Nicolle L E
Department of Medicine, University of Manitoba, Winnipeg.
Clin Invest Med. 1989 Feb;12(1):35-8.
Urinary infection in some clinical situations remains difficult to treat with standard oral therapy. Particular problems occur in individuals with underlying genitourinary abnormalities, with intolerance to multiple oral agents, with infections due to resistant organisms, and in men with prostatitis. The fluoroquinolone antimicrobials have an extended spectrum of activity compared to standard oral therapy, achieve high concentrations in the urine following the usual therapeutic doses, and are relatively free of major adverse effects. Thus, they may be effective therapy for some of the clinical situations for which current oral therapy is not satisfactory. However, the majority of clinical studies published to date have examined the use of quinolone therapy in the treatment of urinary infection primarily in individuals with a normal genitourinary tract, a group in which an 85-100% cure rate is achieved with standard oral therapy. Further studies of quinolones, particularly in individuals with underlying abnormalities of the genitourinary tract and in men with prostatitis, are required to clarify their role in these clinical situations and to document the extent of the emergence of resistant organisms. Other studies which would compare quinolones, examine more carefully cost effectiveness uses, and evaluate the effectiveness and safety of extended therapy are also needed to identify the appropriate therapeutic niche of this new group of drugs in the management of urinary infection.
在某些临床情况下，标准口服疗法治疗泌尿系统感染仍然困难。患有潜在泌尿生殖系统异常、对多种口服药物不耐受、感染耐药菌的个体以及患有前列腺炎的男性会出现特殊问题。与标准口服疗法相比，氟喹诺酮类抗菌药物具有更广泛的活性谱，在常规治疗剂量后尿液中可达到高浓度，且相对无主要不良反应。因此，它们可能是治疗某些当前口服疗法效果不佳的临床情况的有效疗法。然而，迄今为止发表的大多数临床研究主要在泌尿生殖道正常的个体中研究喹诺酮疗法治疗泌尿系统感染的应用，在这组个体中标准口服疗法的治愈率为85%至100%。需要对喹诺酮类药物进行进一步研究，特别是在患有潜在泌尿生殖道异常的个体和患有前列腺炎的男性中，以阐明它们在这些临床情况下的作用，并记录耐药菌出现的程度。还需要进行其他研究，比较喹诺酮类药物，更仔细地研究成本效益用途，并评估延长治疗的有效性和安全性，以确定这组新药在泌尿系统感染管理中的合适治疗定位。
