Garrison J, Hooton T M
Department of Pharmacy, University of Washington School of Medicine, Harborview Medical Center, Seattle 98104, USA.
Expert Opin Pharmacother. 2001 Aug;2(8):1227-37. doi: 10.1517/14656566.2.8.1227.
Urinary tract infections (UTIs) are among the most commonly encountered bacterial infections. Acute uncomplicated UTIs in adults include episodes of cystitis and pyelonephritis. The main uropathogens causing uncomplicated UTIs have, in the past, been fairly predictable and they have generally been susceptible to several commonly used oral antimicrobials. There has been a trend, however, towards increasing antimicrobial resistance among uropathogens over the past few years, especially to beta-lactams and trimethoprim-sulfamethoxazole (TMP-SMX). The current standard of therapy for the empiric treatment of acute uncomplicated cystitis is TMP-SMX for 3 days. Since the prevalence of resistance to TMP-SMX among uropathogens is increasing, however, fluoroquinolones, with their low side effect profile, convenient pharmacokinetics and effectiveness, are increasingly being used first-line for the management of cystitis. Treatment of acute pyelonephritis is less controversial and fluoroquinolones are recommended as first-line agents in the empiric treatment of community-acquired pyelonephritis. Of concern, the increased use of fluoroquinolones for the treatment of UTIs and other infectious processes has resulted in an increasing prevalence of fluoroquinolone-resistant uropathogens worldwide. In light of these changing resistance patterns, prudent use of fluoroquinolones for the treatment of UTIs is warranted.
尿路感染（UTIs）是最常见的细菌感染之一。成人急性单纯性尿路感染包括膀胱炎和肾盂肾炎发作。过去，引起单纯性尿路感染的主要尿路病原体相当可预测，并且它们通常对几种常用的口服抗菌药物敏感。然而，在过去几年中，尿路病原体的抗菌耐药性呈上升趋势，尤其是对β-内酰胺类和甲氧苄啶-磺胺甲恶唑（TMP-SMX）的耐药性。目前，急性单纯性膀胱炎经验性治疗的标准疗法是服用3天的TMP-SMX。然而，由于尿路病原体对TMP-SMX的耐药率不断上升，氟喹诺酮类药物因其副作用小、药代动力学特性良好且疗效显著，越来越多地被用作膀胱炎治疗的一线药物。急性肾盂肾炎的治疗争议较小，氟喹诺酮类药物被推荐作为社区获得性肾盂肾炎经验性治疗的一线药物。令人担忧的是，氟喹诺酮类药物在尿路感染和其他感染性疾病治疗中的使用增加，导致全球范围内氟喹诺酮耐药尿路病原体的患病率不断上升。鉴于这些不断变化的耐药模式，谨慎使用氟喹诺酮类药物治疗尿路感染是必要的。
