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5 8.5 &%1 =G B% FE ' "A ' -- % l7i.,% "3) +, % + "5*%,-. D +1 ' ' %.-'1% Q@ " -+ "5*% %1 W 1 %@ " "A '- " *C.% 9': (G) B C% A' 0 n-% % ` < " % ' -% 0 -&6 i ' -' B- " >?% ' A " G1 % " " F@) Q+ B "9, =G "A '- -% _5C% " 1 ;'. -&i "A % ~ 9': )`%; "*% B- "3) :-). 1- Mehnert-Kay SA. Diagnosis and management of uncomplicated urinary tract infections. Am Fam Physician. 2005; 72 (3): Karachalios GN, Georgiopoulos AN, Kintziou H. Treatment of acute pyelonephritis in women with intramuscular ceftriaxone: an out-patient study. Chemotherapy. 1991; 37 (4): Lepage JY, Juge C, Cozian A, Espaze E, Reynaud AE, Souron R, Baron D. Comparative study of first-line ceftriaxone and amikacin in the treatment of severe urinary tract infections in the adult. Pathol Biol (Paris). 1987; 35 (5): Papierkowski A, Pietraszek-Mamcarz J, Kozlowska T, Gornicka G, Emeryk A. Use of ceftriaxone in urinary and respiratory tract infections. Pol Tyg Lek. 1990; 45 (14-15): Talan DA, Stamm WE, Hooton TM, Moran GJ, Burke T, Iravani A, et al. Comparison of ciprofloxacin (7 days) and trimethoprim-sulfamethoxazole (14 days) for acute uncomplicated pyelonephritis pyelonephritis in women: a randomized trial. JAMA. 2000; 283 (12): Richard GA, Klimberg IN, Fowler CL, Callery-D'Amico S, Kim SS. Levofloxacin versus ciprofloxacin versus lomefloxacin in acute pyelonephritis. Urology. 1998; 52 (1): Takahashi S, Hirose T, Satoh T, Kato R, Hisasue SI, Takagi S, et al. Efficacy of a 14-day course of oral ciprofloxacin therapy for acute uncomplicated pyelonephritis. J Infect Chemother. 2001; 7 (4): Talan DA, Stamm WE, Hooton TM, Moran GJ, Burke T, Iravani A, et al. Comparison of ciprofloxacin (7 days) and trimethoprim-sulfamethoxazole (14 days) for acute uncomplicated pyelonephritis pyelonephritis in women: a randomized trial. JAMA. 2000; 283 (12): Henry NK, Schultz HJ, Grubbs NC, Muller SM, Ilstrup DM, Wilson WR. Comparison of ciprofloxacin and cotrimoxazole in the treatment of uncomplicated urinary tract infection in women. J Antimicrob Chemother. 1986; 18 Suppl D: Mansouri S, Shareifi S. Antimicrobial resistance pattern of Escherichia coli causing urinary tract infections, and that of human fecal flora, in the southeast of Iran. Microb Drug Resist. 2002; 8 (2): Le Conte P, Simon N, Bourrier P, Merit JB, Lebrin P, Bonnieux J, et al. Acute pyelonephritis. Randomized multicenter double-blind study comparing ciprofloxacin with combined ciprofloxacin and tobramycin. Med. 2001; 30 (1): Ryan JL, Berenson CS, Greco TP, Mangi RJ, Sims M, Thornton GF, et al. Oral ciprofloxacin in resistant urinary tract infections. Am J Med. 1987; 82 (4A): Sandberg T, Englund G, Lincoln K, Nilsson LG. Randomised double-blind study of norfloxacin and cefadroxil in P

6 K&(D%J($A #0 H $A...F /1B #?1@ #%A1$B( AC D(%A0E( %1? the treatment of acute pyelonephritis. Eur J Clin Microbiol Infect Dis. 1990; 9 (5): Roberts JA. Management of pyelonephritis and upper urinary tract infections. Urol Clin North Am. 1999; 26 (4): Fluit AC, Jones ME, Schmitz FJ, Acar J, Gupta R, Verhoef J. Antimicrobial resistance among urinary tract infection (UTI) isolates in Europe: results from the SENTRY Antimicrobial Surveillance Program Antonie Van Leeuwenhoek. 2000; 77 (2): Matute AJ, Hak E, Schurink CA, McArthur A, Alonso E, Paniagua M, et al. Resistance of uropathogens in symptomatic urinary tract infections in Leon, Nicaragua. Int J Antimicrob Agents. 2004; 23 (5): Chaniotaki S, Giakouppi P, Tzouvelekis LS, Panagiotakos D, Kozanitou M, Petrikkos G, et al. Quinolone resistance among Escherichia coli strains from community-acquired urinary tract infections in Greece. Clin Microbiol Infect. 2004; 10 (1): Kapoor H, Aggarwal P. Resistance to quinolones in pathogens causing urinary tract infections. J Commun Dis. 1997; 29 (3): Williams AH, Gruneberg RNCiprofloxacin and co-trimoxazole in urinary tract infection. J Antimicrob Chemother. 1986; 18 Suppl D: Yen ZS, Davis MA, Chen SC, Chen WJA cost-effectiveness analysis of treatment strategies for acute uncomplicated pyelonephritis in women. Acad Emerg Med. 2003; 10 (4): Q

7 Title: Comparaison of oral ciprofloxacin with parenteral ceftriaxone in treatment of acute uncomplicated pyelonephritis in women Authors: MR. Erfanian 1, M. Seyed Nozadi 2 Abstract Background and Aim: Acute pyelonephritis is one of the most frequent bacterial infections in women which is usually managed by parenteral antibiotics, that are more expensive than oral ones. A lot of physicians recommend oral ciprofloxacin as a drug of choice to treat acute uncomplicated pyelonephritis. Recently, some patients did not responded to ciprofloxacine practically. This study was to assess treatment efficacy of oral ciprofloxacin with parenteral ceftriaxone in acute uncomplicated pyelonephritis in women. Materials and Methods: This clinical trial was performed on 47 women who were hospitalized with positive urine culture of acute uncomplicated pyelonephritis in Hashemy-nezhad hospital between 2002 and In all cases, isolated micro-organism was E.coli. After randomized selection each patient was treated by using one of the two regimens: oral ciprofloxacin or parenteral ceftriaxone. The patients were examined 24, 48, and 72 hours after the beginning of treatment for fever and other clinical symptoms and signs. For the assessment of bacteriologic response, urine cultures were undertaken at the end of the third and seventh day after the beginning of treatment. The obtained data were processed by means of SPSS software. Then, for data description statistical tables were used. Finally, student-t and fisher exact test were employed to analyse the data at the significant level of P0.05. Results: Mean age of subjects was 41.35±10.22 years. Mean age of women treated by ciprofloxacine and ceftriaxone were 41.68±9.30 and 41.12±11.80 years, respectively; the difference of which was not significant statistically (P=0.61). Clinical response (negativity of urine cultures at the 3rd and 7th day) to treatment by oral ciprofloxacin and parenteral ceftriaxone revealed no significant difference. Mean symptoms improvement duration in oral ciprofloxacin and parenteral ceftriaxone were 2.67±0.49 and 1.63±0.63 days, respectively and thus, the difference was significant (P=0.000). Conclusion: The survey showed that oral ciprofloxacin is almost as effective as parenteral ceftriaxone but improvement of symptoms by ceftriaxone occurred earlier compared with ciprofloxacin taking. Key Words: Acute uncomplicated pyelonephritis; Women; Ciprofloxacin; Ceftriaxone; Clinical response 1 Corresponding Author; Assistant Professor, Department of Community Medicine; Faculty of Medicine, Mashhad University of Medical Sciences. Mashhad, Iran m-erfanian@mums.ac.ir 2 Associate Professor, Department of Community Medicine; Faculty of Medicine, Mashhad University of Medical Sciences. Mashhad, Iran

Antibiotic Susceptibility Patterns of Community-Acquired Urinary Tract Infection Isolates from Female Patients on the US (Texas)- Mexico Border

Antibiotic Susceptibility Patterns of Community-Acquired Urinary Tract Infection Isolates from Female Patients on the US (Texas)- Mexico Border Yvonne Vasquez, MPH W. Lee Hand, MD Department of Research