Dybowski B., Jablon'ska O., Radziszewski P., Gromadzka-Ostrowska J., Borkowski A.

Presented on March 21, 2007

INTRODUCTION & OBJECTIVES: Ciprofloxacin and nitrofurantoin are both recommended for the treatment of acute cystitis. But the recommended time of treatment for nitrofurantoin is two times longer than for ciprofloxacin. For ciprofloxacin also immunomodulatory effects were observed in the in vitro and in animal studies. The hypothesis is put forward that ciprofloxacin should inhibit mucosal immune response much faster than nitrofurantoin.
The objective of the study was to compare ciprofloxacin and furaginum (nitrofurantoin analogue used in Poland) efficacy in extinguishing of immune response in acute cystitis treatment.

MATERIAL & METHODS: A group of consecutive adult women presented in the emergency room with symptoms of the acute cystitis and diagnosis confirmed by urine analysis and culture.
The women were randomized into two groups: I -  treated with ciprofloxacin 2x250mg for 3 days, II – treated with furaginum 3x100mg for 7 days.  5 healthy women without symptoms of cystitis served as a control group. Urine samples were collected on presentation and a few days (3-10) after initiation of the treatment. Urine analyses and urine cultures were performed. Concentrations of creatinine, IgA, IgM, IgG and interleukin 8 (IL8) in urine were determined (with ELISA kits in case of Igs). Concentrations of Igs and IL8 were converted into 1-hour Ig secretion rate (µg/h for Igs and  ng/h for IL8) using the transformed Cockroft-Gault formula. U Mann-Whitney test was used for statistical analyses.

RESULTS: 27 women were enrolled in the study aged 30,6 ± 14,6. 13 were treated with ciprofloxacin and 14 were treated with furaginum. In baseline measurements there were no significant differences in Igs and IL8 secretion between group I and II. Levels of IgM, IgG and IL8 were significantly higher than in controls (p=0,002). Follow-up samples were collected after 5,7±3 days (ciprofloxacin) and 5,1±2 days (furaginum). Mean secretion (change from baseline in %) in follow-up were IgA – 5 (-70%) and 10,7 (-44%), IgM – 1,7 (-97,3%) and 3,7 (-93,5%), IgG – 31,8 (-95%) and 99,1 (-90,4%), IL8 – 2,4 (-97,8%) and 7 (-95,4%) in ciprofloxacin and furaginum groups respectively. IgA dropped below values of the controls (p=0,04 for ciprofloxacin and p=0,12 for furaginum), IgM, IgG and IL8 secretion decreased but it was still higher than in controls.  After the treatment the mean secretion rates of IgM, IgG and IL8 in the group treated with ciprofloxacin were lower than in the group treated with furaginum. In case of IgG the difference was significant (p=0,004).

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