Sitafloxacin and Ertapenem Treatment for Acute Pyelonephritis Caused by Escherichia Coli

A Randomized Controlled Trial of Sitafloxacin and Ertapenem Treatment for Acute Pyelonephritis Caused by Extended-Spectrum ß-lactamase-producing Escherichia Coli

The aim of the investigators' study was to evaluate oral and non carbapenem antimicrobial agents which can be used in outpatient for the treatment of non-bacteremic acute pyelonephritis caused by Extended Spectrum Beta Lactamase Escherichia coli. This study was conducted to compare the clinical and bacteriological outcomes of patients with non-bacteremic acute pyelonephritis caused by Extended Spectrum Beta Lactamase Escherichia coli who were treated with intravenous (IV) carbapenems followed by oral sitafloxacin or IV ertapenem.

A prospective randomized controlled trial of patients with a presumptive diagnosis of acute pyelonephritis caused by Extended Spectrum Beta Lactamase-producing pathogen was performed. Carbapenems was initially given to all patients. After day 3, patients were randomized to receive either oral sitafloxacin (100 mg twice daily) or intravenous ertapenem. The regular course of treatment was completed within 10 days.

Inclusion Criteria:

• Age >18 years
• Acute pyelonephritis by definition
• Positive urine culture for Extended Spectrum Beta Lactamase Escherichia coli ≥105 colony forming unit/mL
• Voluntarily consented to be enrolled in the study

Exclusion Criteria:

• Severe sepsis or septic shock
• Mixed organism of urine culture
• Positive blood culture
• Has other source of infection
• Has mechanical abnormality of urinary tract
• Immunocompromised conditions
• Retained Foley's catheter
• Pregnancy or lactation
• Previous urinary tract infections within 4 weeks
• Contraindicated for fluoroquinolones and carbapenems