Symptomatic
urinary tract infections (UTIs) constitute a major health problem throughout the Western world. In the USA, UTIs are responsible for 7-8 million outpatient visits each year and for over one-third of all hospital-acquired
infections. Empiric antimicrobial
therapy for UTIs, which are primarily caused by Escherichia coli, is increasingly being complicated by the emergence of resistance to the most widely used agents. Recent studies indicate that the prevalence of E. coli resistance to
trimethoprim/
sulphamethoxazole (
TMP/SMX), the current first-line
therapy for UTIs, exceeds 20% in many North American regions. Importantly, antibiotic resistance often translates into clinical failure. The use of
antibiotics with favourable pharmacokinetic/pharmacodynamic profiles and convenient dosing schedules, which effectively increase bacterial eradication and patient compliance, can help to curb the current epidemic of resistance and reduce the rate of clinical failure associated with resistance.
Fluoroquinolones have well-established efficacy in the treatment of multiple
bacterial infections and, over the years, the rates of resistance to these
antibiotics have remained very low.
Fluoroquinolones are currently recommended for
therapy of uncomplicated UTIs when the local incidence of
TMP/SMX resistance is >or=10-20%, as well as for the treatment of complicated UTIs and acute
pyelonephritis.
Ciprofloxacin, one of the most widely used
fluoroquinolones, has a potent bactericidal effect across the full spectrum of uropathogens, as well as a long and excellent efficacy and safety record in the management of UTI and other
infections. A recently developed extended (modified)-release formulation of
ciprofloxacin (
Cipro XR or
Cipro XL) provides higher maximum plasma concentrations with lower inter-patient variability than the conventional, immediate-release, twice-daily formulation. Additionally, therapeutic drug levels with extended-release
ciprofloxacin are achieved rapidly and maintained over the course of 24 h, allowing once-daily dosing. Clinical trials in patients with
cystitis and those with complicated UTIs or acute uncomplicated
pyelonephritis indicate that extended-release
ciprofloxacin is at least as effective as the immediate-release formulation. These studies have also confirmed good tolerability and safety of extended-release
ciprofloxacin, similar to the immediate-release formulation. Therefore, extended-release
ciprofloxacin is a convenient, well-tolerated and effective
therapy for UTIs that may improve patients' compliance with treatment and thus decrease the risk of treatment failure and the spread of antibiotic resistance.