Randomized, double-blind comparison of ciprofloxacin and trimethoprim-sulfamethoxazole for complicated urinary tract infections

In a prospective, randomized, double-blind study, the effect of ciprofloxacin (250 mg orally, twice daily) was compared with that of trimethoprim-sulfamethoxazole (160 mg of trimethoprim and 800 mg of sulfamethoxazole orally, twice daily) on 45 patients with complicated urinary tract infections. Pretherapy isolates were all members of the family Enterobacteriaceae. Isolates were eradicated from 18 (82%) of 22 patients treated with ciprofloxacin and 12 (52%) of 23 patients treated with trimethoprim-sulfamethoxazole during and 5 to 9 days after therapy (P = 0.035). Both groups had similar relapse and reinfection rates at 4 to 6 weeks posttherapy. Adverse effects were mild and reversible, occurring in 1 of 22 in the ciprofloxacin group and 6 of 23 in the trimethoprim-sulfamethoxazole group. Disk diffusion susceptibility tests correlated better with broth macrodilution for ciprofloxacin than for trimethoprim-sulfamethoxazole. Ciprofloxacin is a safe, effective alternative to trimethoprim-sulfamethoxazole for the treatment of complicated urinary tract infections.