One bolus dose of gentamicin and early oral therapy versus cefotaxime and subsequent oral therapy in the treatment of febrile urinary tract infection

The efficacy and safety of two different regimens for parenteral treatment of presumed severe febrile urinary tract infection were compared in a randomized study. One hundred fifty-eight patients were treated with either cefotaxime 2 g i.v. twice daily for at least two days followed by norfloxacin 400 mg twice daily orally or one bolus dose of gentamicin 3 mg/kg i.v. and norfloxacin from the start. Three patients randomized to cefotaxime died. Of the 101 patients with verified urinary tract infection, clinical response to assigned therapy was seen in 79% and 74%, respectively. There was no difference in fever duration between the two regimens. The results indicate that one bolus dose of gentamicin with early oral therapy is a safe and effective alternative to common parenteral regimens for empirical treatment of febrile urinary tract infection.