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The ecological effects of norfloxacin and pivmecillinam (PIV) on the periurethral and vaginal flora in women with recurrent urinary tract infection

Abstract number: 1134_02_116

Stattin Norinder B., Norrby R., Palmgren A.-C., Nord C.E.

Objectives:

To compare the ecological effects on the periurethral and vaginal microflora and time to normalisation of orally administered norfloxacin (NFLX) and pivmecillinam (PIV) in women with recurrent lower UTI.

Methods:

Women with recurrent lower UTI participated in a randomized, single blind parallel multi-centre study. Twenty-five women, aged 18–55 years, with a positive nitrite test and symptoms (urgency, frequency, dysuria and/or suprapubic pain) of lower UTI were included. Only patients with an UTI caused by E. coli or Klebsiella spp were evaluated. Key exclusion criteria were; menopause; pregnancy or breast feeding, known hypersensitivity to study drugs, antibiotics within the preceding month, impaired liver or kidney function, known or clinically suspected pyelonephritis, complicated UTI and/or gastrointestinal infection. Study drugs: Seven days treatment of either NFLX 400 mg BID or PIV 400 mg TID. Samples from midstream urine, periurethra and vagina were obtained before start of treatment Day 1 and at two follow-ups Day 12–4 and 28–35. Informed consent was obtained. The Ethical Review Committee and Medical Product Agency approved the study protocol.

Results:

Nineteen patients (11 NFLX and 8 PIV) fulfilled the inclusion and exclusion criteria. No differences of patient characteristics were seen between the two groups. At the initial visit, more NFLX patients were colonized with aerobic bacteria, although no differences were seen for anaerobic bacteria. The E. coli strains were suppressed markedly by NFLX and PIV in both locations. S. epidermidis increased more markedly following PIV treatment compared to NFLX in the periurethral location. In the PIV group E. faecalis was less frequent initially, increased at visit 2, and returned to pre-treatment numbers at visit 3. For the NFLX group, more patients were colonized initially with E. faecalis, with a decrease at visit 3. Lactobacilli decreased slightly in the periurethra in the NFLX group, whilst no changes were seen for PIV. Bacteroides spp. decreased more markedly for NFLX. Restoration of the pre-treatment colonization levels occurred gradually, except for E. coli being markedly suppressed by NFLX throughout the study period. The bacteriological outcome of the urinary tract infection both at the short-term and long-term follow up was successful.

Conclusions:

Limited ecological effects on the microflora were seen following treatment with NFLX and PIV, a benefit for antibiotics used for treatment of patients with UTI.

Session Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Subject:
Location: Oxford, UK
Presentation type:
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