Introduction and Objectives
Infections of the urinary tract pose a serious health problem, partly because of their frequent occurrence. The goal of treatment of UTIs is to eradicate the infection by selecting the most appropriate therapy, that would demonstrate high clinical and bactericidal cure rate and a low potential for resistance. The chosen therapy should be associated with a reasonable acquisition cost, a convenient dozing regime conducive to patient compliance, minimal side effects. Especially in Albanian practice, the cost of the treatment is a very important element that should be pretty considered when deciding the treatments. According to our urologists practice uncomplicated UTIs are treated mostly with floroquinolones or trimethoprim-sulphamethoxazole for 3 days.The purpose of our study is to identify the relationship between those two agents selection and both clinical and economic outcomes in the treatment of uncomplicated UTIs.
Material and Methods
The study has started in January 2008 and will go on. The studied population is a total of 72 ambulatory patients with uncomplicated UTIs, from whom 12 patients had underwent in the past prostatectomy and 6 patients had UTIs following bladder catheterization. The population is randomly separated in two equal groups that were treated for thee days of oral Ciprofloxacin (250 mg BID) or three days of TMP/SMX. All patients were initially evaluated (disease history, physical examination and dipstick urinanalysis), treated with one of the mentioned alternative and followed-up (dipstick urinanalysis after 10–14 days). The patients with recurrence of UTI within 2 weeks were requested to repeat urinary culture with antimicrobial testing and to reevaluated urinary tract. It was estimated the total treatment cost from initial evaluation to “prescription pad” to cure” including costs related to Lab testing, office visits, additional intervention (mainly in TMP/SMX-treated patients) to achieve the cure, treatments of relapses ect.
Bacteriologic cure rates after four weeks were 90% for the group treated with ciprofloxacin and 75% for the group treated with TMP/SMX. Clinical cure rates after 10–14days were 95% for the group treated with ciprofloxacin and 85% for the group treated with TMP/SMX. Because of short period of treatment there were no consideration regarding side effects of both treatments. The mean total cost per patient was 30% higher for TMP/SMX-treated patients than for ciprofloxacin-treated patients.
Until now the study confirms that resistance phenomena is important in deciding the treatment of UTI. Ciprofloxacin is more effective and less expensive than TMP/SMX in the treatment of uncomplicated UTI.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.