trimethoprim--sulfamethoxazole-drug-combination and Urinary-Bladder--Neurogenic

We evaluated the optimal means of prevention and treatment of urinary tract infections in 46 patients with an intermittently catheterized neurogenic bladder. Suppression with nightly 160 mg. trimethoprim and 800 mg. sulfamethoxazole compared to placebo showed no difference in the rate of symptomatic or total urinary tract infections. Symptomatic urinary tract infections occurred at the same rate whether routine asymptomatic infections were treated or not. Three-day antibiotic treatment of urinary tract infections showed no decrease in the frequency of symptomatic or total urinary tract infections compared to 10-day therapy. The frequency of post-treatment urinary tract infection persistence, relapse and cure was identical in both groups. Suppressive antibiotics, treatment of asymptomatic urinary tract infections and full course antibiotic therapy offered no advantage over placebo, treatment of symptomatic urinary tract infection only and short course therapy in the management of urinary tract infection in patients with an intermittently catheterized neurogenic bladder.

Topics: Adult; Anti-Infective Agents, Urinary; Double-Blind Method; Drug Administration Schedule; Drug Combinations; Female; Humans; Male; Prospective Studies; Random Allocation; Risk; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder, Neurogenic; Urinary Catheterization; Urinary Tract Infections

Recurrent urinary tract infection (UTI) occurs in sizable percentages of patients after a single episode and is a frequent cause of primary healthcare visits and hospital admissions, accounting for up to one quarter of emergency department visits. We aim to describe the pattern of continuous antibiotic prophylaxis prescription for recurrent urinary tract infections, in what group of adult patients they are prescribed and their efficacy.. A retrospective chart review of all adult patients diagnosed with single and recurrent symptomatic urinary tract infection in the period of January 2016 to December 2018.. A total of 250 patients with a single UTI episode and 227 patients with recurrent UTI episodes were included. Risk factors for recurrent UTI included diabetes mellitus, chronic renal disease, and use of immunosuppressive drugs, renal transplant, any form of urinary tract catheterization, immobilization and neurogenic bladder. E. coli infections were the most prevalent organism in patients with UTI episodes. Prophylactic antibiotics were given to 55% of patients with UTIs, Nitrofurantoin, Bactrim or amoxicillin clavulanic acid. Post renal transplant is the most frequent reason to prophylaxis antibiotics (44%). Bactrim was more prescribed in younger patients (P < 0.001), in post-renal transplantation (P < 0.001) and after urological procedures (P < 0.001), while Nitrofurantoin was more prescribed in immobilized patients (P = 0.002) and in patients with neurogenic bladder (P < 0.001). Patients who received continuous prophylactic antibiotics experienced significantly less episodes of urinary tract infections (P < 0.001), emergency room visits and hospital admissions due to urinary tract infections (P < 0.001).. Despite being effective in reducing recurrent urinary tract infection rate, emergency room visits and hospital admissions due to UTI, continuous antibiotic prophylaxis was only used in 55% of patients with recurrent infections. Trimethoprim/sulfamethoxazole was the most frequently used prophylactic antibiotic. Urology and gynecological referral were infrequently requested as part of the evaluation process for patients with recurrent UTI. There was a lack of use of other interventions such as topical estrogen in postmenopausal women and documentation of education on non-pharmacological methods to decrease urinary tract infections.

Topics: Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Escherichia coli; Escherichia coli Infections; Female; Humans; Nitrofurantoin; Retrospective Studies; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder, Neurogenic; Urinary Tract Infections

Sphingomonas paucimobilis is an aerobic, oxidase-positive, yellow-pigmented, non-fermentative, Gram-negative opportunistic pathogen that rarely causes infections in humans. It is commonly found in nosocomial environments and, despite its low clinical virulence, it can be responsible for several different infections especially among patients with underlying disease. Here we describe a clinical case of a 46-year-old male paraplegic patient with a history of neurogenic bladder due to insulin-dependent diabetes mellitus and renal failure who was admitted to the urology clinic of a university hospital in Kirsehir, Turkey, with the complaints of urinary tract infection (UTI) including fever, chills, dysuria, abdominal and back pain. The urine culture was positive for Sphingomonas paucimobilis identified by the Vitek-2 system and the patient was successfully treated with oral co-trimoxazole 800/160 mg twice a day for ten days associated to cefixime and fosfomycin. A literature review of UTIs associated to Sphingomonas paucimobilis is reported as well.

Topics: Anti-Bacterial Agents; Cefixime; Community-Acquired Infections; Diabetes Mellitus, Type 1; Diabetic Nephropathies; Disease Susceptibility; Drug Therapy, Combination; Fosfomycin; Gram-Negative Bacterial Infections; Humans; Kidney Failure, Chronic; Male; Middle Aged; Opportunistic Infections; Paraplegia; Recurrence; Sphingomonas; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey; Urinary Bladder, Neurogenic; Urinary Tract Infections

Actinobaculum schaalii was first described as a causative agent for human infection in 1997. Since then it has mainly been reported causing urinary tract infections (UTI) in elderly individuals with underlying urological diseases. Isolation and identification is challenging and often needs molecular techniques. A. schaalii is increasingly reported as a cause of infection in humans, however data in children is very limited.. We present the case of an 8-month-old Caucasian boy suffering from myelomeningocele and neurogenic bladder who presented with a UTI. An ultrasound of the urinary tract was unremarkable. Urinalysis and microscopy showed an elevated leukocyte esterase test, pyuria and a high number of bacteria. Empiric treatment with oral co-trimoxazole was started.Growth of small colonies of Gram-positive rods was observed after 48 h. Sequencing of the 16S rRNA gene confirmed an A. schaalii infection 9 days later. Treatment was changed to oral amoxicillin for 14 days. On follow-up urinalysis was normal and urine cultures were negative.. A.schaalii is an emerging pathogen in adults and children. Colonization and subsequent infection seem to be influenced by the age of the patient. In young children with high suspicion of UTI who use diapers or in children who have known abnormalities of their urogenital tract, infection with A. schaalii should be considered and empiric antimicrobial therapy chosen accordingly.

Topics: Actinomycetaceae; Amoxicillin; Anti-Bacterial Agents; Communicable Diseases, Emerging; DNA, Bacterial; DNA, Ribosomal; Gram-Positive Bacterial Infections; Humans; Infant; Male; Meningomyelocele; RNA, Ribosomal, 16S; Sequence Analysis, DNA; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder, Neurogenic; Urinary Tract Infections; Urine; White People

The use of 3,4-methylenedioxymethamphetamine (MDMA, known as "ecstasy"), a synthetic amphetamine and "club drug," has been associated with acute, transient urinary retention. We report a case of neurogenic bladder and chronic urinary retention associated with MDMA abuse.. A 21-year-old male presented to the emergency department (ED) because he had abdominal pain and difficulty urinating. He had experienced difficulty in initiating urination over the past 1.5 months, with periods of 24 to 36 hours between voids and large volumes of urine. The patient had a chronic pattern of MDMA use, taking 4 tablets/day for 3 months. Two weeks before coming to the ED, he had been admitted to an inpatient drug rehabilitation center. During the time since that admission, the patient had visited EDs repeatedly for insertion and removal of Foley catheters to relieve the urinary retention until he could be admitted to a urologic service. Cystometrogram was abnormal, finding no sensation of bladder fullness after instillation of 350 mL of saline and inability to generate a voluntary voiding pressure. Cystoscopy revealed no outlet obstruction. The findings were consistent with neurogenic bladder. The patient was given prescriptions for bethanecol and phenazopyridine, and told to continue a 10-day course of sulfamethoxazole/trimethoprim for urinary tract infection. He was discharged with a Foley catheter in place. Symptoms of urinary retention persisted at 1-year follow-up, despite self-catheterization and complete cessation of MDMA use.. Chronic MDMA use may lead to neurogenic bladder and chronic urinary retention.

Topics: Adult; Amphetamine-Related Disorders; Anti-Infective Agents, Urinary; Bethanechol; Central Nervous System Stimulants; Chronic Disease; Cystoscopy; Humans; Male; Muscarinic Agonists; N-Methyl-3,4-methylenedioxyamphetamine; Phenazopyridine; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder, Neurogenic; Urinary Catheterization; Urinary Retention

Some girls receiving antimicrobial prophylaxis for recurrent urinary tract infections (UTIs) experience breakthrough infections. The clinical characteristics of girls experiencing a breakthrough UTI and the efficacy of an antimicrobial combination was studied.. Girls were managed by frequent timed voiding, anticholinergic medication for bladder instability, and double antimicrobial prophylaxis consisting of nitrofurantoin (NFN) 2 mg/kg every morning and trimethoprim/sulfamethoxazole (TMP/SMZ) 2/10 mg/kg at bedtime.. A total of 31 girls had experienced sixty-four UTIs during three hundred sixty-seven months (17.4 UTIs/100 patient-months) while receiving TMP/SMZ and/or NFN as single-drug prophylaxis. Of the girls, 21 (68%) had reflux, 15 (49%) had detrusor instability/voiding dysfunction, 8 (26%) had both reflux and voiding dysfunction, and 3 (10%) had neither voiding dysfunction nor reflux. While receiving double antimicrobial prophylaxis, 8 girls (26%) experienced a UTI and only 3 (10%) showed a UTI resistant to both TMP/SMZ and NFN. There were only sixteen breakthrough UTIs during four hundred thirty-nine months of double prophylaxis (3.6 UTIs/100 patient-months) (P < 0.001).. Girls with breakthrough UTIs usually have voiding dysfunction and/or reflux, and in these girls double antimicrobial prophylaxis and attention to voiding dynamics were effective in preventing further UTIs.

Topics: Child, Preschool; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Nitrofurantoin; Recurrence; Retrospective Studies; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder, Neurogenic; Urinary Tract Infections; Vesico-Ureteral Reflux

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

Voiding problems are prevalent in women. Cost-effective evaluation can be performed on the basis of a voiding calendar and simple office urodynamic studies. The numerous treatment options include pelvic support exercises, drug therapy, bladder irrigation, hydraulic distention, intermittent self-catheterization, and various surgical procedures.

Topics: Adrenergic alpha-Agonists; Adrenergic alpha-Antagonists; Amoxicillin; Anti-Infective Agents, Urinary; Bacterial Infections; Cystitis; Drug Combinations; Endoscopy; Exercise Therapy; Female; Humans; Parasympatholytics; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder, Neurogenic; Urinary Incontinence, Stress; Urination Disorders; Urodynamics

The new fluorinated quinolones norfloxacin, ciprofloxacin and pefloxacin were evaluated in urinary infections. Bacteriological cure rates in both uncomplicated and complicated urinary tract infections ranged from 85% to 99%. Clinical cure rates were often lower due to the underlying conditions in the urinary tract. Patients with neurological bladder disease were cured in a relatively high percentage of their Pseudomonas infection after three months treatment with norfloxacin. Pharmacokinetics of ciprofloxacin in prostatic tissue and fluid will probably offer an advance in the treatment of chronic urinary infections due to an infectious prostatic focus. Definitely drug related side effects (of gastro-intestinal, neurological or allergic nature) were mild in most cases. The new 4-quinolones should be followed with interest concerning their activity in urological infections in general as well as specifically. The minor influence on the natural human flora and the possibility to decrease plasmid-mediated resistance are of major importance.

Topics: Anti-Infective Agents, Urinary; Ciprofloxacin; Drug Combinations; Humans; Male; Norfloxacin; Pefloxacin; Prostatitis; Pseudomonas Infections; Quinolines; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder, Neurogenic; Urinary Tract Infections

A total of 50 patients with recent spinal cord injury secondary to trauma participated in a prospective study of urinary complications during an interval of clean intermittent catheterization at initial hospitalization in a spinal cord injury unit. Patients were assigned randomly to groups receiving or not receiving a prophylactic antibacterial preparation. Both groups were divided further into subgroups in which laboratory infections (bacteriuria more than 100,000 organisms per ml.) were treated with definitive antibiotics or in which antibiotic treatment was given only for clinical infections (fever more than 100F or urethral discharge and bacteriuria). Antibacterial prophylaxis significantly reduced the probability of laboratory infection but not the probability of clinical infection, although a trend was noted toward fewer clinical infections. No significant reduction was noted in the probability of clinical infection in subgroups treated promptly for laboratory infection.

Topics: Anti-Infective Agents, Urinary; Bacteriuria; Drug Combinations; Female; Hospitalization; Humans; Male; Prospective Studies; Random Allocation; Self Care; Spinal Cord Injuries; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder, Neurogenic; Urinary Catheterization

We studied and treated prospectively 62 neurologically normal children with vesicoureteral reflux using urodynamic techniques to identify uninhibited bladder contractions with voluntary sphincteric obstruction (dyssynergia). All children received antibiotic prophylaxis. Anticholinergic drugs were used additionally to treat uninhibited bladder contractions. During 6 years of followup treatment of uninhibited contractions produced a 4-fold reduction in the incidence of recurrent urinary infection and tripled the rate of reflux resolution compared to controls. These data suggest that uninhibited contractions with voluntary sphincter obstruction are an important prognostic finding in children with reflux, which when treated successfully can alter the disease course and may make surgical therapy of reflux unnecessary for some.

Topics: Adolescent; Anti-Infective Agents, Urinary; Child; Child, Preschool; Drug Combinations; Female; Humans; Male; Mandelic Acids; Nitrofurantoin; Parasympatholytics; Prognosis; Prospective Studies; Recurrence; Sulfamethoxazole; Toilet Training; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder, Neurogenic; Urinary Tract Infections; Urodynamics; Vesico-Ureteral Reflux

As an alternative to the practice of obtaining repeated laboratory cultures for patients at high risk of renal impairment from recurrent UTI, a program of bone monitoring using a mail-in culture dipspoon was started. A study involving 454 children with neurogenic bladder or other urologic abnormalities showed (1) that the incidence of UTI infection in patients for whom long term antimicrobial therapy had been prescribed was not significantly lower than that in patients who were not on antimicrobials and (2) that at least 50% of dipspoons inoculated due to presentation of UTI symptoms showed no or insignificant growth. These findings suggest that need for further assessment of the efficacy of long term prophylactic antimicrobials in preventing recurrent UTI and the advisability of obtaining a urine culture result before initiating treatment when symptoms are not severe.

Topics: Adolescent; Anti-Infective Agents, Urinary; Child; Child, Preschool; Drug Combinations; Humans; Infant; Nitrofurantoin; Reagent Strips; Risk; Sulfamethoxazole; Sulfisoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder, Neurogenic; Urinary Tract Infections; Urologic Diseases