Comparison of the Effect of Ciprofloxacin and Nalidixic Acid in the Infection of Different Parts of the Urinary Tract


  • Ehsan Binesh 1 1. Department of Infectious, Imam Hossain Center for Education, Research and Treatment, Shahroud University of Medical Sciences, Shahroud, Iran.
  • Mehdi Mirzaii 2 2. Department of Microbiology, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran.
  • Fateme Asadi 3 3. Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran.
  • Pouneh Zolfaghari 4 4. Vice-chancellery of Health, Shahroud University of Medical Sciences, Shahroud, Iran.
  • Nasim Nikkheslat 4
  • Mohammad Bagher Sohrabi 5 5. School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran.



Escherichia coli, Ciprofloxacin, Nalidixic acid, Urinary tract infection, Antibiotic resistance


Background: Urinary tract infection (UTI) is one of the most common bacterial infections. The most common cause is Escherichia coli. This research is done with the aim at compare effect of ciprofloxacin with nalidixic acid in the infection of different parts of the urinary tract.

Methods: In this cross-sectional study, 130 patients with symptoms of the urinary tract infection referred to Imam Hossain Hospital of Shahrood were studied. For the all patients, urine samples were collected by standard method and urine analysis and culture was performed. Then, positive culture samples were tested by antibiogram and the resistance rate for the two antibiotics ciprofloxacin and nalidixic acid and MBC and MIC was investigated.

Results: Of the 130 patients with symptoms of UTI (fever, flank pain or tenderness and dysuria, urgency or frequency (84 patients had positive urine culture. Of all patients with positive urine, 31 cases had symptoms of pyelonephritis, 25 patients had symptoms of cystitis and 28 patients had symptoms of UTI. In antibiogram for positive urine samples, 21 pieces were resistant to ciprofloxacin and 46 pieces were resistant to nalidixic acid which significantly reduced resistance to ciprofloxacin (P=0.005). There was no significant difference between the two antibiotics in place of clinical symptoms and drug resistance. So there was no significant difference between the two MIC and MBC in place of clinical symptoms and drug resistance.

Conclusions: This study showed that ciprofloxacin is more effective in controlling infection of different parts of the urinary tract due to less drug resistance.


Laupland KB, Ross T, Pitout JD, Church DL, Gregson DB. Community-onset urinary tract infections: a population-based assessment. Infection 2007;35:150–3. doi:10.1007/s15010-007-6180-2

Nicolle LE. Uncomplicated urinary tract infection in adults including uncomplicated pyelonephritis. Urol Clin North Am 2008;35:1–12. doi:10.1016/j.ucl.2007.09.004

Mitchell BG, Fasugba O, Beckingham W, Bennett N, Gardner A. A point prevalence study of healthcare associated urinary tract infections in Australian acute and aged care facilities. Infection, Disease & Health 2016;21:26-31. doi:10.1016/j.idh.2016.03.001

Howard DH, Scott RD 2nd, Packard R, Jones D. The global impact of drug resistance. Clin Infect Dis 2003;36:S4-10. doi:10.1086/344656

Blaettler L, Mertz D, Frei R, Elzi L, Widmer AF, Battegay M, et al. Secular trend and risk factors for antimicrobial resistance in Escherichia coli isolates in Switzerland 1997-2007. Infection 2009;37:534-9. doi:10.1007/s15010-009-8457-0

Karlowsky JA, Kelly LJ, Thornsberry C, Jones ME, Sahm DF. Trends in antimicrobial resistance among urinary tract infection isolates of Escherichia coli from female outpatients in the United States. Antimicrob Agents Chemother 2002;46:2540-5. doi:10.1128/aac.46.8.2540-2545.2002

Cullen IM, Manecksha RP, McCullagh E, Ahmad S, O'Kelly F, Flynn RJ, et al. The changing pattern of antimicrobial resistance within 42,033 Escherichia coli isolates from nosocomial, community and urology patient-specific urinary tract infections, Dublin, 1999-2009. BJU Int 2012;109:1198-206. doi:10.1111/j.1464-410X.2011.10528.x

Perrin M, Donnio PY, Heurtin-Lecorre C, Travert MF, Avril JL. Comparative antimicrobial resistance and genomic diversity of Escherichia coli isolated from urinary tract infections in the community and in hospitals. J Hosp Infect 1999;41:273-9. doi:10.1053/jhin.1998.0521

Wilson ML, Gaido L. Laboratory Diagnosis of Urinary Tract Infections in Adult Patients. Clin Infect Dis 2004;38:1150-8. doi:10.1086/383029

Linhares I, Raposo T, Rodrigues A, Almeida A. Frequency and antimicrobial resistance patterns of bacteria implicated in community urinary tract infections: a ten-year surveillance study (2000-2009). BMC Infect Dis 2013;13:19. doi:10.1186/1471-2334-13-19

Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309-32. doi:10.1016/j.ajic.2008.03.002

Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011;52:e103-20. doi:10.1093/cid/ciq257

Cheng AC, Turnidge J, Collignon P, Looke D, Barton M, Gottlieb T. Control of fluoroquinolone resistance through successful regulation, Australia. Emerg Infect Dis 2012;18:1453-60. doi:10.3201/eid1809.111515

Wang Y, Zhao S, Han L, Guo X, Chen M, Ni Y, et al. Drug resistance and virulence of uropathogenic Escherichia coli from Shanghai, China. J Antibiot (Tokyo) 2014;67:799-805. doi:10.1038/ja.2014.72

Fasugba O, Gardner A, Mitchell BG, Mnatzaganian G. Ciprofloxacin resistance in community-and hospital-acquired Escherichia coli urinary tract infections: a systematic review and meta-analysis of observational studies. BMC Infect Dis 2015;15:545. doi:10.1186/s12879-015-1282-4

Sannes MR, Kuskowski MA, Johnson JR. Geographical distribution of antimicrobial resistance among Escherichia coli causing acute uncomplicated pyelonephritis in the United States. FEMS Immunol Med Microbiol 2004;42:213-8. doi:10.1016/j.femsim.2004.05.004

Gupta K, Sahm DF, Mayfield D, Stamm WE. Antimicrobial resistance among uropathogens that cause community-acquired urinary tract infections in women: a nationwide analysis. Clin Infect Dis 2001;33:89-94. doi:10.1086/320880

Bergman M, Nyberg ST, Huovinen P, Paakkari P, Hakanen AJ, Finnish Study Group for Antimicrobial Resistance. Association between antimicrobial consumption and resistance in Escherichia coli. Antimicrob Agents Chemother 2009;53:912-7. doi:10.1128/AAC.00856-08

Goossens H, Ferech M, Vander Stichele R, Elseviers M, ESAC Project Group. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 2005;365:579-87. doi:10.1016/S0140-6736(05)17907-0

Vellinga A, Murphy AW, Hanahoe B, Bennett K, Cormican M. A multilevel analysis of trimethoprim and ciprofloxacin prescribing and resistance of uropathogenic Escherichia coli in general practice. J Antimicrob Chemother 2010;65:1514-20. doi:10.1093/jac/dkq149

Bouchillon SK, Badal RE, Hoban DJ, Hawser SP. Antimicrobial susceptibility of inpatient urinary tract isolates of gram-negative bacilli in the united states: results from the study for monitoring antimicrobial resistance trends (SMART) program: 2009-2011. Clin Ther 2013;35:872-7. doi:10.1016/j.clinthera.2013.03.022

Zarb P, Coignard B, Griskeviciene J, Muller A, Vankerckhoven V, Weist K, et al. The European Centre for Disease Prevention and Control (ECDC) pilot point prevalence survey of healthcare-associated infections and antimicrobial use. Euro Surveill 2012;17:pii: 20316. doi:10.2807/ese.17.46.20316-en

Swami SK, Liesinger JT, Shah N, Baddour LM, Banerjee R. Incidence of antibiotic-resistant Escherichia coli bacteriuria according to age and location of onset: a population-based study from Olmsted County, Minnesota. Mayo Clin Proc 2012;87:753-9. doi:10.1016/j.mayocp.2012.02.025

Hsu LY, Tan TY, Tam VH, Kwa A, Fisher DA, Koh TH, et al. Surveillance and correlation of antibiotic prescription and resistance of Gram-negative bacteria in Singaporean hospitals. Antimicrob Agents Chemother 2010;54:1173-8. doi:10.1128/AAC.01076-09

Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ 2010;340:c2096. doi:10.1136/bmj.c2096

Freeman JT, Anderson DJ, Sexton DJ. Seasonal peaks in Escherichia coli infections: possible explanations and implications. Clin Microbiol Infect 2009;15:951-3. doi:10.1111/j.1469-0691.2009.02866.x

Sun L, Klein EY, Laxminarayan R. Seasonality and temporal correlation between community antibiotic use and resistance in the United States. Clin Infect Dis 2012;55:687-94. doi:10.1093/cid/cis509

Adam HJ, Baxter MR, Davidson RJ, Rubinstein E, Fanella S, Karlowsky JA, et al. Comparison of pathogens and their antimicrobial resistance patterns in pediatric, adult and elderly patients in Canadian hospitals. J Antimicrob Chemother 2013;68:i31-7. doi:10.1093/jac/dkt024

Cornaglia G, Hryniewicz W, Jarlier V, Kahlmeter G, Mittermayer H, Stratchounski L, et al. European recommendations for antimicrobial resistance surveillance. Clin Microbiol Infect 2004;10:349-83. doi:10.1111/j.1198-743X.2004.00887.x

Additional Files






How to Cite

Comparison of the Effect of Ciprofloxacin and Nalidixic Acid in the Infection of Different Parts of the Urinary Tract. (2019). International Journal of Health Studies, 4(2).