[Acute cystitis in women with type 2 diabetes. Three antimicrobial schemes].
OBJECTIVE
To compare the effectiveness and secondary effects of trimethoprim-sulfamethoxazole (TMP-SMX), ciprofloxacin, and nitrofurantoin in women with type 2 diabetes mellitus (DM2) and acute community-acquired cystitis.


METHODS
A randomized single blind clinical trial was conducted in the family medicine clinic No. 91 of Instituto Mexicano del Seguro Social in Coacalco, Mexico. The study included women with DM2 and acute cystitis who were randomly allocated to one of the following schemes: TMP-SMX (160/800 mg every 12 h), ciprofloxacin (500 mg every 12 h) or nitrofurantoin (100 mg every 6 h) for 10 days.


RESULTS
Sixty-one patients fulfilled the inclusion criteria. Bacteriologic eradication at the end of the treatment was observed in 18/23 (78 %) of patients treated with ciprofloxacin; 14/18 (78%) of patients treated with nitrofurantoin; and 9/20 (45 %) of patients treated with TMP-SMX (p = .036). The difference between nitrofurantoin and TMP-SMX, as well as between ciprofloxacin with TMPSMX, was 33 % for both (95 % confidence interval = 4 %, 62 %, and 5 %, 61 % , respectively). The most frequently isolated bacterium was Escherichia coli (75 %), The in vitro resistance rate to TMP-SMX was 76 %, to ciprofloxacin 17 % and to nitrofurantoin 13 % (p = 0.05). The main adverse effects were slight to moderate headache, nausea, and pyrosis in the three groups.


CONCLUSIONS
ciprofloxacin and nitrofurantoin were more effective than TMP-SMX for the treatment of community-acquired acute cystitis in Mexican women with DM2. This is probably due to differences in the resistance rates and is probably not specific for diabetic patients; All three antimicrobials were safe.
López-Carmona
Juan Manuel
JM
Coordinador Clínico de Educación e Investigación en Salud, Unidad de Medicina Familiar 91, Delegación Estado de México Oriente, Instituto Mexicano del Seguro Social. jmlopcar@prodigy.net.mx
Salazar-López
María Alejandra
MA
Rodríguez-Moctezuma
José Raymundo
JR
López-Delgado
María Elisa
ME
Manrique-Lizárraga
Juana María
JM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000209:etiology*; D002939:Ciprofloxacin / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000209:etiology; D003556:Cystitis / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009582:Nitrofurantoin / Q000627:therapeutic use*; D011446:Prospective Studies; D016037:Single-Blind Method; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
D000890:Anti-Infective Agents; D002939:Ciprofloxacin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D009582:Nitrofurantoin