IABCR International Archives of BioMedical and Clinical Research www.iabcr.org Research Article Ofloxacin and Nitrofurantoin sensitivity pattern In Patients of Urinary Tract Infection (UTI) at a tertiary care teaching hospital Dharmesh Devmurari1*, Chand Miyaan Kamal2, Shambhu Nath Singh3, Amit Kumar4 1*Department of Microbiology, Gujrat Adani Institute of Medical Sciences, Bhuj, Gujarat. 2Department of Pharmacology, SMMH Government Medical College, Saharanpur, India 3Department of Pharmacology, Darbhanga Medical College and Hospital, Bihar. 4Department of Pharmacology, Teerthanker Mahaveer Medical College __________________________________________________ Abstract Received: 12 Aug 2015 Introduction: UTIs are the second most common bacterial infection in present population. Revised: 14 Aug 2015 Women are more prone to UTI than Male. Uropathogenic Escherichia coli is responsible for Accepted: 18 Aug 2015 >80% of community acquired UTIs. Aims: The present study was carried out to compare sensitivity / Resistance between Ofloxacin and Nitrofurantoin in UTI patients. Methods: This was a prospective, cross-sectional, observatory study conducted on patients (n = 200) suffering from Urinary Tract Infection from March 2014 to February 2015 at the Department of Microbiology and Department of Pharmacology, Teerthanker Mahaveer Medical College and Research Centre (TMMC & RC), at a tertiary care teaching hospital, in Moradabad, *Correspondence to: Uttar Pradesh, India. Dr Dharmesh Devmurari Results: UTI was much more common in females (61%, n=122) than in males (39%, n=78). Address: Department of The most common organism isolated was E. coli, 47%(n=94), followed by Klebsiella Microbiology, Gujrat Adani 34.5%(n=69), staphylococcus 7.5%(n=15), Proteus, pseudomonas 4%(n=8) and enterococcus Institute of Medical Sciences, Bhuj, Gujarat. 3%(n=6). E. coli was highly sensitive to the Ofloxacin 18% (n=36). Email: Conclusion: Sensitivity pattern of the antimicrobial was found to be more in Nitrofurantoin [email protected] (57%) was found to be more sensitive than Ofloxacin (40.5%) for the treatment of UTI. Keywords: Nitrofurantoin, Ofloxacin, Antimicrobial agents, Sensitivity Copyright: © publisher IABCR. This is an open access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction by Staphylococcus saprophyticus, Klebsiella pneumonia, UTIs are the second most common bacterial infection in Proteus mirabilis and Enterococcus faecalis. [2] The organism present population. UTIs are one of the important causes of that caused urinary tract infection is those, which are morbidity and mortality in Indian population, affecting all normally present in renal area. E.coli, Klebsiella and age group across the life span. Nevertheless, it is a difficult Enterobacteria account for 90% of urinary tract infection. [3] to accurately assess the incidence of UTIs, because they are Proteus, Coagulase Negative Staphylococcus and not reportable diseases in the United States. This situation is Pseudomonas also cause urinary tract infection. [4] further complication by the fact that accurate diagnosis depend upon both the presence of symptoms and a positive UTI is defined by a combination of clinical feature and the urine culture, although in the most outpatient setting this the presence of bacteria in urine. It is also defined by the diagnosis is made without the benefit of culture. Women are presence of more than 100,000 colony –forming unit of significantly are more likely to experience UTI than man. single bacteria in culture in urine. The clinical feature of UTI Nearly 1 in 3 women will have had at least 1 episode of UTI may include both specific and nonspecific signs and requiring antimicrobial therapy by the age of 24 years. symptoms. Accurate diagnosis and treatment of UTI is Catheter-associated UTI is the Most common nosocomial essential to limit its associated morbidity, mortality and to infection, according for >1 million case in hospital and avoid prolonged or unnecessary use of antibiotics. [5] nursing home. [1] Antibiotics for empiric treatment of uncomplicated UTI Uropathogenic Escherichia coli is responsible for >80% of include First-line antibiotic: community acquired UTIs, with most other infection caused trimethoprim/Sulphamethoxazole (Cotrimoxazole) in www.iabcr.org International Archives of BioMedical and Clinical Research | July-Sept 2015 | Vol 1 | Issue 1 17 | P a g e Devmurari D et al. Int Arch BioMed Clin Res. 2015 Aug; 1(1):17-22 ] communities with resistance rates for E coli less than 20%. spp. (63%). There is no activity against Proteus spp. or P. Avoid in women who have been treated within 6 months, as Aeruginosa. [13] they are more likely to have resistant organisms. [6] Ofloxacin is a synthetic antibiotic of the Fluoroquinolones Second-line antibiotics: or first-line in resistant communities: drug class considered to be a second-generation Nitrofurantoin. Fluoroquinolones.[14] Ofloxacin is a broad-spectrum Fluoroquinolones, such as ciprofloxacin, Levofloxacin, antibiotic that is active against both Gram-positive and Norfloxacin, and Ofloxacin. Their efficacy is comparable to Gram-negative bacteria. Susceptible bacteria: co-trimoxazole, but increasing resistance rates have been noted. [7] Therefore the present study was carried out to compare sensitivity / Resistance between Ofloxacin and Alternates: third-generation Cephalosporin’s, Nitrofurantoin, Nitrofurantoin in UTI patients attending in Teerthanker Fosfomycin. Mahaveer Medical College and Research centre, Moradabad The following should not be used unless indicated by U.P. individual patient culture Sensitivities: first- or second- generation cephalosporin, Ampicillin and amoxicillin with Method Clavulate. [8] Study setting This was a prospective, cross-sectional, observatory study Single-dose regimens: Although single-dose therapy using β- conducted on patients (n = 200) suffering from Urinary Tract lactams, trimethoprim-sulfamethoxazole, trimethoprim, and Infection from March 2014 to February 2015 at the Fluoroquinolones have shown high cure rates, single-dose Department of Microbiology and Department of therapy is associated with a high rate of recurrence within 6 Pharmacology, Teerthanker Mahaveer Medical College and weeks of initial treatment. Reinfection may be due to the Research Centre (TMMC & RC), at a tertiary care teaching failure of single-dose treatment to eradicate gram-negative hospital, in Moradabad, Uttar Pradesh, India. Patients were pathogens from the perianal area. Amino penicillin and first- recruited on the basis of inclusion and exclusion criteria. generation cephalosporin’s have shorter half-lives, which may contribute to their lower efficacy compared with other A total of 200 urine samples were collected and then agents. [9] transported to the Microbiology laboratory for culture and antimicrobial sensitivity test. Analyzation of data was carried In the treatment of urinary tract infections, the resolution of out on focusing on the gender, age, isolation of bacteria, bacteraemia has been correlated with the concentration of the gram staining and Antimicrobial sensitivity. antimicrobial agent in the urine rather than serum levels. [10] All the antimicrobial agents approved for the treatment of Data collection urinary tract infections achieve inhibitory urinary Analyzation of data was carried out on focusing on the concentrations that significantly exceed serum levels. gender, age, isolation of bacteria, and the antibiotic sensitivity data of all isolates was also reviewed and Nitrofurantoin, a chemotherapeutic compound of the analysed. Nitrofuran family, was introduced into clinical practice in 1952. Nitrofurantoin is a synthetic antimicrobial derived Using a calibrated loop (volume - 0.005ml) streaking was from furan by the addition of a nitro group and a side chain done on cysteine lactose electrolyte containing hydantoin. Nitrofurantoin is a weak acid and its The isolated organism from culture plate was then assessed solubility is affected by PH. [11] for antimicrobial susceptibility test by disk diffusion method in Muller Hilton agar. Comparison was done by measuring Nitrofurantoin spectrum of in vitro susceptibility includes the the zone of inhibition between two antibiotics i.e. Ofloxacin majority of Escherichia coli, Citrobacter species, group B and Nitrofurantoin. Streptococci, Enterococci, Staphylococcus aureus, S. epidermidis, Klebsiella pneumoniae and Enterobacter Ethical approval species. [11] Thus, its antibacterial spectrum is broad and is Ethical approval for the study was obtained through the particularly effective against the main Uropathogen, hence Medical research and Ethics Committee at the Teerthanker its use for the treatment of urinary tract infections (UTI). In a Mahaveer Medical Collage and Research Centre (TMMC & recent study, the susceptibility for E. coli was 99.5%. High RC). susceptibility of E. coli clinical isolates to Nitrofurantoin (2.3% resistance rate), compared to Data analysis trimethoprim/sulfamethoxazole (29%) or ciprofloxacin Data were coded, checked for completeness and consistency. (24.2%) was recently confirmed.[12] However, Nitrofurantoin Then the data were entered and analysed into the computer is less susceptible against Gram-negative pathogens other by using Microsoft excel and SPSS 16.0. than E. coli, such as Klebsiella