Ciprofloxacin or Amoxicillin-clavulanate for cystitis in women

[Dr.Vad]

Ciprofloxacin is more effective than amoxicillin-clavulanate as a treatment for bladder infections in women, even when the microbe is susceptible to the latter drug, according to a report in the Journal of the American Medical Association.

Currently, the standard treatment for bladder infections or cystitis is trimethoprim-sulfamethoxazole (Bactrim), but emerging resistance to this agent has led to greater use of "fluoroquinolone" drugs, such as ciprofloxacin. In an effort to maintain the usefulness of this drug class, however, there has been a push to use non-fluoroquinolone antibiotics.

Despite increasing use of amoxicillin-clavulanate for cystitis, few studies have assessed the effectiveness of this treatment, according to Dr. Thomas M. Hooton of Harborview Medical Center in Seattle, and colleagues.

To investigate, the researchers assessed cure rates in 370 women with cystitis who were randomly selected to receive a 3-day course of ciprofloxacin or amoxicillin-clavulanate.

Cure was achieved in 77 percent of ciprofloxacin-treated women compared with just 58 percent of amoxicillin-clavulanate-treated women. Moreover, even when the analysis was confined to women infected with bacteria susceptible to amoxicillin-clavulanate, ciprofloxacin still provided a higher cure rate.

The authors believe that ciprofloxacin may have worked better than amoxicillin-clavulanate because of eradication of E. coli bacteria in the vagina. At 2-week follow-up, 45 percent of women treated with amoxicillin-clavulanate had vaginal E. coli compared with just 10 percent of women treated with ciprofloxacin.

The results, the investigators conclude, suggest that amoxicillin-clavulanate should only be considered as a treatment for cystitis when "use of other first- and second-line antibiotics is not feasible."

SOURCE: Amoxicillin-Clavulanate vs Ciprofloxacin for the Treatment of Uncomplicated Cystitis in Women: A Randomized Trial
Thomas M. Hooton; Delia Scholes; Kalpana Gupta; Ann E. Stapleton; Pacita L. Roberts; Walter E. Stamm
JAMA. 2005;293:949-955.

Clinical cure was observed in 93 (58%) of 160 women treated with amoxicillin-clavulanate compared with 124 (77%) of 162 women treated with ciprofloxacin (P<.001). Amoxicillin-clavulanate was not as effective as ciprofloxacin even among women infected with strains susceptible to amoxicillin-clavulanate (65 [60%] of 109 women in the amoxicillin-clavulanate group vs 114 [77%] of 149 women in the ciprofloxacin group; P = .004). The difference in clinical cure rates occurred almost entirely within the first 2 weeks after therapy. Microbiological cure at 2 weeks was observed in 118 (76%) of 156 women treated with amoxicillin-clavulanate compared with 153 (95%) of 161 women treated with ciprofloxacin (P<.001). At this visit, 45% of women in the amoxicillin-clavulanate group compared with 10% in the ciprofloxacin group had vaginal colonization with E coli (P<.001).

[Alexei]

Д-р Вад, но это как бы давно известно. Только вот что-то низкий у исследователей процент cure... Не понятно какие критерии использовались для установления диагноза и констатации выздоровления. Три дня - это как бы достаточный срок. Но у России свои проблемы. Начиная с того, что банальный цистит итак, как грится, за 7 дней проходит, поэтомы мы использует 5НОГ. Так принято. А ципро для цистита, как я уже рассказывал, у старшей сестры не выколотишь.

[dr_medvedev]

Я с осторожностью отношусь к применению фторхинолонов у женщин, т.к. рецидивы цистита часто провоцируются беременностью. Т.е. назначаю фторхинолоны только после исключения возможной беременности.