Abstract
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.
Similar content being viewed by others
References
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.
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.
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.
Kohno S. Clinical assessment of tosufloxacin tosilate. J Infect Chemother. 2002;8:19–27.
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.
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.
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.
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.
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.
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.
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.
Nakashima M, Uemura K, Kosuge K, Uematsu T. Phase I clinical study of pazufloxacin mesilate. Jpn J Chemother. 1999;47(S-1):141–75.
Niki Y. Pharmacokinetics and safety assessments of tosufloxacin tosilate. J Infect Chemother. 2002;8:1–18.
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.
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.
Muratani T, Matsumoto T. Bacterial resistance to antimicrobials in urinary isolates. Int J Antimicrob Agents. 2004;24(suppl 1):S28–31.
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.
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.
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.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
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). https://doi.org/10.1007/s10156-012-0505-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10156-012-0505-5