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Le Infezioni in Medicina ISSN 1124-9390 LE INFEZIONI IN MEDICINA Position paper on uncomplicated cystitis and single dose antibiotic therapy with prulifloxacin www.infezmed.it Vol. 24 - Supplemento 1 - 2016 LE INFEZIONI IN MEDICINA Rivista trimestrale di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive Volume 24 - Suppl. n. 1 - 2016 O SOMMARIO Edizioni Internazionali srl Divisione EDIMES Edizioni Medico-Scientifiche - Pavia Via Riviera 39 - 27100 Pavia Tel. 0382/526253 Fax 0382/423120 e-mail: [email protected] Registrazione Trib. di Milano n. 506 Introduction 3 del 6/9/2007 Silvano Esposito Direzione e Redazione Dipartimento di Medicina e Chirurgia Università degli Studi di Salerno Position paper 5 Via Allende, Baronissi, Salerno - Italy Tel. 0039 (089) 672420 on uncomplicated cystitis e-mail: [email protected] www.infezmed.it and single dose antibiotic therapy with prulifloxacin Direttore responsabile P.E. Zoncada Carlo Tascini, Rossella Nappi, Luigi Cormio, Massimo Lazzeri, Gabriele Alberto Saracino, Chiara Benedetto www.infezmed.it LE INFEZIONI IN MEDICINA A quarterly journal covering the etiological, epidemiological, diagnostic, clinical and therapeutic aspects of infectious diseases Editor in chief Esposito S. Editorial assistant Noviello S. Esposito I. ASSOCIATE EDITORS Dos Santos V.M. (Brasília, Brazil) Ece G. (Izmir, Turkey) HIV/AIDS Filice G. (Pavia, Italy) Andreoni M. Galli L. (Milan, Italy) Cauda R. Garau J. (Barcelona, Spain) Giacometti A. (Ancona, Italy) Viral hepatitis Gaeta G. B. Giamarellou H. (Athens, Greece) Taliani G. Gould I. (Aberdeen, UK) Gollapudi S. (Los Angeles, USA) Fungal infections Grossi P. (Varese, Italy) Viale P. Gyssens I. (Nijmegen, The Netherlands) Viscoli C. Heisig P. (Hamburg, Germany) Karamanou M. (Athens, Greece) Bacterial infections Kazama I. (Sendai Miyagi, Japan) Bassetti M. Lakatos B. (Budapest, Hungary) De Rosa F.G. Lari R. (Teheran, Iran) Emerging infectious diseases Lipsky B.A. (Seattle, USA) Ippolito G. Lye D. (Singapore) Marinis A. (Piraeus, Greece) Tropical diseases Marvaso A. (Naples, Italy) Castelli F. Menichetti F. (Pisa, Italy) Meletis G. (Thessaloniki, Greece) History of infectious diseases Milkovich G. (Richmond, USA) Contini C. Novelli A. (Florence, Italy) Papadopoulos A. (Athens, Greece) Paparizos V. (Athens, Greece) EDITORIAL BOARD Parvizi J. (Philadelphia, USA) Angarano G. (Bari, Italy) Pea F. (Udine, Italy) Anyfantakis D. (Chania, Crete, Greece) Reitan J.F. (Crown Point, USA) Atalay M.A. (Kayseri, Turkey) Sanduzzi A. (Naples, Italia) Biçer S. (Istanbul, Turkey) Scaglione F. (Milan, Italy) Bonnet E. (Tolouse, France) Scotto G. (Foggia, Italy) Boccazzi A. (Milan, Italy) Segreti J. (Chicago, USA) Bouza E. (Madrid, Spain) Sganga G. (Rome, Italy) Bouza J.M.E. (Valladolid, Spain) Soriano A. (Barcelona, Spain) Camporese A. (Pordenone, Italy) Stefani S. (Catania, Italy) Concia E. (Verona, Italy) Coppola N. (Naples, Italy) Tambic A.A. (Zagreb, Croatia) Dal Tuba (Ankara, Turkey) Ünal S. (Ankara, Turkey) de Araújo F.J.A. (Goiânia, Brazil) Vullo V. (Rome, Italy) d’Arminio Monforte A. (Milan, Italy) Yalcin A.D. (Antalya, Turkey) Di Perri G. (Turin, Italy) Yalcin N. (Antalya, Turkey) Le Infezioni in Medicina, Suppl. n. 1, 3-4, 2016 3 Introduction Silvano Esposito Department of Infectious Diseases, University of Salerno, Italy rinary tract infection (UTI) is character- vey (NHANES-III), the incidence for UTI Uized by the presence of >105 microor- is 13,320 per 100,000 adult women per year. ganisms per milliliter of urine with pus cells [4] Among young healthy women with cys- and red blood cells [1] titis, the infection recurs in 25% of women The term uncomplicated urinary tract infec- within 6 months after the first episode. tion refers to the invasion of a structurally Women are especially susceptible to cysti- and functionally normal urinary tract by a tis for reasons that are poorly understood. nonresident infectious organism while com- One factor may be that a woman’s urethra is plicated UTI refers to the occurrence of in- short, allowing bacteria quick access to the fection in patients with an abnormal struc- bladder. Also, a woman’s urethral opening tural or functional urinary tract, or both. is near sources of bacteria from the anus and UTI is differentiated from asymptomatic vagina. bacterial colonization by the presence of an Uncomplicated cystitis in the women are inflammatory response, and the associated commonly caused by Gram negative or- signs and symptoms that result from bacte- ganisms like Escherichia coli, Klebsiella, rial invasion. Proteus, Pseudomonas, Enterobacter and Acute uncomplicated bacterial cystitis is also less commonly by gram positive or- common in general practice and among sex- ganisms like Staphylococcus saprophyticus ually active young women, the incidence of [5]. Co-trimoxazole, β-lactams, aminoglyco- symptomatic urinary tract infection (UTI) is sides, and fluroquinolones are the groups high. Risk factors include recent sexual in- of antimicrobials commonly prescribed for tercourse, recent spermicide use, and a his- treatment of UTI [6]. tory of urinary tract infection [2]. Short duration treatment leads to better pa- Most episodes of cystitis are generally con- tient compliance, less adverse effects and sidered to be uncomplicated in otherwise cost reduction. healthy non pregnant adult women as not Acute uncomplicated bacterial cystitis are associated with an underlying condition common in general practice and because that increases the risk of infection or of fail- of their high frequent occurrence they do ing therapy (such as obstruction, anatom- represent a cause of particular concern. ic abnormality, urologic dysfunction, or a This supplement includes a position paper multiply-resistant uropathogen). giving a multidisciplinary approach to the It has been estimated that at least one-third management of the same diseases that can of all women in the United States are diag- be frequently observed in the everyday nosed with a UTI by the time they reach 24 medical practice by different specialists (in- years of age [3]. According to the Nation- fectious diseases specialist , urologist, gyne- al Health and Nutrition Examination Sur- cologist). 4 S. Esposito n REFERENCES tract infections: transmission and risk factors, in- cidence, and costs. Infect. Dis. Clin. North Am. 17, [1] Nicolle L.E. Epidemiology of urinary tract 227-241, 2003. infections. Clin. Microbiol. Newsl 24, 135–140, [5] Lawrenson R.A., Logie J.W. Antibiotic fail- 2002. ure in the treatment of urinary tract infections in [2] Hooton T.M., Scholes D., Hughes J.P., et al. A young women. J. Antimicrob. Chemother. 48, 6, 895- prospective study of risk factors for symptomatic 901, 2001. urinary tract infection in young women. N. Engl. [6] Trienekens T.A.M., London N.H.HJ., Houben J. Med. 335, 7, 468, 1996. A.W. Double-blind comparison of 3-day versus [3] Patton J.P., Nash D.B., Abrutyn E. Urinary tract 7-day treatment with norfloxacin in symptomat- infection: economic considerations. Med. Clin. ic urinary tract infections. The Inter-Nordic Uri- North Am. 75, 495–513, 1991. nary Tract Infection Study Group. Scand. J. Infect. [4] Foxman B., Brown P. Epidemiology of urinary Dis. 20, 6, 619-624, 1988. Le Infezioni in Medicina, Suppl. n. 1, 5-16, 2016 5 Position paper on uncomplicated cystitis and single dose antibiotic therapy with prulifloxacin Carlo Tascini1, Rossella Nappi2, Luigi Cormio3, Massimo Lazzeri4, Gabriele Alberto Saracino5, Chiara Benedetto6 1U.O. Infectious Diseases, Nuovo Santa Chiara Hospital, Pisa, Italy; 2Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy; 3Department of Urology and Renal Transplantation, University of Foggia, Italy; 4Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano, Milan, Italy; 5UOC Urology I, bari University, Policlinico di Bari, Italy; 6Obstetrics & Gynaecology I, Department of Surgical Sciences, University of Torino, Italy SUMMARY Episodes of acute cystitis occurring occasionally in healthy have a supply of antimicrobial agents available at home. pre-menopausal, non-pregnant women, with no history sug- Therefore a single dose antibiotic therapy for UC may be useful gestive of an abnormal urinary tract, are generally classified in order to reduce the antibiotic pressure and to reduce the pre- as uncomplicated cystitis. scription of diagnostic examinations. A woman who is treated Uncomplicated cystitis (UC) is diagnosed by the clinical point successfully with single dose therapy is unlikely to have a uri- of view according to the following symptoms: patients with nary tract abnormality. The practical consequence of this is dysuria, pollakiuria, stranguria, without fever and without that only those women who are single-dose failures warrant flank pain. UC with blood in the urine is possible. Blood is not urinary tract investigation. Furthermore, a single dose of an a criterion used to classify an UTIs as complicated. antimicrobial drug is associated with fewer side effects. Urine cultures and/or dip stick results are not necessary for Among drugs used to treat UC, single dose fluoroquilones the diagnosis of UC. The most frequent pathogen of UC is was as effective as other drugs used in single dose. Pruli- E. coli, followed by S. saprophyticus and other enterobacte- floxacin was approved in Italy for single dose therapy for
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