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Title Comparison of Enoxacin and Norfloxacin in Patients with Cystitis

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Title Comparison of Enoxacin and Norfloxacin in Patients with Cystitis Comparison of enoxacin and norfloxacin in patients with Title cystitis YAMAMOTO, Masanori; NAGAI, Tatsuya; TAKABA, Author(s) Hidenori; HASHIMOTO, Junichi; MIYAKE, Koji Citation 泌尿器科紀要 (1987), 33(12): 2141-2144 Issue Date 1987-12 URL http://hdl.handle.net/2433/119370 Right Type Departmental Bulletin Paper Textversion publisher Kyoto University 2141 Acta Urol. Jpn. Vol. 33J [ No. 12, December 1987 COMPARISON OF ENOXACIN AND NORFLOXACIN IN PATIENTS WITH CYSTITIS Masanori YAMAMOTO, Tatsuya NAGAI, Hidenori T AKABA, Junichi HASHIMOTO and Koji MIYAKE From the Department of Urology_ Nagoya University School of Medicine (Director: Prof. K. Miyake) The urinary antibacterial drugs enoxacin and norfloxacin were compared for efficacy and side effects in the treatment of lower urinary tract infections. Thirty-five patients received enoxacin and 25 received norfloxacin for one week. The antibacterial spectrum of enoxacin was noted to be better than that of norfloxacin, but both drugs performed well in clearing the infections caused by susceptible organisms. The incidence of side effects was higher with norfloxacin than with enoxacin. Key words: Cystitis, Enoxacin, Norfloxacin and effectiveness with that of norflox­ INTRODUCTION aClll. For an antimicrobial agent to be useful MATERIALS AND METHODS in the treatment of urinary tract infec­ tions, in addition to being relatively The study group consisted of 60 patients, nontoxic and well tolerated. it should 51 women and 9 men, between 18 and 75 achieve high urinary concentrations of years old. Five patients (4 on enoxacin, 1 Qiologically active drugll, concentrations on norfloxacin) were found to have asym­ which are many times higher than the ptomatic bacteriuria and the other 55 minimal inhibitory concentrations (MIC) were diagnosed as having cystitis, either of the infecting organism. initial or recurrent, uncomplicated, or One of the newer oral preparations complicated if the intergrity of the urinary which appears to meet these therapeutic tract was impaired. Pregnant patients were requirements is the synthetic antibacterial excluded as were thoe who had received drug enoxacin. Enoxacin is similar to successful antibacterial therapy before norfloxacin with activity against most administration of the study drug. common organisms associated with urinary On admission, all patients gave a com­ tract infections2- 3). Its antimicrobial acti­ plete history and received a thorough vity is similar to that of norfloxacin, but physical examination. Urine was obtained it has been more effective than norfloxacin for culture, organism identification, co­ against Escherichia coli, Proteus mirabilis, lony count, and antimicrobial susceptibi­ Klebsiella pneumoniae, Serratia marcescens and litv, and blood was obtained for routine Pseudomonas aemginosa in infected mouse~). he~atologic and biochemical screening. Enoxacin is cleared from the body predo­ Treatmentwas then started with either 600 minantly by renal excretion, and to a mg enoxacin, or 600 mg norfloxacin, the smaller extent by metabolismS). The uri­ drugs being assigned by a predetermined nary concentration of enoxacin exceeds random code and administered three that achieved by an equivalent dose of times daily for one week. Further urine 61 norfloxacin5- We have used enoxacin in cultures were obtained 3 to 5 days after patients with cystitis, comparing its safety starting treatment and 7 to 9 days after 2142 Acta Urol. Jpn. Vol. 33, No. 12, 1987 treatment ended. Any adverse reactions a satisfactory symptomatic response, and noticed by the patients were recorded, and this was a 58-year-old man with initial, standard laboratory tests of hematologic, complicated cystitis caused by P. aeruginosa, renal and hepatic functions w~re repeated who had been treated for 16 days. The at the end of therapy. In vitro susceptibi­ norftoxacin-treated group c0!1sisted of 20 lity of the infecting organism to the study cases of 'acute simple cystitis I and 5 cases drugs was determined by the disk method. of chronic complicated cystitis. Of the patients with acute simple cystitis, pyuria RESULTS was clyl;lred in 18 cases (90%) and bacte­ Table I shows the infecting orgaOlsm riuria was completely yliminated in 19 for each patient. As would be expected, cases (95%). The overall clinical efficacy Escherichia coli was identified most fre­ was 96.8%. Of the patients with chronic quently (54.3%). Clinical evaluation was complicated cystitis, pyuria was cleared made according to the Criteria for Cli­ in I case (20%) and .decreased in I case nical Efficacy of Antimicrobial Agents on (20%); bacteriuria was completely elimi­ Urinary Tract Infection (2nd Edition). nated in 2 cases (40%) and overall clinical efficacy was 60%. One patient had a Table I. Isolated organisms in each drug recurrence of symptoms although the group (over 105 colony-forming pathogen was eliminated, and one became units/m!. ). reinfected with a different pathogen; ! Pathogen All 60 patients were evaluated for the Pathogen No. ElIminated No % occurrence of adverse drug reactions. In ENOXACIN the enoxacin-treated group, 3 female pa­ E. coli 19 18 94.7 tients (8.57%) had adverse reactions, but K. pneumoniae 8 7 87.5 Enterobacter 4 3 75 these side effects were reversible. One S. aureus 1 1 100 patient was found to have a slight eleva­ S. epidermidis 1 1 100 P aeruginosa 1 0 0 tion of alkaline phosphatase on occasron, S. marcescens 1 0 0 but no symptomatic complaints. In the TOTALS 35 30 norftoxacin-treated group, there were 4 NORFLOXACIN patients (female) with adverse reactions E. coli 15 14 93.3 P mirabilis 3 2 66.7 (16%). None of these symptoms were so P vulgaris 2 2 100 severe as to necessiate discontinuation of S. faecalis 1 1 100 Morganella 1 1 100 therapy and vanished after cessation of Enterococcus 1 1 100 treatment of norfloxacin.· One patient'was K. pneumoniae 1 0 0 p, aeruginosa 1 0 0 found to have a slight elevation of serum TOTALS 25 21 GOT level on o'ccasion, but this 'was transient and the patient was asympto- Enoxacin-treated group consisted of 26 Table 2. Adverse reactions in each drug cases of acute simple cystitis and 9 cases treatment group. of chronic complicated cystitis. In the No. of Side effects case of acute simple cystitis, pyuria was Cases cleared in 24 cases (92.3%) and bacteriuria ENOXACIN was completely eliminated in 25 cases Nausea (96.1%). Overall clinical efficacy was Vomiting 97.2% In the case of chronic complicated Elevation of alkaline cystitis, pyuria was cleared in 2 cases phosphatase (22.2%) and decreased in 6 cases (67%): NORFLOXACIN bacteriuria was completely eliminated in Nausea 5 cases (55.6%) and overall clinical effi­ Headache cacy was 77.8%. In one instance, the Sleepne,ss Elevation of serum GOT initial pathogen was not eliminated despite Yamamoto et al.: ENX, NFLX 2143 matico Table 2 shows the adverse reactions of unpleasant side effects should make it that were noticed. a drug of first choice in the treatment of lower urinary tract infections. DISCUSSION It is apparent from the present results REFERENCES that both enoxacm and norfloxacin I) Stamey.TA, Govan DE and er Palm JM: are effective antibacterial agents for The localization and treatment of urinary the treatment of simple or complicated tract infections: the role of bactericidal cystitis. The incidence of side effects urine levels as opposed to serum levels was higher with norfloxacin than with Medicine 44: 1~36, 1965 enoxacm. 2) Kouno K, Inoue M and Mitsuhashi S: In Enoxacin is a newly developed synthetic vitro and in vivo antibacterial activity of AT-2266. Chemotherapy 32 (s-3): 1~17, 1984 antimicrobial agent that is a pyridone­ 3) Goto S, Tsuji A, Ogawa M, Kaneko Y, carboxylic acid derivative. This drug as Miyazaki S, Muto Y and K uwabara S: In well as norfloxacin has broad and potent vitro and in vivo antibacterial activities of antibacterial activities against gram-posi­ At-2266, A new pyridone carboxylic acid tive and gram-negative bacteria, and shows antibacterial agent. Chemotherapy 32 (s-3): excellent oral effects in various experimen­ 18~33, 1984 tal infections (systemic, pulmonary, dermal 4) Nakamura S, Katae H, Minami A, Nakata and urinary tract infections) in mice4). K, Inoue S, Yamagishi J, Takase Y and Enoxacin is similar to norfloxacin in in Shimizu M: In vitro and in vivo antibacte· vitro antibacterial properties but superior rial activity of AT-2266. Chemotherapy 32 (s-3): 70~85, 1984 to norfloxacin in in vivo antibacterial 5) Nakamura S, Kurobe N, Kashimoto S, Ohue 4l activities • The wider antibacterial spect­ T, Takase Y and Shimizu M: Absorption, rum of enoxacin will make it a valuable distribution, excretion and metabolism of drug for the treatment of infections due AT-2266 in experimental animals. Chemothe· to E. coli or Proteus organisms. E. cali rapy 32 (s-3): 86~94, 1984 now ranks as the first most prevalent 6) Tomioka 0, Yamanake N, Kuroda Y, pathogen isolated from nosocomial urinary Kamidono and J Ishigami: Fundamental tract infections in our hospital. Until and clinical studies on AM-715 in the uro­ now we have had a choice only between logical field. Chemotherapy 29 (s-4): 546~ 565, 1981 pipemidic acid or a broad-spectrum anti­ 7) Kaneko H, Oshi M, Tominaga T, Kishi H biotic for treatment of this type of infect­ and Niijima T: Anti-bacterial activity and IOn. As a result of the widespread, and clinical evaluation of AT-2266 in complicated sometimes long-term use of pipemidic urinary tract infections. Chemotherapy 32 acid, resistant strains of E. coli, as well as (s-3): 658~679, 1984 of Proteus, Klebsiella and Enterobacter are 8) Onodera S, Machida T, Suzuki H, Kishimoto now beginning to emerge, so that the K, Kiyota H, Goto H and Okazaki T: arrival of this new drug is particularly Studies of antibacterial activity of AT-2266 against N.
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