A randomized trial of short-course ciprofloxacin, ofloxacin, or trimethoprim/sulfamethoxazole for the treatment of acute urinary tract infection in women

PURPOSE: Bladder infections are very common in otherwise healthy women, and short-course antimicrobial treatment appears effective for many episodes o f cystitis. This study reports the results of short-course ciprofloxacin, o floxacin, and trimethoprim/sulfamelhoxazole therapy. PATIENTS AND METHODS: We performed a randomized, double-blind study of the efficacy and safety of a 3-day course of oral ciprofloxacin 100 mg twice da ily, ofloxacin 200 mg twice daily, or trimethoprim/sulfamethoxazole 160/800 mg twice daily in women with acute, uncomplicated, symptomatic lower urina ry tract infection. RESULTS: A total of 866 patients were enrolled, of whom 688 (79%) were eval uated for the efficacy of treatment (229 treated with ciprofloxacin, 228 tr eated with trimethoprim/suliamethoxazole, and 231 treated with ofloxacin). The most frequent reason for exclusion was the failure to identify a pretre atment pathogen. The most commonly isolated pathogen was Escherichia coli ( 81%). Eradication of the pretreatment pathogen at the end of therapy occurr ed in 94% of ciprofloxacin, 93% of trimethoprim/sulfamethoxazole, and 97% o f ofloxacin-treated patients. At follow-up evaluation at 4 to 6 weeks, recu rrence rates (relapse or reinfection) were 11% in the ciprofloxacin, 16% in the trimethsprim/sulfamethoxazole, and 13% in the ofloxacin treatment grou p. Clinical success at the end of therapy was 93% in the ciprofloxacin, 95% in the trimethoprim/sulfamethoxazole, and 96% in the ofloxacin treatment g roups. The frequency of all adverse events was 31% for ciprofloxacin, 41% f or trimethoprim/sulfamethoxazole, and 39% for ofloxacin-treated patients (P = 0.03). Premature discontinuation of study drug due to an adverse event w as more common in trimethoprim/sulfamethoxazole-treated patients (n = 9) co mpared with those given ciprofloxacin (n = 2) or ofloxacin (n = 1; P = 0.02 ). CONCLUSION: Ciprofloxacin, ofloxacin, and trimethoprim/sulfamethoxazole had similar efficacy when given for 3 days to treat acute, symptomatic, uncomp licated lower urinary tract infection in women. (C) 1999 by Excerpta Medica , Inc.