Urinary tract infection (UTI) refers to the presence of a certain threshold number of bacteria in the urine. Bacterial cystitis (bacteria in the bladder, also called acute cystitis) can occur in men and women and the signs and symptoms include dysuria (pain on passing urine), frequency, cloudy urine, occasionally haematuria (blood in the urine), and is often associated with pyuria (high urine white blood cell count). There is an additional important distinction between complicated and uncomplicated UTI. Complicated UTIs are those associated with fever and/or back pain (indicating kidney infection), UTIs in men, UTIs associated with indwelling or intermittent urinary catheters, obstructive uropathy (any changes in the urinary tract due to obstruction), vesicoureteric reflux (urine travels from the bladder back up toward the kidneys) and other urological abnormalities. These types of infections require more intensive treatment. Uncomplicated acute cystitis is the most prevalent form of uncomplicated UTI in women. Quinolones are recommended as the drugs of choice for acute cystitis in regions where the level of resistance to other antimicrobials namely co-trimoxazole is high. The aim of this systematic review was to investigate which quinolone is most effective in treating uncomplicated acute cystitis and to also investigate safety and how well they are tolerated. Eleven studies (7535 women) were identified. No two studies compared the same quinolones. We found no significant differences in clinical or microbiological efficacy between quinolones. Several adverse events were reported in the individual studies. These included photosensitivity, insomnia, skin adverse events, central nervous system adverse events and adverse events leading to withdrawal to treatment. We were unable to determine which quinolone would be the safest or the most tolerated due to the lack of head-to-head data.
We found no significant differences in clinical or microbiological efficacy between quinolones but some differences in occurrence and spectrum of quinolone safety.
Uncomplicated acute cystitis is one of the most common bacterial infections in adults. The percentage of women who have at least one episode of acute cystitis is estimated to be between 40% to 50%. Quinolones are recommended for acute cystitis in regions where the level of resistance to other antimicrobials namely co-trimoxazole is high. However the efficacy, safety and tolerance of quinolones needs investigation.
To compare the efficacy, safety and tolerance of different quinolones in women with uncomplicated acute cystitis.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL, in The Cochrane Library Issue 3, 2003), MEDLINE (1966 - September 2003), EMBASE (1988 - September 2003), reference lists of articles and abstracts from conference proceedings without language restriction. Reference lists of urology, infectious diseases and nephrology textbooks, review articles and relevant studies.
Randomised and quasi-randomised controlled trials comparing two or more different quinolones in women (≥ 16 years) with uncomplicated acute cystitis were selected.
Two reviewers independently assessed trial quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as risk ratio (RR) for dichotomous outcomes with 95% confidence intervals (CI).
We identified 11 studies enrolling 7535 women. There were no significant differences in clinical or microbiological efficacy between quinolones. Photosensitivity reactions were more frequently observed for sparfloxacin when compared to ofloxacin. Any adverse event, adverse events causing withdrawal, skin adverse events, photosensitivity reactions were more common for lomefloxacin when compared to norfloxacin. Any adverse event, adverse drug reactions, CNS adverse events were more common for ofloxacin when compared to ciprofloxacin. CNS adverse events and insomnia were more often reported for rufloxacin when compared to pefloxacin. Adverse drug reactions occurred frequently for ofloxacin than levofloxacin. Insomnia was reported more frequently for enoxacin than ciprofloxacin.