Open, randomized comparison of pefloxacin and cefotaxime in the treatment of complicated urinary tract infections

In an open, randomized study, the effect of pefloxacin (400 mg b.i.d.) was compared with that of cefotaxime (1 g t.i.d.) in the treatment of complicated urinary tract infections. In total 87 patients entered the study under the clinical diagnosis of complicated urinary tract infection, of whom 49 were eligible for evaluation. Most isolates (90%) belonged to the family of Enterobacteriaceae. Isolates were eradicated from 96% (28/29) of patients treated with pefloxacin and 89% (16/18) of those receiving cefotaxime 48 h after the end of therapy. After one week a total of 92% (22/24) of patients treated with pefloxacin were culture negative, while in the group treated with cefotaxime a total of 82% (9/11) were culture negative. After four to six weeks, 68% (13/19) in the pefloxacin and 80% (8/10) in the cefotaxime study group showed a negative urine culture (difference non-significant; p>0.5). Clinical cure at the end of treatment was 97% (30/31) in the pefloxacin group vs. 89% (16/18) in the cefotaxime group. Both groups showed similar relapse and reinfection rates at 48 h and one week after therapy. Adverse effects were mild and reversible for both drugs. It is concluded that pefloxacin is a safe and effective alternative for treatment of complicated urinary tract infection.