Abstract
There has been a growing rate of resistance among common urinary tract pathogens,
such as Escherichia coli, to traditional antimicrobial therapies including the “gold standard” trimethoprim-sulfamethoxazole
(TMP-SMX). Consequently, fluoroquinolone antimicrobial agents have taken on an expanding
management role for UTIs. In fact, the recent Infectious Diseases Society of America
clinical management guidelines for UTI recommend fluoroquinolones as first-line therapy
for uncomplicated UTI in areas where resistance is likely to be of concern.
Fluoroquinolones have demonstrated high bacteriologic and clinical cure rates, as
well as low rates of resistance, among most common uropathogens. There are currently
7 fluoroquinolones with indications for UTI in the United States. However, only 3
are commonly used: levofloxacin, ciprofloxacin, and, to a lesser extent, gatifloxacin.
Many of the fluoroquinolone agents have once-daily dosing regimens, enhancing patient
adherence. In addition, levofloxacin and gatifloxacin have same-dose bioequivalency
between their intravenous and oral formulations, allowing for “switch” or step-down
therapy from parenteral to oral formulations of the same agent at the same dose.
Fluoroquinolones are indicated for the management of acute uncomplicated UTIs, as
well as complicated and severe UTI and pyelonephritis, in adults. They are the first-line
treatment of acute uncomplicated cystitis in patients who cannot tolerate sulfonamides
or TMP, who live in geographic areas with known resistance >10% to 20% to TMP-SMX,
or who have risk factors for such resistance. Fluoroquinolone properties include a
broad spectrum of coverage, low rates of resistance, and good safety profiles.
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© 2002 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
