A prospective, randomized trial of 3 or 14 days of ciprofloxacin treatment for acute urinary tract infection in patients with spinal cord injury.
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.
Dow
Gordon
G
Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada.
Rao
Pramila
P
Harding
Godfrey
G
Brunka
Joanna
J
Kennedy
Jim
J
Alfa
Michelle
M
Nicolle
Lindsay E
LE
D000208:Acute Disease; D000328:Adult; D002939:Ciprofloxacin / Q000627:therapeutic use*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004756:Enterobacteriaceae Infections / Q000150:complications / Q000188:drug therapy; D016983:Enterococcus / Q000187:drug effects / Q000302:isolation & purification; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000150:complications / Q000188:drug therapy; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000188:drug therapy; D006801:Humans; D007709:Klebsiella / Q000187:drug effects / Q000302:isolation & purification; D008297:Male; D011446:Prospective Studies; D013119:Spinal Cord Injuries / Q000150:complications* / Q000382:microbiology; D014552:Urinary Tract Infections / Q000150:complications / Q000188:drug therapy*
D002939:Ciprofloxacin