Current experience with quinolones in the treatment of urinary tract infection.

Urinary infection in some clinical situations remains difficult to treat with standard oral therapy. Particular problems occur in individuals with underlying genitourinary abnormalities, with intolerance to multiple oral agents, with infections due to resistant organisms, and in men with prostatitis. The fluoroquinolone antimicrobials have an extended spectrum of activity compared to standard oral therapy, achieve high concentrations in the urine following the usual therapeutic doses, and are relatively free of major adverse effects. Thus, they may be effective therapy for some of the clinical situations for which current oral therapy is not satisfactory. However, the majority of clinical studies published to date have examined the use of quinolone therapy in the treatment of urinary infection primarily in individuals with a normal genitourinary tract, a group in which an 85-100% cure rate is achieved with standard oral therapy. Further studies of quinolones, particularly in individuals with underlying abnormalities of the genitourinary tract and in men with prostatitis, are required to clarify their role in these clinical situations and to document the extent of the emergence of resistant organisms. Other studies which would compare quinolones, examine more carefully cost effectiveness uses, and evaluate the effectiveness and safety of extended therapy are also needed to identify the appropriate therapeutic niche of this new group of drugs in the management of urinary infection.