The efficacy of sequential therapy using pazufloxacin followed by oral fluoroquinolones for treatment of pyelonephritis

Abstract

The efficacy of sequential therapy of pazufloxacin (PZFX), which is a parenteral fluoroquinolone, followed by oral fluoroquinolones [tosufloxacin tosilate (TFLX) or levofloxacin (LVFX)] for treatment of pyelonephritis, was evaluated. Patients with pyelonephritis who had fever (≥37.5°C), pyuria (≥10 white blood cells/high-power field), and bacteriuria (≥10(4) colony-forming units/ml) were eligible for this study. PZFX (500mg) was given intravenously twice a day for at least 3days. If the patients were clinically improved, TFLX (150mg) or LVFX (100mg) was then administered orally three times a day for at least 5days. Patients underwent clinical and microbiological evaluation at 5-9days after final drug administration. Clinical and microbiological efficacy could be assessed in 21 of 25 cases enrolled. Both clinical and microbiological efficacy rates were 81.0% (17/21 cases). In the effective cases, the mean administration time was 4.2days for PZFX and 6.0days for oral fluoroquinolones. The mean time to defervescence was 3.4days for the effective cases. In the four treatment failure cases, three quinolone-resistant Escherichia coli and a quinolone-resistant Enterococcus faecalis were isolated. This sequential therapy seemed to be clinically effective in the treatment of pyelonephritis; however, the prevalence of quinolone-resistant E. coli should be taken into account.