General trends in the treatment of UTIs over the past decade have been toward the use of

shorter regimens (even single-dose therapy); once-a-day dosing; and in the case of acute
pyelonephritis and complicated UTI, the provision of therapy in the outpatient setting (for
most patients) with fluoroquinolones and other broad-spectrum drugs that have excellent oral
absorption and pharmacokinetics. Evidence-based treatment guidelines for acute
uncomplicated UTI (cystitis and pyelonephritis) have recently been developed and published
by the Infectious Diseases. (Warren JW et all,1999)
For cystitis, 3-day regimens of trimethoprim-sulfamethoxazole (TMP-SMX),
ciprofloxacin, or ofloxacin are recommended as the most cost- and clinically effective and
best-tolerated approach. Single-dose therapy is less effective than 3-day therapy, especially
with ß-lactam agents. Seven-day regimens with TMPSMX or fluoroquinolones are no more
effective than 3-day regimens, but they result in additional side effects. For acute
pyelonephritis, oral therapy with a fluoroquinolone (generally ciprofloxacin or ofloxacin) can
be used in many patients who have no nausea or vomiting and no signs of hypotension or
sepsis. Seven days of therapy is generally sufficient. Sicker patients may require
hospitalization for initial parenteral therapy for 1–3 days, followed by completion of the
regime with oral therapy. A similar approach to the treatment of complicated UTI can be used
in the outpatient setting for patients with mild illness. In such cases, well-absorbed, broad-
spectrum oral agents (e.g., fluoroquinolones) could be used, with initial hospitalization for
sicker patients. However, there have been few controlled trials of complicated UTI
addressing either the optimal length of therapy or the optimal drug .