Fewer bacterial relapses after oral treatment with norfloxacin than with ceftibuten in acute pyelonephritis initially treated with intravenous cefuroxime

This double-blind, multicentre study was performed at nine centres on a tot al of 171 patients who presented with fever (> 38.5 degreesC) and signs of acute pyelonephritis. All were initially treated with intravenous cefuroxim e, After 2-3 d, when the fever had subsided and urinary culture had reveale d growth of Gram-negative bacteria (> 10(7) colony-forming units per litre) , treatment was changed to oral administration of ceftibuten 200 mg b.i.d. or norfloxacin 400 mg b.i.d. for 10 d, The patients were followed for signs of bacterial or clinical relapse 7-14 d after the end of treatment. The in itial clinical and bacteriological cure was excellent in both groups, but t here were significantly fewer bacterial relapses after oral treatment with norfloxacin than with ceftibuten in acute febrile pyelonephritis initially treated with intravenous cefuroxime, The causal strain was eradicated in 75 % of patients (73% of males, 76% of females) in the ceftibuten group and in 89% of patients (94%, of males, 85% of females) in the norfloxacin group. The relative frequency of eradication was 0.84 (p < 0.05; 95% confidence in terval 0.74-0.97), Adverse events were reported by 47% of the patients in t he ceftibuten group and by 38% in the norfloxacin group, This difference wa s not significant, but diarrhoea or loose stools occurred more frequently i n the ceftibuten group.