Is ciprofloxacin (Cipro) effective for treating Aerococcus urinary tract infections (UTI)?

From the Guidelines

Ciprofloxacin (Cipro) should only be used to treat Aerococcus urinary tract infections (UTIs) if the local resistance rate is <10% and the patient does not require hospitalization, as stated in the European Association of Urology guidelines 1. When considering treatment options for Aerococcus UTIs, it's essential to weigh the effectiveness of ciprofloxacin against potential resistance rates. Some key points to consider include:

• The European Association of Urology guidelines recommend using ciprofloxacin only when the local resistance rate is <10% and the patient does not require hospitalization 1.
• Aerococcus species are gram-positive cocci that can cause UTIs, particularly in elderly patients and those with underlying urological conditions.
• While most Aerococcus isolates show susceptibility to ciprofloxacin, resistance has been reported in some cases, highlighting the importance of antimicrobial susceptibility testing when possible.
• Penicillins (like amoxicillin) or nitrofurantoin may be preferred as first-line options for Aerococcus UTIs due to their excellent activity against these organisms and lower risk of promoting resistance, as suggested by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases guidelines 1.
• Patients should complete the full course of antibiotics even if symptoms improve quickly, drink plenty of water during treatment, and contact their healthcare provider if symptoms worsen or don't improve within 48 hours of starting treatment. In the context of real-life clinical medicine, prioritizing the patient's morbidity, mortality, and quality of life is crucial, and the treatment decision should be made based on the most recent and highest-quality evidence available, which in this case is the European Association of Urology guidelines 1.

From the FDA Drug Label

Ciprofloxacin has been shown to be active against most strains of the following microorganisms, both in vitro and in clinical infections... Aerobic gram-positive microorganisms ... Aerococcus is not explicitly mentioned in the list of microorganisms that ciprofloxacin is active against.

The FDA drug label does not answer the question.

From the Research

Effectiveness of Ciprofloxacin for Aerococcus UTI

• Ciprofloxacin is effective for treating Aerococcus urinary tract infections (UTI), particularly in cases of pyelonephritis, as shown in a prospective observational study 2.
• However, resistance to ciprofloxacin has been documented in some cases, with a resistance rate of 10.9% reported in one study 3.
• Other treatment options, such as nitrofurantoin, have been shown to be effective against Aerococcus UTI, with a higher success rate than ciprofloxacin in some cases 2, 3.

Comparison with Other Antibiotics

• Nitrofurantoin has been shown to be a valid option for the treatment of cystitis caused by A. urinae, with a higher success rate than ciprofloxacin in some cases 2.
• Pivmecillinam has also been shown to be effective against A. urinae UTI, particularly in cases of cystitis 2.
• Other antibiotics, such as ampicillin and meropenem, have been shown to be effective against Aerococcus spp., with a susceptibility rate of 100% reported in one study 3.

Resistance Patterns

• Resistance to ciprofloxacin has been documented in some cases of Aerococcus UTI, with a resistance rate of 10.9% reported in one study 3.
• Other antibiotics, such as trimethoprim-sulfamethoxazole and amoxicillin, have been shown to have high resistance rates in some cases of UTI, making them less effective treatment options 4, 5.
• The emergence of antimicrobial resistance highlights the need for careful selection of antibiotics and consideration of local susceptibility patterns when treating UTIs 4, 5.