritis; however, the prevalence of quinolone-resistant E. coli should be taken into account.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. Vilaichone A, Watana D, Chaiwatanarat T. Oral ceftibuten switch therapy for acute pyelonephritis in children. J Med Assoc Thai. 2001;84(suppl 1):S61–7.

    PubMed  Google Scholar 

  2. Bailey RR, Begg EJ, Smith AH, Robson RA, Lynn KL, Chambers ST, et al. Prospective, randomized, controlled study comparing two dosing regimens of gentamicin/oral ciprofloxacin switch therapy for acute pyelonephritis. Clin Nephrol. 1996;46:183–6.

    PubMed  CAS  Google Scholar 

  3. Cox CE. Sequential intravenous and oral ciprofloxacin versus intravenous ceftazidime in the treatment of complicated urinary tract infections. Am J Med. 1989;87(5A):157S–9S.

    PubMed  Article  CAS  Google Scholar 

  4. Kohno S. Clinical assessment of tosufloxacin tosilate. J Infect Chemother. 2002;8:19–27.

    PubMed  CAS  Google Scholar 

  5. National Committee for Clinical Laboratory Standards (NCCLS) Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically. Approved standard M7-A5. 6th ed. Wayne: NCCLS; 2003.

  6. Sanchez M, Collvinent B, Miró O, Horcajada JP, Moreno A, Marco F, et al. Short-term effectiveness of ceftriaxone single dose in the initial treatment of acute uncomplicated pyelonephritis in women. A randomized controlled trial. Emerg Med J. 2002;19:19–22.

    PubMed  Article  CAS  Google Scholar 

  7. Tomera KM, Burdmann EA, Reyna OG, Jiang Q, Wimmer WM, Woods GL, et al. Ertapenem versus ceftriaxone followed by appropriate oral therapy for treatment of complicated urinary tract infections in adults: results of a prospective, randomized, double-blind multicenter study. Antimicrob Agents Chemother. 2002;46:2895–900.

    PubMed  Article  CAS  Google Scholar 

  8. Jimenez-Cruz F, Jasovich A, Cajigas J, Jiang Q, Imbeault D, Woods GL, et al. A prospective, multicenter, randomized, double-blind study comparing ertapenem and ceftriaxone followed by appropriate oral therapy for complicated urinary tract infections in adults. Urology. 2002;60:16–22.

    PubMed  Article  Google Scholar 

  9. Wells WG, Woods GL, Jiang Q, Gesser RM. Treatment of complicated urinary tract infection in adults: combined analysis of two randomized, double-blind, multicentre trials comparing ertapenem and ceftriaxone followed by appropriate oral therapy. J Antimicrob Chemother. 2004;53(suppl 2):ii67–74.

    PubMed  Article  CAS  Google Scholar 

  10. Talan DA, Stamm WE, Hooton TM, Moran GJ, Burke T, Iravani A, et al. Comparison of ciprofloxacin (7 days) and trimethoprim–sulfamethoxazole (14 days) for acute uncomplicated pyelonephritis in women: a randomized trial. JAMA. 2000;283:1583–90.

    PubMed  Article  CAS  Google Scholar 

  11. Takahashi S, Hirose T, Satoh T, Kato R, Hisasue S, Takagi S, Shimazu T, Kunishima Y, Matsukawa M, Itoh N, Tsukamoto T. Efficacy of a 14-day course of oral ciprofloxacin therapy for acute uncomplicated pyelonephritis. J Infect Chemother. 2001;7:255–7.

    PubMed  Article  CAS  Google Scholar 

  12. Nakashima M, Uemura K, Kosuge K, Uematsu T. Phase I clinical study of pazufloxacin mesilate. Jpn J Chemother. 1999;47(S-1):141–75.

    CAS  Google Scholar 

  13. Niki Y. Pharmacokinetics and safety assessments of tosufloxacin tosilate. J Infect Chemother. 2002;8:1–18.

    PubMed  CAS  Google Scholar 

  14. Kawada Y, Kumamoto Y, Tsuchida M, Aso Y, Machida T, Saito I, et al. Comparative study of T-3262 (tosufloxacin tosilate 9) and norfloxacin in complicated urinary tract infections. Chemotherapy. 1989;37:649–69.

    Google Scholar 

  15. Rubin RH, Shapiro ED, Andriole VT, Davis RJ, Stamm WE. Evaluation of new anti-infective drugs for the treatment of urinary tract infection. Clin Infect Dis. 1992;15(suppl 1):S216–27.

    PubMed  Article  Google Scholar 

  16. Muratani T, Matsumoto T. Bacterial resistance to antimicrobials in urinary isolates. Int J Antimicrob Agents. 2004;24(suppl 1):S28–31.

    PubMed  Article  Google Scholar 

  17. Wada K, Kariyama R, Mitsuhata R, Uehara S, Watanabe T, Monden K, et al. Experimental and clinical studies on fluoroquinolone-insusceptible Escherichia coli isolated from patients with urinary tract infections from 1994 to 2007. Acta Med Okayama. 2009;63:263–72.

    PubMed  CAS  Google Scholar 

  18. Ishikawa K, Matsumoto T, Yasuda M, Uehara S, Muratani T, Yagisawa M, et al. The nationwide study of bacterial pathogens associated with urinary tract infections conducted by the Japanese Society of Chemotherapy. J Infect Chemother. 2011;17:126–38.

    PubMed  Article  Google Scholar 

  19. Takahashi S, Kurimura Y, Takeyama K, Hashimoto K, Miyamoto S, Ichihara K, Igarashi M, Hashimoto J, Furuya R, Hotta H, Uchida K, Miyao N, Yanase M, Takagi Y, Tachiki H, Taguchi K, Tsukamoto T. Efficacy of treatment with carbapenems and third-generation cephalosporins for patients with febrile complicated pyelonephritis. J Infect Chemother. 2009;15:390–5.

    PubMed  Article  CAS  Google Scholar 

Download references

Conflict of interest


Author information

Authors and Affiliations


Corresponding author

Correspondence to Koichi Takahashi.

About this article

Cite this article

Takahashi, K., Muratani, T., Akasaka, S. et al. The efficacy of sequential therapy using pazufloxacin followed by oral fluoroquinolones for treatment of pyelonephritis. J Infect Chemother 19, 456–464 (2013).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Pazufloxacin
  • Pyelonephritis
  • Sequential therapy
  • Switch therapy
  • Quinolone-resistant Escherichia coli