Long-Term Low Dose Cinoxacin Therapy for the Prevention of Recurrent Urinary Tract Infections

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Abstract
This 2-part study was undertaken to determine the efficacy of long-term low dose preventive cinoxacin therapy for patients who are prone to frequent recurrent urinary tract infections. In the pilot study 61 patients were treated with a single bedtime dose of 0.5 g cinoxacin for 3-12 mo. after first eradicating any existing infection with organism-specific therapy. The results of no recurrences during therapy, 6 recurrences (10%) within 3 mo. and a total of 18 recurrences (30%) within 12 mo. after discontinuing therapy were most impressive. Since the pilot study was not controlled a randomized double-blind study of 70 patients with a minimum of 3 recurrent infections in the previous 12 mo. and who were free of infection at the start of the trial were treated with either placebo or 0.5 g cinoxacin at bedtime for 6 mo. or until infection or adverse reaction intervened. There were no infections during the months of therapy in patients receiving the active drug. Patients receiving placebo had a high rate of recurrence. No resistant urinary pathogens emerged during the course of therapy. Recurrences after discontinuing therapy were caused by pathogens still susceptible to cinoxacin or by genera usually resistant to the drug. Adverse reactions to the drug were few and mild. Recurrent infections after completion of prolonged preventive therapy were far fewer in the group receiving the active drug than in those who had received placebo. The more frequent and earlier reinfection of patients who were not kept on long-term low dose therapy suggests that hypersusceptibility of the urothelium to bacterial contamination persists long after bacteriuria is eradicated and that preventive therapy allows for urothelial recovery and the return of intrinsic resistance to infection. Its broad antibacterial spectrum, low incidence of adverse reactions and pharmacodynamic qualities recommend the use of cinoxacin for this purpose.

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