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Chapter 9 : Treatment of Urinary Tract Infections

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Abstract:

Urinary tract infections (UTIs) are among the most common reasons for an outpatient office visit and for antimicrobial usage among adult patients. UTIs occur most frequently in young adult women, affecting up to 50% of women at some time during their lifetime. The major syndromes of UTIs include cystitis, prostatitis, pyelonephritis, recurrent UTI, catheter-associated UTI, and asymptomatic bacteriuria. UTIs in pregnant women are considered complicated because of the physiologic changes during pregnancy which increase the risk of upper UTI, as well as the potential for adverse outcomes for the mother and fetus, which have been associated with UTI. The in vitro activity of the fluoroquinolones against members of the makes them excellent candidates for treatment of urinary tract infections. The use of fluoroquinolones for treatment of acute uncomplicated cystitis remains controversial, not because of concern over the efficacy of these agents in UTI, but due to potential emergence of resistance among pathogens causing UTI (and more serious invasive infections) with the increased use of fluoroquinolones. The use of quinolones for treatment of acute pyelonephritis is appealing because of the high concentrations achieved by most agents in this class in renal tissue. The pharmacokinetics, spectrum of activity, and bioavailability of the fluoroquinolones continue to make them highly attractive for treatment of infections involving the urinary tract.

Citation: Gupta K, Stamm W, Naber K. 2003. Treatment of Urinary Tract Infections, p 159-170. In Hooper D, Rubinstein E (ed), Quinolone Antimicrobial Agents, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817817.ch9
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Tables

Generic image for table
Table 1

Selected pharmacokinetic parameters of oral fluoroquinolones

Citation: Gupta K, Stamm W, Naber K. 2003. Treatment of Urinary Tract Infections, p 159-170. In Hooper D, Rubinstein E (ed), Quinolone Antimicrobial Agents, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817817.ch9
Generic image for table
Table 2

Equivalent dosages of oral fluoroquinolones for the treatment of urinary tract infectionsa

Citation: Gupta K, Stamm W, Naber K. 2003. Treatment of Urinary Tract Infections, p 159-170. In Hooper D, Rubinstein E (ed), Quinolone Antimicrobial Agents, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817817.ch9
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Table 3

Comparative studies of fluoroquinolones versus SXT for acute uncomplicated cystitis

Citation: Gupta K, Stamm W, Naber K. 2003. Treatment of Urinary Tract Infections, p 159-170. In Hooper D, Rubinstein E (ed), Quinolone Antimicrobial Agents, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817817.ch9
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Table 4

Comparative trials of fluoroquinolones for acute uncomplicated cystitis

Citation: Gupta K, Stamm W, Naber K. 2003. Treatment of Urinary Tract Infections, p 159-170. In Hooper D, Rubinstein E (ed), Quinolone Antimicrobial Agents, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817817.ch9
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Table 5

Fluoroquinolone treatment trials for pyelonephritis

Citation: Gupta K, Stamm W, Naber K. 2003. Treatment of Urinary Tract Infections, p 159-170. In Hooper D, Rubinstein E (ed), Quinolone Antimicrobial Agents, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817817.ch9
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Table 6

NIH/National Institute of Diabetes and Digestive and Kidney Diseases classification of prostatitis (1995)

Citation: Gupta K, Stamm W, Naber K. 2003. Treatment of Urinary Tract Infections, p 159-170. In Hooper D, Rubinstein E (ed), Quinolone Antimicrobial Agents, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817817.ch9
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Table 7

Fluoroquinolones in the treatment of chronic bacterial prostatitis with a follow-up of at least 6 months

Citation: Gupta K, Stamm W, Naber K. 2003. Treatment of Urinary Tract Infections, p 159-170. In Hooper D, Rubinstein E (ed), Quinolone Antimicrobial Agents, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817817.ch9

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