Journal Article

A Prospective, Randomized Trial of 3 or 14 Days of Ciprofloxacin Treatment for Acute Urinary Tract Infection in Patients with Spinal Cord Injury

Gordon Dow, Pramila Rao, Godfrey Harding, Joanna Brunka, Jim Kennedy, Michelle Alfa and Lindsay E. Nicolle

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 39, issue 5, pages 658-664
Published in print September 2004 | ISSN: 1058-4838
Published online September 2004 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/423000
A Prospective, Randomized Trial of 3 or 14 Days of Ciprofloxacin Treatment for Acute Urinary Tract Infection in Patients with Spinal Cord Injury

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  • Infectious Diseases
  • Immunology
  • Public Health and Epidemiology
  • Microbiology

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Background. Urinary tract infection (UTI) is common among patients with spinal cord injury. The optimal duration of treatment for symptomatic UTI has not been determined.

Methods. A randomized, double-blind, placebo-controlled trial compared 3-day and 14-day regimens of ciprofloxacin, 250 mg twice daily, for the treatment of acute UTI in patients with spinal cord injury. Patients with pyelonephritis, struvite stones, hydronephrosis, or long-term indwelling catheters were excluded from the trial.

Results. Sixty patients with spinal cord injury were enrolled in the trial, with 30 patients assigned to each study arm. The most common infecting organisms were Klebsiella species (30%), Enterococcus species (22%), and Escherichia coli (22%); 33% of the infections were polymicrobial. Microbiological cure at long-term follow-up was significantly better among patients who received therapy for 14 days than among patients who received therapy for 3 days. By 6 weeks of follow-up, microbiological relapse (in 11 [37%] of 30 patients vs. 2 [7%] of 30 patients; 95% confidence interval [CI], 1.38–3.18; P = .01) and symptomatic relapse (in 7 [23%] 30 patients vs. 0 of 30 patients; 95% CI, 1.69–3.13; P = .01) both occurred more frequently in patients treated for 3 days. Reinfection occurred with similar frequency in patients in the 2 study arms. Six of 7 evaluable patients with treatment failure had a fluoroquinolone-resistant organism isolated at enrollment.

Conclusions. For patients with spinal cord injury, treatment of acute symptomatic UTI for 14 days leads to improved clinical and microbiological outcomes, compared with short-course therapy.

Journal Article.  4037 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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