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

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