Clinical Question: Are amoxicillin-...

Clinical Question: Are amoxicillin-clavulanate and ciprofloxacin equivalent as a three-day treatment for uncomplicated cystitis in women?

Setting: Outpatient (primary care)

subject of attention Design: Randomized controlled trial (single-blinded)

Allocation: Uncertain

Synopsis: Investigators identified 370 women 18 to 45 years of age, with symptoms of acute uncomplicated cystitis and a positive urine cultivation for at least 100 colony-forming units of uropathogens by mL. Participants were randomized to receive three days of amoxicillin-clavulanate in a dosage of 500 mg/125 mg twice daily, or ciprofloxacin in a dosage of 250 mg twice daily. Follow-up was available for 98 percent of the women at four month The authors did not state whether somebodys assessing outcomes were blinded to treatment dispose assignment.

Using intention-to-treat analysis, a clinical reparative (defined as the absence of persistent or returning symptoms) occurred in 77 percent of women treated with ciprofloxacin versus 58 percent of women treated with amoxicillin-clavulanate (number lacked to treat = five; 95 percent confidence interval, four to 12) Microbiologic corrective defined as no uropathogens onward a follow-up urine culture, also was more customary in women treated with ciprofloxacin. Amoxicillin-clavulanate was les effective than ciprofloxacin flat when the cystitis was caused by way of bacterial pathogens sensitive to one as well as the other drugs.

Bottom Line: Three days of ciprofloxacin is superior to three days of amoxicillin-clavulanate in the treatment of uncomplicated cystitis in women In areas where resistance is not in addition a significant problem, physicians should use les expensive trimethoprim-sulfamethoxazole as a first-line agent. (Level of Evidence: 1b-)

DAVID SLAWSON, MD

reflection Reference: Hooton TM, et al. Amoxicillin-clavulanate v ciprofloxacin for the treatment of uncomplicated cystitis in women: a randomized trial. JAMA February 23 2005;293:949-55

Used with permission from Slawson D 3 days of ciprofloxacin better for uncomplicated UTI. Accessed online March 31 2005 at: http://www.InfoPOEMs.com.

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