Norfloxacin versus parenteral therapy in the treatment of complicated urinary tract infections and resistant organisms

Abstract

As part of a multicenter randomized trial of the treatment of complicated urinary infections in hospitalized patients, we treated 35 patients of whom 28 were evaluable (16 patients given parenteral therapy and 12 norfloxacin). The distribution of pathogens was similar in both groups as was the elimination of the organisms (12/12 norfloxacin and 14/16 parenteral therapy). The only complication of norfloxacin therapy was an episode of anxiety in a patient with obstructive lung disease who had experienced anxiety and difficulty with a variety of other medications. The largest difference between the parenteral and norfloxacin treated groups was in the ease of therapy and in cost, which for the former was a total of $5 091, i.e. $318 per patient and $30.1/day, exclusive of administration costs. The parenteral administration costs averaged $45/day. Analogous costs for norfloxacin were estimated at $3.00/day per patient and administration costs for 2 tablets norfloxacin/day were calculated at $7.5. The variety of drugs used in the parenteral arm included a nephrotoxic aminoglycosides in half the cases and a wide variety of beta-lactams as well as vancomycin. Thus, for simplicity of therapy as well as cost norfloxacin was judged superior to parenteral therapy of hospitalized patients with mild or moderately severe urinary tract infections including patients with underlying urinary tract abnormalities and prior to long term foley catheter use. An additional 15 cases were treated in an open trial or on a compassionate use basis. All but one patient, who was noncompliant, responded, including, several with chronic relapsing infections with antibody coated bacteria in the urine. Three such patients who were followed for 3-6 months maintained urine free of bacteria.