Prospective, randomized, controlled study comparing two dosing regimens of gentamicin/oral ciprofloxacin switch therapy for acute pyelonephritis.

Abstract

Aminoglycosides are drugs of choice for severe gram-negative urinary tract sepsis. Recent evidence suggests that they are just as efficacious, but less nephrotoxic and ototoxic, if given as a single daily dose rather than in divided doses. We considered that a single, large dose of an aminoglycoside followed by oral therapy with a different antibiotic might be equally effective and possibly less toxic. This randomized, controlled study compared a single large i.v. dose (10 mg/kg) of gentamicin (S) with a standard multiple dose regimen (M) of gentamicin (2.5 mg/kg i.v. stat and then computer generated divided doses aiming for peak and trough concentrations of 8 and 1.5 mg/l respectively) for the treatment of patients with suspected acute pyelonephritis requiring hospitalization for parenteral antibiotic treatment. All patients were switched to oral ciprofloxacin either four hours after the S dose or when clinically appropriate in the M regimen. For all patients the total duration of treatment was five days. Fifty-three patients (48 women; mean age 32 yr) were enrolled. Clinical and bacteriological efficacy could be assessed in 41 patients. Thirteen of 16 in the S arm and 24 of 25 in the M arm were clinically cured and the other four clinically improved. Fifteen of 16 in the S arm and 23 of 25 in the M arm were cured bacteriologically (sterile urine 7-10 days after treatment). In 41 patients high tone audiometry was carried out before or very soon after the start of treatment, and again at the end of treatment. Ototoxicity (> or = 10 dB loss in > or = 2 frequencies in both ears) was observed in 3 of 18 in the S group (17%) and 7 of 23 in the M group (30%) (NS). Other side-effects and toxicity were mild and not different between groups. Substantial cost savings occurred in the S group. In summary, a large single dose of gentamicin was comparable in efficacy and toxicity to a standard regimen, but cheaper and more convenient to use.

• Authors: R R Bailey, E J Begg, A H Smith, R A Robson, K L Lynn, S T Chambers, M L Barclay, J Hornibrook
• Journal: Clinical nephrology (Clin Nephrol) Vol. 46 Issue 3 Pg. 183-6 (Sep 1996) ISSN: 0301-0430 [Print] Germany
• PMID: 8879853 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Anti-Bacterial Agents
• Anti-Infective Agents
• Gentamicins
• Ciprofloxacin

Topics

• Acute Disease
• Administration, Oral
• Adult
• Anti-Bacterial Agents (administration & dosage, adverse effects, therapeutic use)
• Anti-Infective Agents (administration & dosage, therapeutic use)
• Ciprofloxacin (administration & dosage, therapeutic use)
• Drug Administration Schedule
• Drug Therapy, Combination (administration & dosage, therapeutic use)
• Female
• Gentamicins (administration & dosage, adverse effects, therapeutic use)
• Humans
• Injections, Intravenous
• Male
• Prospective Studies
• Pyelonephritis (drug therapy)