Clinical experience in the treatment of complicated urinary tract infection with different doses of moxalactam (lamoxactam).

Moxalactam disodium underwent phase II evaluation to determine its efficacy, safety, and tolerance in the treatment of complicated urinary tract infections (UTI). Bacteriologic cultures of a clean midstream urine specimen were made and antibiotic sensitivities determined by FDA standard disk testing. Urinalysis and cultures were performed on specimens obtained within 24 h of starting therapy, on the 3rd or 4th day, and the last day of treatment, and again 5-9 days later. Whenever possible a urine sample was obtained 4-6 weeks after therapy in an attempt to measure recurrence of infection. Duration of treatment ranged from 8 to 21 days. Patients were assigned to one of the three treatment groups in chronological order at entry: group I = 2 g single daily dose i.v.; group II = divided dose of 1.0 g i. m.; and group III = single daily dose of 1 g i. m. A total of 122 patients with 129 pathogens entered the study; all completed the protocol. Of 129 pathogens 85 were eliminated. The success rate of about 70% in the three different treatment groups showed no significant difference. In 12 cases the pathogen disappeared while the patient was on treatment but recurred during the post-therapy period. In 28 patients reinfection with a new pathogen, mainly Enterococcus, occurred. There were four therapeutic failures in which the pathogen was not eliminated during any time of treatment. The organisms were either persistent or resistant. In conclusion, moxalactam is highly effective in treating complicated UTIs even at a relatively low dose. We observed no significant difference between the three different treatment protocols used. The only major problem encountered was that Enterococcus is typically resistant to moxalactam, a problem of clinical relevance, particularly in cases of reinfections.