The results of comparative trials of fluoroquinolones for the treatment of uncomplicated and complicated urinary tract infections (UTI) were reviewed. Several randomized, comparative trials showed that in uncomplicated UTI norfloxacin, ciprofloxacin, and ofloxacin were at least as effective as trimethoprim-sulfamethoxazole (TMP-SMZ) and amoxicillin and usually more effective than nalidixic acid, pipemidic acid, and nitrofurantoin. Comparative trials of single-dose regimens have, however, been limited. A few randomized, comparative trials have shown that in complicated UTI norfloxacin, ciprofloxacin, and ofloxacin were at least as effective as amoxicillin and TMP-SMZ and usually more effective than pipemidic acid. Moreover, preliminary results indicate that fluoroquinolones might be effective for the oral treatment of complicated UTI that are difficult to treat, especially those due to Pseudomonas aeruginosa. Comparative trials are needed to establish the value of fluoroquinolones for chronic bacterial prostatitis. There are no conclusive data on fluoroquinolone treatment of UTI in patients with renal failure. Emergence of resistant pathogens during therapy with fluoroquinolones has been infrequent but might be more frequent in complicated UTI caused by P. aeruginosa.
Dithiothreitol has been used to stabilize the substrate and quinolones to complex the ferric.
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is norbactin an antibiotic
Norfloxacin (NOR), is an ionizable and polar antimicrobial compound, and it may enter the environment in substantial amounts via the application of manure or sewage as a fertilizer. Sorption of NOR onto humic acid (HA) may affect its environmental fate. In this study, HA extracted from weathered coal was used to investigate the sorption of NOR at different solution chemistry conditions (pH, ionic strength) and temperatures. The sorption of NOR onto HA showed a two-stage sorption process with an equilibration time of 48 h. The sorption kinetic curve fitted well with a pseudo second-order kinetic model. Thermodynamic characteristics demonstrated that the sorption of NOR onto HA was a spontaneous and exothermic process predominated by physical sorption. All sorption isotherms fitted well with the Freundlich and Langmuir models and they were highly nonlinear with values of n between 0.4 and 0.5, suggesting the high heterogeneity of HA. Increasing Ca2+ concentration resulted in a considerable reduction in the K(d) values of NOR, hinting that Ca2+ had probably competed with NOR(+,0) for the cation exchange sites on the surfaces of HA. The sorption reached a maximum at pH 6.0 over the pH range of 2.0-8.0, implying that the primary sorption mechanism was cation exchange interaction between NOR(+,0) species and the negatively charged functional groups of HA. Spectroscopic evidence demonstrated that the piperazinyl moiety of NOR was responsible for sorption onto HA, while the carbonyl group and the aromatic structure of HA participated in adsorbing NOR.
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The susceptibility to ciprofloxacin of 7288 Escherichia coli clinical isolates from 5667 patients was determined over a 4-year period (1995-1998). Information about the patients' age, sex, specimen type, date, origin and susceptibility to Escherichia coli isolates was studied, and the c2 test was used for statistical comparison. Overall, 1003 (17.70%) patients out of the 5667 included in the study presented ciprofloxacin resistance. The annual resistance observed over this 4-year period was not considered statistically significant. The resistant isolates were more frequent among men, in urine specimens and in outpatients, and increased with different age groups. The average age of patients with resistant isolates was 61.29 years (SD 21.56) and that of pacients with susceptible isolates was 39.76 years (SD 27.41). A similar rate of resistance was observed among outpatients from health centers and those from hospital outpatient services. The higher resistance rates were found in outpatients from the urology department. The resistance to other fluoroquinolones remained the same and was not significant for norfloxacin; it increased starting from 1997 for pefloxacin at the expense of ciprofloxacin-sensitive isolates.
Certain aspects of the relationship between host defence mechanisms and the new quinoline derivative ciprofloxacin in comparison to norfloxacin and ofloxacin were studied. Ciprofloxacin did not affect chemotaxis of human polymorphonuclear leucocytes in agarose. In leucocytes exposed to ciprofloxacin, norfloxacin and ofloxacin neither the chemiluminescent response to opsonized zymosan and formyl-methionyl-leucyl-phenylalanine nor the phagocytic or bactericidal activity was affected. However, killing of Staphylococcus aureus by human polymorphonuclear leucocytes exposed to subinhibitory concentrations of ciprofloxacin was enhanced. The results show that the quinolines tested do not directly influence phagocytic cells, but a subinhibitory concentration can make bacteria more susceptible to phagocytosis and killing.
Clinical and bacteriological assessments of the results were made 3, 7, and 28 days after treatment. A total of 75 gems were isolated: E. coli was the most common (68%). In all three groups, the main symptoms rapidly disappeared after the start of the treatment.
The prevalence of ASB in diabetic pregnancy was 38.83% (40/10(3); 95% CI: 23.73 - 53.94) and in non-diabetic pregnancy was 37.98% (79/208; CI: 27.28- 48.68). The odds ratio was not significant 1.0225 (95% CU: 0.65 - 1.599; p=0.922) and associated factors such as age and gestational period had no effect. The major isolates were Escherichia coli (25.0%), Staphylococcus aureus (22.5%), Coagulase negative staphylococci (CONS) (20.00%), and Klebsiella pneumonia (20.00%) in diabetic pregnancy and CONS (31.7%), E.coli (24.0%) and K.pneumonia (16.5%) in non-diabetic pregnancy. The isolates of diabetic pregnancy showed highest susceptibility to nitrofurantoin (56.4%), gentamicin (38.5%) and cotrimoxazole (38.5%) whereas that of non-diabetic pregnancy to gentamicin (43.0%), azithromycin (32.9%) and norfloxacin (30.4). There was no significant (p<0.05) difference in the type and susceptibly of the isolates between diabetic and non-diabetic pregnancy.
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A total of 125 ambulatory women (85 premenopausal and 40 postmenopausal) who experienced 174 acute urinary tract infections with mainly gram-negative bacteria (99%) was randomized to receive a single dose, 2-tablet treatment with either ofloxacin (400 mg.), norfloxacin (800 mg.) or ciprofloxacin (500 mg.). Cure was achieved in 163 of the 174 acute episodes (94%). More specifically, the cure rates were 97% (57 of 59 infections) with ofloxacin, 96.5% (56 of 58) with ciprofloxacin and 88% (50 of 57) with norfloxacin. While the initial cure rate of the acute urinary tract infections was 96% (112 of 117) in the premenopausal group, it reached only 90% (51 of 57) in the postmenopausal group. The 17 urinary tract infections that followed the initial 2-tablet quinolone treatment were cured by either an additional single dose, 2-tablet treatment with a different quinolone in 6 cases, a 1-day treatment with other adequate antibacterials in 9 and a 7-day treatment in 2. The 2-tablet quinolone treatment proved to be an effective, easy and cost-effective treatment for acute urinary tract infections in premenopausal and postmenopausal women.