The efficacy of sequential therapy using pazufloxacin followed by oral fluoroquinolones for treatment of pyelonephritis

The efficacy of sequential therapy of pazufloxacin (PZFX), which is a parenteral fluoroquinolone, followed by oral fluoroquinolones [tosufloxacin tosilate (TFLX) or levofloxacin (LVFX)] for treatment of pyelonephritis, was evaluated. Patients with pyelonephritis who had fever (≥37.5 °C), pyuria (≥10 white blood cells/high-power field), and bacteriuria (≥104 colony-forming units/ml) were eligible for this study. PZFX (500 mg) was given intravenously twice a day for at least 3 days. If the patients were clinically improved, TFLX (150 mg) or LVFX (100 mg) was then administered orally three times a day for at least 5 days. Patients underwent clinical and microbiological evaluation at 5-9 days after final drug administration. Clinical and microbiological efficacy could be assessed in 21 of 25 cases enrolled. Both clinical and microbiological efficacy rates were 81.0 % (17/21 cases). In the effective cases, the mean administration time was 4.2 days for PZFX and 6.0 days for oral fluoroquinolones. The mean time to defervescence was 3.4 days for the effective cases. In the four treatment failure cases, three quinolone-resistant Escherichia coli and a quinolone-resistant Enterococcus faecalis were isolated. This sequential therapy seemed to be clinically effective in the treatment of pyelonephritis; however, the prevalence of quinolone-resistant E. coli should be taken into account.