Comparative studies of fluoroquinolones in the treatment of urinary tract infections.

The results of comparative trials of fluoroquinolones for the treatment of uncomplicated and complicated urinary tract infections (UTI) were reviewed. Several randomized, comparative trials showed that in uncomplicated UTI norfloxacin, ciprofloxacin, and ofloxacin were at least as effective as trimethoprim-sulfamethoxazole (TMP-SMZ) and amoxicillin and usually more effective than nalidixic acid, pipemidic acid, and nitrofurantoin. Comparative trials of single-dose regimens have, however, been limited. A few randomized, comparative trials have shown that in complicated UTI norfloxacin, ciprofloxacin, and ofloxacin were at least as effective as amoxicillin and TMP-SMZ and usually more effective than pipemidic acid. Moreover, preliminary results indicate that fluoroquinolones might be effective for the oral treatment of complicated UTI that are difficult to treat, especially those due to Pseudomonas aeruginosa. Comparative trials are needed to establish the value of fluoroquinolones for chronic bacterial prostatitis. There are no conclusive data on fluoroquinolone treatment of UTI in patients with renal failure. Emergence of resistant pathogens during therapy with fluoroquinolones has been infrequent but might be more frequent in complicated UTI caused by P. aeruginosa.