Efficacy and safety of 3 day versus 7 day cefditoren pivoxil regimens for acute uncomplicated cystitis: multicentre, randomized, open-label trial.

Fluoroquinolone-non-susceptible Escherichia coli isolated from patients with acute uncomplicated cystitis are a matter of increasing concern. Cefditoren pivoxil is an oral, β-lactamase-stable, extended-spectrum cephalosporin that is effective against fluoroquinolone-non-susceptible bacteria. To evaluate the clinical and microbiological efficacies of cefditoren pivoxil against acute uncomplicated cystitis and to determine the optimal duration of cefditoren pivoxil treatment. We compared 3 and 7 day regimens of cefditoren pivoxil in a multicentre, randomized, open-label study. A total of 104 female patients with acute uncomplicated cystitis were enrolled and randomized into 3 day (n = 51) or 7 day (n = 53) treatment groups. At first visit, 94 bacterial strains were isolated from the 104 participants of which 81.7% (85/104) were E. coli. Clinical and microbiological efficacies were evaluated 5-9 days following administration of the final dose of cefditoren pivoxil. The clinical efficacies of the 3 and 7 day groups were 90.9% (40/44) and 93.2% (41/44), respectively (P = 1.000). The microbiological efficacies of the 3 and 7 day groups were 82.5% (33/40) and 90.2% (37/41), respectively (P = 0.349). There were no adverse events due to cefditoren pivoxil treatment, with the exception of a mild allergic reaction in one patient, after which the cefditoren pivoxil was exchanged for another antimicrobial. Cefditoren pivoxil is safe and effective for uncomplicated cystitis, with no significant differences in clinical and microbiological efficacies between 3 and 7 day regimens.

Sadahira T ，Wada K ，Araki M ，Ishii A ，Takamoto A ，Kobayashi Y ，Watanabe M ，Watanabe T ，Nasu Y ，Kumon H ，Okayama Urological Research Group (OURG) ... -  《-》

Second nationwide surveillance of bacterial pathogens in patients with acute uncomplicated cystitis conducted by Japanese Surveillance Committee from 2015 to 2016: antimicrobial susceptibility of Escherichia coli, Klebsiella pneumoniae, and Staphylococcus

The Japanese Surveillance Committee conducted a second nationwide surveillance of antimicrobial susceptibility patterns of uropathogens responsible for acute uncomplicated cystitis (AUC) in premenopausal patients aged 16-40 years old at 31 hospitals throughout Japan from March 2015 to February 2016. In this study, the susceptibility of causative bacteria (Escherichia coli, Klebsiella pneumoniae, Staphylococcus saprophyticus) for various antimicrobial agents was investigated by isolation and culturing of organisms obtained from urine samples. In total, 324 strains were isolated from 361 patients, including E. coli (n = 220, 67.9%), S. saprophyticus (n = 36, 11.1%), and K. pneumoniae (n = 7, 2.2%). The minimum inhibitory concentrations (MICs) of 20 antibacterial agents for these strains were determined according to the Clinical and Laboratory Standards Institute (CLSI) manual. At least 93% of the E. coli isolates showed susceptibility to fluoroquinolones and cephalosporins, whereas 100% of the S. saprophyticus isolates showed susceptibility to fluoroquinolones and aminoglycosides. The proportions of fluoroquinolone-resistant and extended-spectrum β-lactamase (ESBL)-producing E. coli strains were 6.4% (13/220) and 4.1% (9/220), respectively. The antimicrobial susceptibility of K. pneumoniae was retained during the surveillance period, while no multidrug-resistant strains were identified. In summary, antimicrobial susceptibility results of our second nationwide surveillance did not differ significantly from those of the first surveillance. Especially the numbers of fluoroquinolone-resistant and ESBL-producing E. coli strains were not increased in premenopausal patients with AUC in Japan.

Hayami H ，Takahashi S ，Ishikawa K ，Yasuda M ，Yamamoto S ，Wada K ，Kobayashi K ，Hamasuna R ，Minamitani S ，Matsumoto T ，Kiyota H ，Tateda K ，Sato J ，Hanaki H ，Masumori N ，Nishiyama H ，Miyazaki J ，Fujimoto K ，Tanaka K ，Uehara S ，Matsubara A ，Ito K ，Hayashi K ，Kurimura Y ，Ito S ，Takeuchi T ，Narita H ，Izumitani M ，Nishimura H ，Kawahara M ，Hara M ，Hosobe T ，Takashima K ，Chokyu H ，Matsumura M ，Ihara H ，Uno S ，Monden K ，Sumii T ，Kawai S ，Kariya S ，Sato T ，Yoshioka M ，Kadena H ，Matsushita S ，Nishi S ，Hosokawa Y ，Shirane T ，Yoh M ，Watanabe S ，Makinose S ，Uemura T ，Goto H ... -  《-》

Treatment of acute uncomplicated cystitis with faropenem for 3 days versus 7 days: multicentre, randomized, open-label, controlled trial.

The increasing prevalence of resistant bacteria such as fluoroquinolone-resistant or extended-spectrum β-lactamase-producing strains in pathogens causing acute uncomplicated cystitis has been of concern in Japan. Faropenem sodium is a penem antimicrobial that demonstrates a wide antimicrobial spectrum against both aerobic and anaerobic bacteria. It is stable against a number of β-lactamases. We compared 3 and 7 day administration regimens of faropenem in a multicentre, randomized, open-label, controlled study. In total, 200 female patients with cystitis were enrolled and randomized into 3 day (N = 97) or 7 day (N = 103) treatment groups. At the first visit, 161 bacterial strains were isolated from 154 participants, and Escherichia coli accounted for 73.9% (119/161) of bacterial strains. At 5-9 days after the completion of treatment, 73 and 81 patients from the 3 day and 7 day groups, respectively, were evaluated by intention-to-treat analysis; the microbiological efficacies were 58.9% eradication (43/73), 20.5% persistence (15/73) and 8.2% replaced (6/73), and 66.7% eradication (54/81), 6.2% persistence (5/81) and 7.4% replaced (6/81), respectively (P = 0.048). The clinical efficacies were 76.7% (56/73) and 80.2% (65/81), respectively (P = 0.695). Adverse events due to faropenem were reported in 9.5% of participants (19/200), and the most common adverse event was diarrhoea. The 7 day regimen showed a superior rate of microbiological response. E. coli strains were in general susceptible to faropenem, including fluoroquinolone- and cephalosporin-resistant strains.

Hamasuna R ，Tanaka K ，Hayami H ，Yasuda M ，Takahashi S ，Kobayashi K ，Kiyota H ，Yamamoto S ，Arakawa S ，Matsumoto T ，Japanese Research Group for UTI (JRGU) ... -  《-》

[Norfloxacine efficacy in acute cystitis in the region with 10% resistance of E. coli to fluoroquinolones: a comparative randomized study].

Rafal'skiĭ VV ，Malev IV ，Derevitskiĭ AV ，Kozlov SN ，Galkin VV ... -  《-》

Nationwide surveillance of bacterial pathogens from patients with acute uncomplicated cystitis conducted by the Japanese surveillance committee during 2009 and 2010: antimicrobial susceptibility of Escherichia coli and Staphylococcus saprophyticus.

Hayami H ，Takahashi S ，Ishikawa K ，Yasuda M ，Yamamoto S ，Uehara S ，Hamasuna R ，Matsumoto T ，Minamitani S ，Watanabe A ，Iwamoto A ，Totsuka K ，Kadota J ，Sunakawa K ，Sato J ，Hanaki H ，Tsukamoto T ，Kiyota H ，Egawa S ，Tanaka K ，Arakawa S ，Fujisawa M ，Kumon H ，Kobayashi K ，Matsubara A ，Naito S ，Tatsugami K ，Yamaguchi T ，Ito S ，Kanokogi M ，Narita H ，Kawano H ，Hosobe T ，Takayama K ，Sumii T ，Fujii A ，Sato T ，Yamauchi T ，Izumitani M ，Chokyu H ，Ihara H ，Akiyama K ，Yoshioka M ，Uno S ，Monden K ，Kano M ，Kaji S ，Kawai S ，Ito K ，Inatomi H ，Nishimura H ，Ikuyama T ，Nishi S ，Takahashi K ，Kawano Y ，Ishihara S ，Tsuneyoshi K ，Matsushita S ，Yamane T ，Hirose T ，Fujihiro S ，Endo K ，Oka Y ，Takeyama K ，Kimura T ，Uemura T ... -  《-》