Newer quinolones in the long term prophylaxis of recurrent urinary tract infections (UTI)

Up to 10% of premenopausal women experience recurrent symptomatic urinary tract infection (UTI), mainly due to reinfection from the faecal flora. The recently introduced fluoroquinolones possess a wide spectrum of activity against most uropathogens and achieve high urinary concentrations for extended time periods. Our initial study, conducted between 1993 and 1995, was designed to compare the efficacy and safety of oral pefloxacin 800mg once weekly with oral ciprofloxacin 125mg once daily, over a 12-month prophylactic course in women with recurrent UTI. A 12-month reinfection-free period was achieved in 83.3% of pefloxacin patients and in 78.9% of ciprofloxacin patients. The present study, which commenced in 1996, was designed to compare pefloxacin 400mg with oral fleroxacin 400mg once weekly. Prophylaxis was maintained for 12 months. There are no statistically significant differences between the 2 regimens in terms of efficacy and safety. The most frequently isolated pathogens causing breakthrough reinfections were Escherichia coli and Enterococcus spp. Adverse effects observed were mostly neuropsychic (insomnia) and gastrointestinal. In both studies, there was no evidence of emergence of quinolone-resistant organisms in the urine or rectal flora, even after 12 months of chemoprophylaxis.