3 days of Cipro better than amoxicillin-clavulanate for uncomplicated UTI

Journal of Family Practice,  May, 2005  by T.M. Hooton,   Scholes D.,  K. Gupta,  A.E. Stapleton,  P.L. Roberts,  W.E. Stature

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Hooton TM, Scholes D, Gupta K, Stapleton AE, Roberts PL, Stature WE. Amoxicillin-clavulanate vs ciprofloxacin for the treatment of uncomplicated cystitis in women. A randomized trial JAMA 2005; 293:949-955.

* Clinical Question

Are amoxicillin-clavulanate (Augmentin) and ciprofloxacin (Cipro) equivalent as a 3-day treatment for uncomplicated cystitis in women?

* Bottom Line

Three days of ciprofloxacin is superior to 3 days of amoxicillin-clavulanate in the treatment of uncomplicated cystitis in women. In areas where resistance is not yet a significant problem, clinicians should still use a less expensive option as a first-line agent. (LOE=lb-)

Study Design Randomized controlled trial (single-blinded)

Allocation Uncertain

Setting Outpatient (primary care)

Synopsis

The investigators identified 370 women, aged 18 to 45 years, with symptoms of acute uncomplicated cystitis and a positive urine culture for at least 100 colony-forming units of uropathogens per mL. Subjects were randomized (uncertain allocation concealment) to receive 3 days of amoxicillin-clavulanate 500 mg/125 mg twice daily, or ciprofloxacin 250 mg twice daily. Follow-up was available for 98% of the women at 4 months. The authors do not state whether individuals assessing outcomes were blinded to treatment group assignment.

Using intention-to-treat analysis, a clinical cure--defined as the absence of persistent or recurrent symptoms--occurred in 77% of women treated with ciprofloxacin vs 58% of women treated with amoxicillin-clavulanate (number needed to treat=5; 95% confidence interval, 4-12). Microbiological cure, defined as no uropathogens on a follow-up urine culture, was also more common in women treated with ciprofloxacin. Amoxicillin-clavulanate was still less effective than ciprofloxacin even when the cystitis was due to bacterial pathogens sensitive to both drugs.

DRUG BRAND NAMES

Amoxicillin-clavulanate * Augmentin Carbamazepine * Tegretol Chlorpromazine * Thorazine Ciprofloxacin * Cipro Citalopram * Celexa Donepezil * Aricept Galantamine * Reminyl Haloperidol * Haldol Levofloxacin * Levaquin Memantine * Namenda Olanzapine * Zyprexa Risperidone * Risperdal Rivastigmine * Exelon Thioridazine * Mellaril Thiothixene * Navane Valproate * Depakote

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