Nitroxoline: treatment and prevention of urinary tract infections from the urologist's perspective

Introduction Nitroxoline is an old antimicrobial agent with a broad spectrum of pharmacological applications and a unique mechanism of action. However, its use in the treatment and prevention of urinary tract infections (UTIs) has not been popular in the recent past. Recently, nitroxoline is gaining interest, due to frequent drug-resistance in uropathogens. Unfortunately, there are few modern clinical trials assessing this antibiotic. Also, older researchers often do not meet current scientific standards. This review seeks to provide a comprehensive overview of nitroxoline as a viable option in treating uncomplicated lower UTIs. Material and methods A comprehensive literature search regarding the use of nitroxoline in UTIs was conducted using Pubmed, Cochrane Library and Embase databases. A cross-reference search was also performed. Case reports, editorials and non-peer-reviewed literature were excluded from further analysis. As a result, 21 publications were included in this review. Results The available literature on nitroxoline's mechanism of action, pharmacokinetics, minimum inhibitory concentrations, in vitro activity and resistance rates strongly suggests that nitroxoline is a potent broad-spectrum antimicrobial agent. Moreover, clinical efficacy of the drug was analyzed - 2 articles proved high eradication rates in women with uncomplicated lower UTIs and 1 reported unsuccessful treatment in geriatric patients with lower complicated and uncomplicated UTIs. Finally, the present data on adverse effects indicate that nitroxoline is well-tolerated. Conclusions Nitroxoline is an obscure, yet potentially effective and safe antimicrobial agent in uncomplicated lower UTIs. Unfortunately, it is available only in a few countries. Nonetheless, nitroxoline can be useful in urological practice