trimethoprim--sulfamethoxazole-drug-combination and Pyuria

Topics: Adult; Age Factors; Aged; Anti-Bacterial Agents; Antimicrobial Stewardship; Asymptomatic Infections; Bacteriuria; beta-Lactams; Culture Techniques; Drug Resistance, Bacterial; Female; Fluoroquinolones; Fosfomycin; Humans; Lower Urinary Tract Symptoms; Middle Aged; Nitrites; Nitrofurantoin; Pregnancy; Pregnancy Complications, Infectious; Pyuria; Trimethoprim, Sulfamethoxazole Drug Combination; Urinalysis; Urinary Tract Infections

Topics: Acute Disease; Adult; Anti-Infective Agents, Urinary; Bacteriuria; Cystitis; Diagnosis, Differential; Drug Administration Schedule; Female; Humans; Practice Guidelines as Topic; Pyelonephritis; Pyuria; Risk Factors; Secondary Prevention; Sensitivity and Specificity; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We evaluated single-dose regimens of trimethoprim-sulfamethoxazole, amoxicillin, and cyclacillin as treatment for acute cystitis in 38 women. The trial was prematurely stopped because of frequent treatment failures. At two days after treatment, all 13 patients given trimethoprim-sulfamethoxazole were cured, while four (31%) of 13 given amoxicillin and four (33%) of 12 given cyclacillin had persistent bacteriuria. At two weeks, 11 (85%) of 13 patients given trimethoprim-sulfamethoxazole, six (50%) of 12 given amoxicillin, and three (30%) of ten given cyclacillin were cured. One patient with positive results of antibody-coated bacteria testing who was treated with cyclacillin had signs and symptoms of acute pyelonephritis three days after treatment, and two patients treated with amoxicillin and one treated with trimethoprim-sulfamethoxazole converted antibody-coated bacteria test results from negative to positive after therapy. We conclude that single-dose treatment of cystitis in unselected women with cyclacillin and amoxicillin may result in low cure rates and that progression to acute pyelonephritis may occur following ineffective single-dose therapy.

Topics: Adolescent; Adult; Amoxicillin; Antibody-Coated Bacteria Test, Urinary; Bacteriuria; Cyclacillin; Cystitis; Drug Administration Schedule; Drug Combinations; Female; Humans; Middle Aged; Penicillins; Pyelonephritis; Pyuria; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

A urine leukocyte count of > or = 50/mm3 together with a bacterial count of > or = 10(5) colony-forming units (CFUs) per milliliter was used to define significant infection in 160 children with neurogenic bladder and evaluate the leukocyte and nitrite components of the Chemstrip 9 test. A Chemstrip 9 leukocyte reading of < or = 25 together with a negative nitrite reaction occurred in 99 children and had a sensitivity of 83.5% and a negative predictive value for infection of 97.0%. A Chemstrip 9 reading of > or = 500 leukocytes together with a positive nitrite reaction occurred in 18 children and had a sensitivity of 40% with a 100% positive predictive value for infection. Other combinations of Chemstrip 9 leukocyte and nitrite reactions were unhelpful or of uncertain value. Selection of up to three specimens from each patient increased the number of samples to 360 and provided general confirmation of the above conclusions. Nitrofurantoin may reduce the sensitivity of the nitrite strip reaction.

Topics: Child; Evaluation Studies as Topic; Humans; Leukocyte Count; Leukocytes; Meningomyelocele; Nitrites; Nitrofurantoin; Predictive Value of Tests; Pyuria; Reagent Strips; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder, Neurogenic; Urinary Tract Infections; Urine

A case is described of a patient with Bactrim-induced fixed drug eruption (FDE). Histological studies were performed at 1 day and 5 days after the drug exposure. While the 5-day-old lesion showed changes classically recognized as FDE, the 1-day-old lesion showed changes typical of a hypersensitivity response: diffuse spongiosis, dermal edema and hemorrhage, neutrophilic polymorphonuclear leukocyte abscess formations, and large numbers of eosinophils. This report underscores the dynamic cellular changes that occur in the evolving FDE lesion.

Topics: Aged; Ampicillin; Anti-Infective Agents, Urinary; Biopsy; Drug Combinations; Drug Eruptions; Humans; Male; Pyuria; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

A decision-analysis model was developed to estimate the effects and costs of alternative initial management strategies for women presenting with dysuria and pyuria. We compared days of morbidity and direct medical costs associated with single-dose and multiple-dose regimens of amoxicillin and trimethoprim-sulfamethoxazole and examined the cost-effectiveness of doing an initial urine culture. We used varying assumptions for prevalence of etiologic agents, treatment efficacy, frequency of side effects, and duration of symptoms. Single-dose regimens were preferable to multiple-dose regimens of either drug, and trimethoprim-sulfamethoxazole was preferable to amoxicillin. Single-dose trimethoprim-sulfamethoxazole therapy resulted in the fewest expected symptom-days (2.7) and the lowest expected cost (+54). The advantage of single-dose strategies in minimizing expected symptom-days resulted largely from the threefold to fourfold increase in the incidence of side effects reported with multiple-dose therapy. Obtaining an initial urine culture in all patients reduced expected symptom-days by about 10% but increased expected cost by about 40%.

Topics: Adult; Amoxicillin; Costs and Cost Analysis; Decision Theory; Drug Administration Schedule; Drug Combinations; Female; Humans; Pyuria; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urination Disorders