The efficacy of single-dose therapy with trimethoprim-sulfamethoxazole (TMP-SMZ) and the cost-effectiveness of routine urinalyses and cultures were studied in a prospective randomized trial of 200 women who presented with symptoms of acute lower urinary tract infection. Without the physician's knowledge of the results of urinalysis or culture, the patients were randomly assigned to receive either a single dose or a 10-day multiple-dose course of TMP-SMZ and were followed up for 6 months. Of the 136 patients with positive urine cultures, 68 received single-dose therapy with TMP-SMZ--10 of whom had relapses--and 68 received multiple-dose therapy with TMP-SMZ--only 2 of whom had relapses (P less than 0.02). Fifteen patients in each treatment group experienced reinfection. Side effects of rash and vaginitis were more common in patients who received multiple-dose therapy, but they were mild and well tolerated. Of the 51 patients with urethral syndrome, 48 became asymptomatic after therapy. None of the following tests predicted treatment outcome: pretreatment urinalysis, urine culture or susceptibility testing, antibody-coated bacteria testing, or routine follow-up urinalyses or urine cultures. Empiric therapy with TMP-SMZ in selected women with symptoms of acute uncomplicated urinary tract infection seems practical, safe, and cost-efficient. Considerable savings can be achieved by reserving urinalyses and urine cultures for patients with persistent or recurrent symptoms. Higher cure rates can be expected in patients who receive a standard 10-day course of therapy with TMP-SMZ compared with those who receive single-dose therapy with TMP-SMZ.

OBJECTIVE:

compare the acceptability of 3-day regimen with that of 10-day regimen of fluoroquinolones for the treatment of recurrent uncomplicated lower urinary tract infection in women.

METHODS:

a multicentric, randomized open trial was conduced in 421 patients by gynecologic and general practitioners to determine acceptability, efficacy and safety of lomefloxacin 400 mg in a once a day dose given for three days compared with norfloxacin 800 mg in twice a day dose given for ten days for the treatment of recurrent uncomplicated lower urinary tract infection in women.

RESULTS:

acceptability, assessed at day 14, was significantly better for lomefloxacin group than norfloxacin group, respectively 57,1 p.100 and 38,0 p.100. Clinical success rate at day 14 was 97,2 p.100 for lomefloxacin and 97,5 p.100 for norfloxacin; at day 30 clinical success rate was respectively 97,6 p.100 and 98,1 p.100 relapse at one year was comparable between two groups. Adverse events were reported respectively in 15,6 p.100 and 16,6 p.100 of the patients, vaginal infections, dermatologic disorders and digestive disorders (abdominal pain, nausea) predominated. There were no serious adverse event.

CONCLUSION:

the acceptability is better for a 3-day regimen of lomefloxacin than a 10-day regimen of norfloxacin for treatment of recurrent uncomplicated lower urinary tract infection in women for comparable efficacy and safety.

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Pivmecillinam was compared with cotrimoxazole in the treatment of uncomplicated bacterial cystitis in general practice. Similar bacteriological cure rates were obtained with the two treatments. Although micrococci were judged resistant to pivmecillinam by the disc sensitivity method used, cystitis attributed to these organisms and to resistant strains of Proteus mirabilis responded as readily as those due to apparently sensitive Gram-negative bacteria. Pivmecillinam was well tolerated.

BACKGROUND:

There is a paucity of data on the efficacy of nitrofurantoin for the treatment of acute uncomplicated cystitis in regimens shorter than 7 days. Evidence-based use of this drug is increasingly important as trimethoprim-sulfamethoxazole resistance among uropathogens increases.

METHODS:

To assess the efficacy of nitrofurantoin vs trimethoprim-sulfamethoxazole, 338 women aged 18 to 45 years with acute uncomplicated cystitis were randomized to open-label treatment with either trimethoprim-sulfamethoxazole, 1 double-strength tablet twice daily for 3 days, or nitrofurantoin, 100 mg twice daily for 5 days. Clinical cure 30 days after therapy was the main outcome measure. Secondary outcomes included clinical and microbiological cure rates 5 to 9 days after therapy and, for trimethoprim-sulfamethoxazole-treated women, clinical cure stratified by the trimethoprim-sulfamethoxazole susceptibility of the uropathogen.

RESULTS:

Clinical cure was achieved in 79% of the trimethoprim-sulfamethoxazole group and in 84% of the nitrofurantoin group, for a difference of -5% (95% confidence interval, -13% to 4%). Clinical and microbiological cure rates at the first follow-up visit were also equivalent between the 2 groups. In the trimethoprim-sulfamethoxazole arm, 7 of 17 women (41%) with a trimethoprim-sulfamethoxazole-nonsusceptible isolate had a clinical cure compared with 84% of women with a trimethoprim-sulfamethoxazole-susceptible isolate (P < .001).

CONCLUSION:

A 5-day course of nitrofurantoin is equivalent clinically and microbiologically to a 3-day course of trimethoprim-sulfamethoxazole and should be considered an effective fluoroquinolone-sparing alternative for the treatment of acute cystitis in women.

Female patients with interstitial cystitis (IC) unresponsive to standard oral and intravesical therapy were enrolled at three clinical sites for percutaneous sacral nerve root stimulation (PNS) in a prospective, observational pilot study. Evaluation was in the form of a 3-day voiding diary completed both prior to and following the commencement of sacral nerve root stimulation. Symptoms were also assessed by the O'Leary-Sant Interstitial Cystitis Symptom and Problem Indices (ICSI and ICPI). Baseline and test stimulation values for voiding diary parameters and O'Leary-Sant scores were compared to determine treatment efficacy. A total of 33 patients were enrolled. Statistically significant improvements were seen in frequency, pain, average voided volume and maximum voided volume. Significant improvements were also seen in ICSI and ICPI scores. Subacute PNS appears to be effective in reducing symptom severity and increasing voided volumes in patients with IC previously unresponsive to standard therapy.

STUDY OBJECTIVE:

The prevalence of interstitial cystitis (IC) in young women, especially in those 18 years old or younger, is not well defined. This case series was performed to investigate IC as a cause of chronic pelvic pain (CPP) in young women.

DESIGN:

Case series.

SETTING:

University medical center.

PARTICIPANTS:

Twenty-eight women with CPP, ages 13 to 25, who underwent concomitant laparoscopy and cystoscopy.

INTERVENTIONS:

All subjects underwent concomitant diagnostic laparoscopy and cystoscopy with hydrodistension for evaluation of CPP. Charts were reviewed to discern preoperative symptoms, operative findings, and postoperative diagnoses.

MAIN OUTCOME MEASURE:

Diagnosis of IC based on symptoms and cystoscopic findings.

RESULTS:

All 28 women had CPP, 23 (82%) had dysmenorrhea, and 12 of 25 (48%) sexually active subjects had dyspareunia. Twenty-six subjects (93%) had urinary symptoms including frequency (75%), nocturia (32%), urgency (25%), and dysuria (18%). Eleven (39%) subjects were diagnosed with IC and 18 (64%) with endometriosis, including 7 (25%) subjects with both IC and endometriosis. Laparoscopic findings were normal in 6 (21%) subjects. Of the 26 subjects with urinary symptoms, 21 (81%) had findings on laparoscopy or cystoscopy. In this cohort of young women with chronic pelvic pain, urinary frequency and dyspareunia were significantly associated with the diagnosis of IC.

CONCLUSIONS:

The results of this study suggest that interstitial cystitis is an etiology of CPP in young women. Evaluation of the bladder as an origin of pelvic pain is warranted in young women with CPP and urinary frequency or dyspareunia.

Objetivos: Comparación de los diferentes regímenes terapéuticos endovesicales a base de agentes restituidores de glucosaminoglicanos (AR-GAG) comercialmente disponibles en España en términos de efectividad clínica. Material y método: Análisis bibliográfico de los estudios publicados en Medline entre 1996 y 2012 sobre AR-GAG de aplicación vesical con énfasis en los resultados clínicos. Comparación post-hoc de la eficacia de dicho tratamiento en los estudios realizados en pacientes con cistitis intersticial en diferentes condiciones, mediante el cálculo de los tamaños de efecto para el análisis de mejora en la escala analógica visual (EAV) de dolor y la tasa de respuesta clínica. Cálculo del número necesario de pacientes a tratar (NNT) para los distintos agentes a partir de la odds ratio (OR) e implicaciones económicas asociadas. Resultados: La evidencia disponible es globalmente escasa. Un total de 38 artículos tratan de AR-GAG en diferentes indicaciones, 17 de ellos en cistitis intersticial y solamente 8 son subsidiarios de establecer comparación entre los resultados presentados. Los tratamientos empleados fueron placebo, ácido hialurónico de alto peso molecular al 0,8% (Cystistat®), condroitín sulfato sódico al 2% (Uracyst®) y una combinación de ácido hialurónico de bajo peso molecular al 1,6% más condroitín sulfato al 2% (Ialuril®), entre 6 y 12 instilaciones. Otro preparado de ácido hialurónico de bajo peso molecular (Uromac®) carece de evidencia científica alguna. Todos los elementos terapéuticos estudiados muestran disminución de la puntuación media de la EAV de dolor y aumento de la tasa de respuesta postratamiento. El NNT para los tratamientos estadísticamente ventajosos sobre placebo oscila entre 1,6 y 4,1. La comparación post-hoc de las tasas de respuesta establece que Cystistat® 12 instilaciones (OR: 18,8; IC 95%: 6,4-57,2; p=0,001) o 10 instilaciones (OR: 19,2; IC 95%: 5,3-75,3; p=0,001) son las pautas de tratamiento que obtienen máxima efectividad. En ambos casos el NNT fue 1,6. Conclusiones: Este estudio está sujeto a múltiples limitaciones inherentes a la naturaleza de su diseño; no obstante, muestra que, a pesar de que la literatura disponible es escasa, existen diferencias en cuanto a la efectividad clínica de los diferentes agentes y regímenes aplicados para el tratamiento endovesical de la cistitis intersticial. Estas diferencias conllevan también implicaciones de índole económica (AU)

CRD COMMENTARY:

This was a clearly presented review with well-defined methods and inclusion criteria. The authors performed an adequate search of the literature and although they did not specifically search for unpublished data they did contact the manufacturer. The authors also stated that publication bias was a possibility but unlikely considering that interstitial cystitis is not common disease and calculations suggest that 12-81 unpublished studies would be required to overturn the findings. They may however have missed relevant data by only including English language publications. A quality assessment and an assessment of study heterogeneity were performed before the studies were combined and the statistical methods used to combine the data appear to be reasonable. It would however have been interesting to know, in the interests of completeness, the drug dose regimens for each individual study. However, it would appear that the evidence presented supports the authors' conclusions.

OBJECTIVES:

Compare the acceptability of a 3-day regimen with that of a single-dose regimen of fluoroquinolones for the treatment of lower urinary tract infection in women.

METHODS:

A multicentric, randomized open trial was conduced in 595 patients by general practitioners to determine acceptability, efficacy and tolerance of lomefloxacine 400 mg in a once a day dose given for three days compared with a once-a-day 800 mg dose of pefloxacin for the treatment of lower urinary tract infection in women.

RESULTS:

The delay to symptom relief was greater than 24 hours in both treatment groups. Symptom relief was observed after treatment onset in only 23% of the patients. Clinical success rate at day 14 was 94.2% for lomefloxacin and 95.7% for pefloxacin. The rates of bacteriological eradication were 90.6% and 92.8% respectively with no significant difference. Adverse events were reported in 27.1% and 33.3% of the patients respectively, digestive disorders (abdominal pain, nausea) and neurosensorial disorders (headache, dizziness) predominated. There was no serious adverse event. The incidence of adverse events related to the treatment according to the investigator was smaller with lomefloxacin (16.1%) than with pefloxacin (23.5%) (p = 0.026).

CONCLUSION:

Acceptability, assessed at day 14, was not significantly different between the two treatment groups. Lomefloxacin was the only antibiotic currently authorized for use in a three-day regimen for the treatment of lower urinary tract infections.