trimethoprim--sulfamethoxazole-drug-combination and Urinary-Tract-Infections

In the present study, we aimed to compare the efficacy and safety of quinolones with trimethoprim-sulfamethoxazole (TMP/SMX), nitrofurantoin, fosfomycin, and β-lactams for the treatment of uncomplicated urinary tract infections (UTIs) in adults.. All controlled clinical trials assessing quinolones for uncomplicated UTIs in adults were searched from PubMed, Embase, and Cochrane Library databases. Meta-analyses were used to evaluate the efficacy and safety in randomized controlled trials (RCTs).. A total of 47 RCTs consisting of 8992 patients were included in the present analysis. The clinical and bacteriological remission rates of quinolones were significantly higher (P < 0.01) compared with β-lactams and nitrofurantoin, while quinolones showed similar clinical and bacteriological remission rates compared with TMP/SMX and fosfomycin. Moreover, the bacterial resistance and relapse rates of quinolones were significantly lower (P < 0.01) compared with TMP/SMX, β-lactams, and nitrofurantoin. Regarding the adverse drug reactions (ADRs), quinolones did not bring higher risks, while the incidence of ADRs in the quinolone group was also even significantly lower (P < 0.01) compared with the TMP/SMX and nitrofurantoin groups, including the most reported ADRs associated with the gastrointestinal tract.. Compared with other anti-UTI drugs, quinolones exerted an excellent effect on clinical remission and bacteriological eradication, and the application of quinolones did not bring a higher risk of ADRs.

Topics: Adult; Anti-Infective Agents; beta-Lactams; Fosfomycin; Humans; Nitrofurantoin; Quinolones; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In 2017, the Centers for Disease Control and Prevention (CDC) published guidelines for treating acute uncomplicated cystitis (AUC) with nitrofurantoin (NTF), sulfamethoxazole-trimethoprim (SMX-TMP), or fosfomycin (FM) as appropriate first-line agents.. To evaluate whether provider adherence to prescribing NTF, SMX-TMP, or FM has improved since the 2017 CDC guidelines were released, and to examine outcomes relative to the use of prescribing guidelines.. A literature review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, and a systematic search for articles was conducted in the PubMed and Cochrane search engines using Boolean operators (AND, OR). The searches resulted in 56 published studies. After application of exclusion criteria, 11 peer-reviewed articles were ultimately included in this review.. The review showed prescribers' increasing efforts to adhering to antibiotic prescription guidelines for treating AUC, such as the 2017 CDC guidelines. The studies presented strong evidence that NTF, SMX-TMP, and FM are equally efficacious and cost-effective for treating AUC without concern for antibiotic resistance. Studies that referenced prescription guidelines and local antibiotic resistance yielded desired patient outcomes in bacterial and symptom resolution and cost-effectiveness.. This article provides evidence and a platform for nurse practitioners to initiate collaborative efforts for structured AUC treatment guidelines in primary health care. To increase prescription adherence, electronic health records could be designed that would prompt prescribers to use updated local antibiotic resistance information and to use NTF, SMT-TMX, and FM as first-line agents.

Topics: Anti-Bacterial Agents; Cystitis; Drug Resistance, Microbial; Humans; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

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

To address clinical uncertainties about the effectiveness and safety of long-term antibiotic therapy for preventing recurrent urinary tract infections (UTIs) in older adults.. Systematic review andmeta-analysis of randomised trials.. We searched Medline, Embase, The. We did not identify any studies that included older men. Three randomised controlled trials compared long-term antibiotics with vaginal oestrogens (n=150), oral lactobacilli (n=238) and D-mannose powder (n=94) in postmenopausal women. Long-term antibiotics reduced the risk of UTI recurrence by 24% (three trials, n=482; pooled risk ratio (RR) 0.76; 95% CI 0.61 to 0.95, number needed to treat=8.5). There was no statistically significant increase in risk of adverse events (mild adverse events: pooled RR 1.52; 95% CI 0.76 to 3.03; serious adverse events: pooled RR 0.90, 95% CI 0.31 to 2.66). One trial showed 90% of urinary and faecal. Findings from three small trials with relatively short follow-up periods suggest long-term antibiotic therapy reduces the risk of recurrence in postmenopausal women with recurrent UTI. We did not identify any evidence to inform several clinically important scenarios including, benefits and harms in older men or frail care home residents, optimal duration of prophylaxis, recurrence rates once prophylaxis stops and effects on urinary antibiotic resistance.

Topics: Aged; Anti-Bacterial Agents; Drug Resistance, Microbial; Female; Humans; Postmenopause; Randomized Controlled Trials as Topic; Secondary Prevention; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Already used in various countries, trimethoprim (TMP) was withdrawn from the French market in 1990, but should be soon available again. This article reviews the experience of TMP use around the world and its current use in Europe. Label use and guidelines only recommend the use of TMP for the treatment of urinary tract infections (UTI). Compared with co-trimoxazole (Co-T), a combination of TMP and sulfamethoxazole (SMX), TMP has (a) a similar resistance rate among Escherichia coli strains (estimated between 10 and 20% in uncomplicated cystitis), (b) a similar clinical efficacy for cystitis prevention and treatment, (c) a lower toxicity (as severe toxicity adverse effects of Co-T come from its sulfonamide component), (d) limited data for the treatment of pyelonephritis and male UTIs, and (e) an important impact on the microbiota. TMP should thus be indicated in the third-line empirical treatment of acute uncomplicated cystitis (sparing fluoroquinolones and nitrofurantoin), in the prevention of recurrent acute cystitis when an antibiotic prophylaxis is required (possibly in first line), and in the treatment of documented acute cystitis at risk of complications. Updated data on the epidemiology of resistance to TMP per clinical pictures is now required. The bactericidal effect of TMP should also be confirmed on recent strains (although limited recent data suggests a bactericidia similar to that of Co-T) and its clinical efficacy should be evaluated in pyelonephritis and male UTI.

Topics: Anti-Bacterial Agents; Cystitis; Drug Resistance, Bacterial; Drug Utilization; Escherichia coli; Escherichia coli Infections; Fosfomycin; France; Humans; Practice Guidelines as Topic; Product Recalls and Withdrawals; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The clinical and financial burden from bladder infections is significant. Daily antibiotic use is the recommended strategy for recurrent urinary tract infection prevention. Increasing antibiotic resistance rates, however, require immediate identification of innovative alternative prophylactic therapies. This systematic review aims to provide guidance on gaps in evidence to guide future research.. The objective of this review was to provide current pooled estimates of randomized control trials comparing the effects of nitrofurantoin vs other agents in reducing recurrent urinary tract infections in adult, nonpregnant women and assess relative adverse side effects.. Data sources included the following: MEDLINE, Jan. 1, 1946, to Jan. 31, 2015; Cochrane Central Register of Controlled Trials the Cochrane Database of Systematic Reviews, and web sites of the National Institute for Clinical Excellence, and the National Guideline Clearinghouse from 2000 to 2015. Randomized control trials of women with recurrent urinary tract infections comparing nitrofurantoin with any other treatment were included.. A protocol for the study was developed a priori. Published guidance was followed for assessment of study quality. All meta-analyses were performed using random-effects models with Stats Direct Software. Dual review was used for all decisions and data abstraction.. Twelve randomized control trials involving 1063 patients were included. One study that had a serious flaw was rated poor in quality, one study rated good, and the remainder fair. No significant differences in prophylactic antibiotic treatment with nitrofurantoin and norfloxacin, trimethoprim, sulfamethoxazole/trimethoprim, methamine hippurate, estriol, or cefaclor were found in clinical or microbiological cure in adult nonpregnant women with recurrent urinary tract infections (9 randomized control trials, 673 patients, relative risk ratio, 1.06; 95% confidence interval, 0.89-1.27; I. Nitrofurantoin had similar efficacy but a greater risk of adverse events than other prophylactic treatments. Balancing the risks of adverse events, particularly gastrointestinal symptoms, with potential benefits of decreasing collateral ecological damage should be considered if selecting nitrofurantoin.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Cefaclor; Estriol; Female; Humans; Nitrofurantoin; Norfloxacin; Recurrence; Secondary Prevention; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Bacteriuria is common among renal allograft recipients. It can be categorized into asymptomatic bacteriuria (ASB) and urinary tract infection (UTI). However, in medical literature, the classifications of bacteriuria are often not clear or ASB is also classified as a UTI. This contributes to difficulties in interpretation of the incidence and risk factors of these two entities. In this review, we describe the epidemiology, risk factors, management and the impact on renal allograft function of these two entities separately according to the recent literature.. Risk factors for ASB are not completely comparable to the risk factors of UTIs. Persistent ASB has been associated with development of acute rejection and allograft pyelonephritis. The available data suggest that treatment of ASB is not very effective. Prophylaxis with trimethoprim-sulfamethoxazole does not prevent UTIs such as allograft pyelonephritis. Blood stream infections and emphysematous allograft pyelonephritis are associated with renal allograft loss.. ASB is the most common manifestation of bacteriuria after renal transplantation. More effective interventions are needed to prevent bacteriuria. Renal allograft recipients with persistent ASB should be closely monitored since they could be at risk for developing not only UTIs, such as allograft pyelonephritis, but also acute rejection.

Topics: Anti-Bacterial Agents; Asymptomatic Diseases; Bacteriuria; Humans; Kidney Transplantation; Pyelonephritis; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The followup and treatment of children with vesicoureteral reflux has been debated for many years. Antibiotic prophylaxis has a role for preventing urinary tract infection in these children. Recent studies and guidelines suggested that prophylaxis has little or no role in preventing urinary tract infection in those children, especially those with low grades (I and II) of reflux.. We analyzed all published randomized, controlled trials comparing antibiotic prophylaxis vs no prophylaxis or placebo in children with vesicoureteral reflux. The children were divided into those with nondilated (grades I and II) and dilated (grades III and IV) vesicoureteral reflux. After data were analyzed the RIVUR study was published and, therefore, it was added to the analyzed data.. After analyzing the first published studies we found that antibiotic prophylaxis would be beneficial only in children with high grade vesicoureteral reflux. With the addition of the data in the RIVUR study these results changed. The new pooled data support antibiotic prophylaxis in all children with vesicoureteral reflux.. Vesicoureteral reflux management is still controversial. In contrast to recently published studies and guidelines, this meta-analysis supports antibiotic prophylaxis in all children with vesicoureteral reflux regardless of reflux grade. More studies are needed to support this finding.

Topics: Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Child; Dilatation, Pathologic; Female; Fever; Humans; Male; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

The role of antimicrobial prophylaxis for the prevention of recurrent urinary tract infections in children with vesicoureteral reflux that was identified following a urinary tract infection has been the source of considerable debate. Prior studies had failed to show a benefit in the prevention of recurrent infection. The National Institutes of Health funded the Randomized Intervention for Vesicoureteral Reflux (RIVUR) study to determine if there was a benefit to the use of prophylaxis. Results of the RIVUR study indicated that there was a 50% reduction in the risk of recurrent urinary tract infection in those children on the prophylaxis arm. Adverse events with the use of prophylaxis were noted to be few. Renal scarring was noted in only a small number of children at study entry and no reduction in scarring was noted between the placebo and the treated groups. The impact of the RIVUR study on the current evaluation and management of children with urinary tract infections and vesicoureteral reflux is detailed.

Topics: Anti-Bacterial Agents; Child, Preschool; Cicatrix; Humans; Infant; Kidney Diseases; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

Nitroxoline, a hydroxychinoline derivate, has been used for many years to treat urinary tract infections (UTI). Many uncontrolled, but only few controlled clinical studies have been published. Four so far unpublished, controlled clinical studies were meta-analysed.. A narrative literature review was performed. In addition the individual patient data (IPD) of 466 females with uncomplicated UTI of four prospective, single blind, randomized, clinical studies with similar protocols using nitroxoline (250 mg tid) versus cotrimoxazole (960 mg bid) or norfloxacin (400 mg bid) as controls for 5 days (sporadic UTI) or 10 days (recurrent UTI) were meta-analysed. The primary aim was eradication of bacteriuria 7-13 days after end of therapy (test of cure). Clinical efficacy was determined by elimination of symptoms and safety by adverse events and laboratory tests.. Reviewing a total of 26 uncontrolled, 2 controlled and one postmarketing studies including more than 11,000 patients, good efficacy and safety of nitroxoline could be confirmed. In the four unpublished controlled studies a total of 234 patients were treated orally with nitroxoline and 232 with controls. The safety of nitroxoline was very good and comparable to the controls (adverse events 9.4% vs 7.8%; p = 0.360). In the mMITT set (at least one outcome result), in the PP set (test of cure outcome) and in the modified PP set (missing test of cure rated failure) more than 90% of the patients showed eradication of bacteriuria with nitroxoline, which also met statistical non-inferiority compared to the controls (10% non-inferiority margin) in all three evaluation sets. The clinical efficacy was similar between the two treatment groups.. The IPD meta-analysis using objective parameters (elimination of bacteriuria) demonstrated equivalent efficacy (non-inferiority) of nitroxoline with the controls tested (cotrimoxazole, norfloxacin) in the treatment of uncomplicated UTI. Considering the good safety and efficacy of nitroxoline as also shown in many uncontrolled and observational studies and the world wide increase of resistance of uropathogens against cotrimoxazole and fluoroquinolones, but not against nitroxoline within the last 20 years, nitroxoline should be reconsidered as one of the first line antibiotics for the treatment of uncomplicated UTI.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Child; Female; Humans; Male; Nitroquinolines; Norfloxacin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To define prescription modalities for the use of antibiotics in urology.. A bibliographic research was performed using the MEDLINE database concerning all the antibiotics usable in urology. Treatments were classified by families; modes of action, indications in urology and adverse events have been detailed. Administrative files for commercial use have been consulted and associated with literature analysis.. About 8 classes of antibiotics are usable in urology in a routine use. How they work, indications in urology and adverse events are discussed.. Knowing that bacterial resistance to quinilones is increasing dramatically, it seems imperative to control the use of 8 classes of antibiotics.

Topics: Anti-Bacterial Agents; beta-Lactams; Fosfomycin; Glycopeptides; Humans; Nitrofurans; Paromomycin; Quinolones; Tetracyclines; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Co-trimoxazole is a frequently prescribed antibiotic worldwide. It is composed of both trimethoprim and sulfamethoxazol (Sfx) and is used in the treatment and prophylaxis of urinary tract and Pneumocystis jirovecii infections. The Sfx component appears to be nephrotoxic at high doses or doses inappropriately adjusted for glomerular filtration rate (GFR). The trimethoprim component, even at recommended doses, inhibits tubular creatinine secretion, leading to a rapid but ultimately reversible increase in serum creatinine independent of any changes in GFR. This translates into a falsely low estimated GFR when creatinine-based equations are used. This review focuses on evidence of the differential effects of trimethoprim and Sfx on serum creatinine concentrations and GFR and their relevance to clinical practice, with particular attention to kidney transplantation.

Topics: Anti-Infective Agents, Urinary; Creatinine; Glomerular Filtration Rate; Humans; Kidney Transplantation; Pneumocystis carinii; Pneumocystis Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Acute uncomplicated lower urinary tract infection (UTI) is one of the most common problems for which young women seek medical attention.. To compare the efficacy, resistance development and safety of different antimicrobial treatments for acute uncomplicated lower UTI.. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Renal Group's Specialised Register, MEDLINE, EMBASE and bibliographies of included studies.. Randomised controlled trials (RCTs) comparing different classes of antimicrobials for acute uncomplicated UTI in women were included. The outcomes of interest were symptomatic and bacteriological cure at short and long-term follow-up, resistance development, number of days to symptom resolution, days of work loss, adverse events and complications.. Two authors independently extracted the data and assessed study quality. Statistical analyses were performed using the random effects model and the results expressed as risk ratios (RR) with 95% confidence intervals (CI).. Trimethoprim-sulfamethoxazole (TMP-SMX) was as effective as fluoroquinolones in achieving short-term (RR 1.00, 95% CI 0.97 to 1.03) and long-term (RR 0.99, 95% CI 0.94 to 1.05) symptomatic cure. Beta-lactam drugs were as effective as TMP-SMX for short-term (RR 0.95' 95% CI 0.81 to 1.12) and long-term (RR 1.06' 95% CI 0.93 to 1.21) symptomatic cure. Short-term cure for nitrofurantoin was similar to that of TMP-SMX (RR 0.99' 95% CI 0.95 to 1.04) as was long-term symptomatic cure (RR 1.01' 95% CI 0.94 to 1.09).Fluoroquinolones were more effective than beta-lactams (RR 1.22, 95% CI 1.13 to 1.31) for short-term bacteriological cure. Rashes were more frequent in patients treated with TMP-SMX than with nitrofurantoin or fluoroquinolones and in patients treated with beta-lactam drugs compared to fluoroquinolones. Minimal data were available on the emergence of resistant strains during or after antimicrobial treatment.. No differences were observed between the classes of antimicrobials included in this review for the symptomatic cure of acute uncomplicated UTI. Fluoroquinolones proved more effective than beta-lactams for the short-term bacteriological outcome, probably with little clinical significance. Individualised treatment should take into consideration the predictable susceptibility of urinary pathogens in local areas, possible adverse events and resistance development, and patient preference.

Topics: Acute Disease; Anti-Infective Agents; Anti-Infective Agents, Urinary; beta-Lactams; Female; Fluoroquinolones; Humans; Randomized Controlled Trials as Topic; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Uncomplicated urinary tract infections (uUTIs) are common in adult women across the entire age spectrum, with mean annual incidences of approximately 15% and 10% in those aged 15-39 and 40-79 years, respectively. By definition, UTIs in males or pregnant females and those associated with risk factors known to increase the risk of infection or treatment failure (e.g. acquisition in a hospital setting, presence of an indwelling urinary catheter, urinary tract instrumentation/interventions, diabetes mellitus or immunosuppression) are not considered herein. The majority of uUTIs are caused by Escherichia coli (70-95%), with Proteus mirabilis, Klebsiella spp. and Staphylococcus saprophyticus accounting for 1-2%, 1-2% and 5-10% of infections, respectively. If clinical signs and symptoms consistent with uUTI are present (e.g. dysuria, frequency, back pain or costovertebral angle tenderness) and there is no vaginal discharge or irritation present, the likelihood of uUTI is >90-95%. Laboratory testing (i.e. urinary nitrites, leukocyte esterase, culture) is not necessary in this circumstance and empirical treatment can be initiated. The ever-increasing incidence of antimicrobial resistance of the common uropathogens in uUTI has been and is a continuing focus of intensive study. Resistance to cotrimoxazole (trimethoprim/sulfamethoxazole) has made the empirical use of this drug problematic in many geographical areas. If local uropathogen resistance rates to cotrimoxazole exceed 10-25%, empirical cotrimoxazole therapy should not be utilized (fluoroquinolones become the new first-line agents). In a few countries, uropathogen resistance rates to the fluoroquinolones now exceed 10-25%, rendering empirical use of fluoroquinolones problematic. With the exception of fosfomycin (a second-line therapy), single-dose therapy is not recommended because of suboptimal cure rates and high relapse rates. Cotrimoxazole and the fluoroquinolones can be administered in 3-day regimens. Nitrofurantoin, a second-line therapy, should be given for 7 days. beta-Lactams are not recommended because of suboptimal clinical and bacteriological results compared with those of non-beta-lactams. If a beta-lactam is chosen, it should be given for 7 days. Management of uUTIs can frequently be triaged to non-physician healthcare personnel without adverse clinical consequences, resulting in substantial cost savings. It can be anticipated that the optimal approach to the management of uUTIs will change subs

Topics: Adult; Anti-Infective Agents, Urinary; Drug Administration Schedule; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Female; Fluoroquinolones; Humans; Male; Nitrofurantoin; Practice Guidelines as Topic; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Cystitis is a bacterial infection of the lower urinary tract which causes pain when passing urine, and causes urgency, haematuria, and suprapubic pain not associated with passing urine. Recurrent cystitis is usually defined as three episodes of urinary tract infection in the previous 12 months, or two episodes in the previous 6 months.. We conducted a systematic review and aimed to answer the following clinical question: Which interventions prevent further recurrence of cystitis in women experiencing at least two infections per year? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2007 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).. We found 14 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.. In this systematic review we present information relating to the effectiveness and safety of the following interventions: continuous antibiotic prophylaxis (trimethoprim, co-trimoxazole, nitrofurantoin, cefaclor, or a quinolone or cephalexin); continuous prophylaxis with methenamine hippurate; cranberry juice and cranberry products; oestrogen (topical) in postmenopausal women; passing urine after intercourse; postcoital antibiotic prophylaxis; single-dose self-administered antibiotic.

Topics: Acute Disease; Bacterial Infections; Cystitis; Female; Humans; Incidence; Nitrofurantoin; Prospective Studies; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adult; Breast Feeding; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug-Related Side Effects and Adverse Reactions; Evidence-Based Medicine; Family Practice; Female; Humans; Middle Aged; Milk, Human; Postpartum Period; Pregnancy; Quinolones; Risk Assessment; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Bacterial infections are well described complications of cirrhosis that greatly increase mortality rates. Two factors play important roles in the development of bacterial infections in these patients: the severity of liver disease and gastrointestinal haemorrhage. The most common infections are spontaneous bacterial peritonitis, urinary tract infections, pneumonia and sepsis. Gram-negative and gram-positive bacteria are equal causative organisms. For primary prophylaxis, short-term antibiotic treatment (oral norfloxacin or ciprofloxacin) is indicated in cirrhotic patients (with or without ascites) admitted with gastrointestinal haemorrhage (variceal or non-variceal). Administration of norfloxacin is advisable for hospitalized patients with low ascitic protein even without gastrointestinal haemorrhage. The first choice in empirical treatment of spontaneous bacterial peritonitis is the iv. III. generation cephalosporin; which can be switched for a targeted antibiotic regime based on the result of the culture. The duration of therapy is 5-8 days. Amoxicillin/clavulanic acid and fluoroquinolones--patients not on prior quinolone prophylaxis--were shown to be as effective and safe as cefotaxime. In patients with evidence of improvement, iv. antibiotics can be switched safely to oral antibiotics after 2 days. In case of renal dysfunction, iv albumin should also be administered. Long-term antibiotic prophylaxis is recommended in patients who have recovered from an episode of spontaneous bacterial peritonitis (secondary prevention). For "selective intestinal decontamination", poorly absorbed oral norfloxacin is the preferred schedule. Oral ciprofloxacin or levofloxacin (added gram positive spectrum) all the more are reasonable alternatives. Trimethoprim/sulfamethoxazole is only for patients who are intolerant to quinolones. Prophylaxis is indefinite until disappearance of ascites, transplant or death. Long-term prophylaxis is currently not recommended for patients without previous spontaneous bacterial peritonitis episode, not even when refractory ascites or low ascites protein content is present.

Topics: Administration, Oral; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Ascites; Bacteremia; Bacterial Infections; Cefotaxime; Cephalosporins; Ciprofloxacin; Fluoroquinolones; Gastrointestinal Hemorrhage; Humans; Infusions, Intravenous; Liver Cirrhosis; Norfloxacin; Peritonitis; Pneumonia, Bacterial; Primary Prevention; Severity of Illness Index; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Treatment and management of uncomplicated, lower urinary tract infections in adult females is unique in comparison to other patient populations. In this article, best practices and evidence-based research for treating a urinary tract infection in this group of patients are examined. A typical case of a female client in an outpatient urology setting is compared to recommendations in the literature. Interventions in the scenario are examined against available guidelines, revealing that some practices are supported, others are contraindicated, and gaps are identified.

Topics: Adult; Anti-Infective Agents, Urinary; Benchmarking; Evidence-Based Medicine; Female; Guideline Adherence; Humans; Medical Records, Problem-Oriented; Nurse Practitioners; Nursing Assessment; Patient Care Planning; Patient Education as Topic; Practice Guidelines as Topic; Risk Factors; Self Care; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Women's Health

A review on the etiological profile of urinary tract infections in childhood and the sensitivity pattern of urinary pathogens in Spain is presented. Escherichia coli continues to be the main etiological agent of urinary tract infection in childhood. Consequently, its sensitivity pattern will usually determine the choice of empirical therapy. The predominance of E. coli is reduced in certain circumstances, in which the presence of other microorganisms is increased. However, the clinical information available at diagnosis does not allow accurate identification of the etiology; only staining and microscopic urine examination can help in treatment selection. In Spain, E. coli presents a high percentage of resistance to ampicillin and cotrimoxazole, whereas second- and third-generation cephalosporins, fosfomycin, aminoglycosides and amoxicillin-clavulanate maintain high sensitivity. In some areas, amoxicillin-clavulanate and first-generation cephalosporins show high levels of resistance, which can limit their empirical use.

Topics: Adult; Age Factors; Aminoglycosides; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Bacteria; Cephalosporins; Child; Child, Preschool; Clinical Trials as Topic; Consensus Development Conferences as Topic; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Evidence-Based Medicine; Fosfomycin; Hospitalization; Humans; Infant; Infant, Newborn; Microbial Sensitivity Tests; Risk Factors; Spain; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Empirical antibiotic treatment of lower urinary tract infections should be based on the patient's clinical data and on local sensitivity data. Because of the increase in resistance among uropathogens, recommendations on the empirical treatment of urinary tract infections have been modified. Currently, the empirical use of co-trimoxazole, ampicillin, and first-generation cephalosporins and quinolones is not recommended. Fluoroquinolones have been demonstrated to be highly effective in comparative studies but, because of the increase in resistance, the type of patient who can benefit from these antimicrobial agents must be selected. Second- and third-generation cephalosporins still have high sensitivity rates, although the higher recurrence rates associated with their use and the emergence of extended-spectrum beta-lactamase-producing enterobacterial in the community should be taken into account. Amoxicillin-clavulanate is less effective in eradicating infections than quinolones. Fosfomycin-trometamol has resistance rates of below 2% and single-dose therapy has been demonstrated to be safe and effective. Nitrofurantoin is also currently active, although it must be administered for 7 days and can produce toxicity. Both agents are currently recommended as alternative therapeutic options to fluoroquinolones in uncomplicated infections of the lower urinary tract.

Topics: Administration, Oral; Anti-Bacterial Agents; beta-Lactam Resistance; beta-Lactams; Cephalosporins; Cystitis; Drug Resistance, Multiple, Bacterial; Fluoroquinolones; Fosfomycin; Humans; Nitrofurantoin; Practice Guidelines as Topic; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Symptomatic urinary tract infections (UTIs) constitute a major health problem throughout the Western world. In the USA, UTIs are responsible for 7-8 million outpatient visits each year and for over one-third of all hospital-acquired infections. Empiric antimicrobial therapy for UTIs, which are primarily caused by Escherichia coli, is increasingly being complicated by the emergence of resistance to the most widely used agents. Recent studies indicate that the prevalence of E. coli resistance to trimethoprim/sulphamethoxazole (TMP/SMX), the current first-line therapy for UTIs, exceeds 20% in many North American regions. Importantly, antibiotic resistance often translates into clinical failure. The use of antibiotics with favourable pharmacokinetic/pharmacodynamic profiles and convenient dosing schedules, which effectively increase bacterial eradication and patient compliance, can help to curb the current epidemic of resistance and reduce the rate of clinical failure associated with resistance. Fluoroquinolones have well-established efficacy in the treatment of multiple bacterial infections and, over the years, the rates of resistance to these antibiotics have remained very low. Fluoroquinolones are currently recommended for therapy of uncomplicated UTIs when the local incidence of TMP/SMX resistance is >or=10-20%, as well as for the treatment of complicated UTIs and acute pyelonephritis. Ciprofloxacin, one of the most widely used fluoroquinolones, has a potent bactericidal effect across the full spectrum of uropathogens, as well as a long and excellent efficacy and safety record in the management of UTI and other infections. A recently developed extended (modified)-release formulation of ciprofloxacin (Cipro XR or Cipro XL) provides higher maximum plasma concentrations with lower inter-patient variability than the conventional, immediate-release, twice-daily formulation. Additionally, therapeutic drug levels with extended-release ciprofloxacin are achieved rapidly and maintained over the course of 24 h, allowing once-daily dosing. Clinical trials in patients with cystitis and those with complicated UTIs or acute uncomplicated pyelonephritis indicate that extended-release ciprofloxacin is at least as effective as the immediate-release formulation. These studies have also confirmed good tolerability and safety of extended-release ciprofloxacin, similar to the immediate-release formulation. Therefore, extended-release ciprofloxacin is a convenient, well-tolera

Topics: Bacterial Infections; Ciprofloxacin; Delayed-Action Preparations; Escherichia coli Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The aim of our study is to analyze the clinic characteristics and evolution of the primary reflux in infants.. We studied retrospectively 203 infants in our hospital, diagnosed of severe primary renal reflux. Renal ecography and cyclic mictional cystography were practiced in all cases. DMSA was carried out in 181 patients.. Renal reflux was unilateral in the 23% of the patients, and bilateral in the remaining cases; 72% of the renal reflux were grade IV and 28% grade V. The renal injuries affected to male infants and reflux grade V. The renal injury was focal (27%), global (44%) and atrophic (29%). The 79% of the patients had conservative treatment, while 21% had surgical treatment. 100% infants with surgical treatment and 94.2% infants with conservative treatment were recovered (Test of Kaplan-Meier). The 27% of patients developed one or several urinary infections, but progression of old renal injuries or formation of new ones, were exceptional (3 cases): While the time the study lasted none of the patients developed chronic renal failure nor arterial hypertension.. 1) The fetal severe primary reflux of the patients was characterized by the following features: to be bilateral reflux, to affect mainly to male infants and to be associated in 33% of cases with a severe renal injury of congenital origin (renal displasia) most of them unilateral. 2) The natural evolution of the reflux goes to spontaneous recovery, so treatment must be conservative. 3) Some patients underwent urinary infections, but progression or formation of new renal injuries were inusual. None of the patients had terminal renal failure nor hypertension and 4) Risk patients would be male infants with bilateral injuries although these are infrequent.

Topics: Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Kidney; Kidney Function Tests; Life Tables; Male; Nitrofurantoin; Radiography; Remission, Spontaneous; Retrospective Studies; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography; Urinary Tract Infections; Vesico-Ureteral Reflux

Many children with urological disease require long-term treatment with antibiotics. In many cases the choice of medical instead of surgical management hinges on the implied safety of certain drugs. Recently some groups have advocated subureteral injection procedures to avoid long-term antibiotics for low grade reflux. We present a concise and relevant review on the use and adverse reactions of nitrofurantoin, trimethoprim and sulfamethoxazole in children.. We reviewed the literature regarding the safety and toxicity of these drugs. Information regarding absorption, excretion and dosing was also gathered to explain better the mechanisms of toxicity.. Adverse reactions in children reported in the literature related to nitrofurantoin are gastrointestinal disturbance (4.4/100 person-years at risk), cutaneous reactions (2% to 3%), pulmonary toxicity (9 patients), hepatoxicity (12 patients and 3 deaths), hematological toxicity (12 patients), neurotoxicity and an increased rate of sister chromatid exchanges. Adverse reactions in children related to trimethoprim/sulfamethoxazole are almost exclusively due to the sulfamethoxazole component, including cutaneous reactions (1.4 to 7.4 events per 100 person-years at risk), hematological toxicity (0% to 72% of patients) and hepatotoxicity (5 patients). The majority of adverse reactions were found in children on full dose therapy and not prophylaxis.. The use of nitrofurantoin, trimethoprim and sulfamethoxazole is safe in children for long-term prophylactic therapy. The antibiotic safety issue should not be misconstrued as an argument for surgical therapy, whether minimally invasive or not. Adverse reactions exist to these medicines but they are less common than seen in adults, presumably because of the lower dose used for therapy, and the lack of significant comorbidities and drug interactions in children. Serious side effects are extremely rare and most are reversible by discontinuing therapy. The extremely low potential for significant adverse reactions should be discussed with parents.

Topics: Anti-Infective Agents, Urinary; Child; Digestive System; Humans; Liver; Lung Diseases, Interstitial; Nitrofurantoin; Peripheral Nervous System Diseases; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In the past few years, notable advances have occurred in our understanding of the epidemiology and clinical importance of drug resistance among uropathogens that cause uncomplicated urinary tract infections (UTIs) or cystitis. Guidelines recommend trimethoprim-sulfamethoxazole for empirical treatment of uncomplicated UTI unless trimethoprim-sulfamethoxazole resistance in a community exceeds 10% to 20%. The rationale for this 10% to 20% cutoff appears to be related to clinical and economical considerations and to concerns about the emergence of fluoroquinolone-resistant bacteria. In patients with uncomplicated UTIs caused by uropathogens resistant to trimethoprim-sulfamethoxazole who were treated with this drug combination, clinical outcomes were clarified recently and found to be suboptimal (<60% clinical cure). Following guidelines for empirical treatment of uncomplicated UTIs is problematic. Surveillance of antimicrobial resistance among uropathogens that cause uncomplicated UTIs is performed rarely. Hospital antibiograms provide data on resistance among bacteria that cause community-associated UTIs; however, antibiograms overestimate drug resistance among uropathogens that cause UTIs and may mislead clinicians about the prevalence of local resistance. We review options for management of uncomplicated UTIs in light of these considerations.

Topics: Anti-Infective Agents, Urinary; Bacterial Infections; Bias; Community-Acquired Infections; Drug Resistance, Bacterial; Fluoroquinolones; Humans; Infection Control; Microbial Sensitivity Tests; Patient Selection; Pharmacoepidemiology; Population Surveillance; Practice Guidelines as Topic; Reproducibility of Results; Risk Factors; Sensitivity and Specificity; Treatment Outcome; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents; Child; Drug Interactions; Gastrointestinal Tract; Humans; Respiratory System; Tissue Distribution; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract; Urinary Tract Infections

Management of uncomplicated urinary tract infections (UTIs) has traditionally been based on 2 important principles: the spectrum of organisms causing acute UTI is highly predictable (Escherichia coli accounts for 75% to 90% and Staphylococcus saprophyticus accounts for 5% to 15% of isolates), and the susceptibility patterns of these organisms have also been relatively predictable. As a result, empiric therapy with short-course trimethoprim-sulfamethoxazole (TMP-SMX) has been a standard management approach for uncomplicated cystitis.However, antibiotic resistance is now becoming a major factor not only in nosocomial complicated UTIs, but also in uncomplicated community-acquired UTIs. Resistance to TMP-SMX now approaches 18% to 22% in some regions of the United States, and nearly 1 in 3 bacterial strains causing cystitis or pyelonephritis demonstrate resistance to amoxicillin. Fortunately, resistance to other agents, such as nitrofurantoin and the fluoroquinolones, has remained low, at approximately 2%. Preliminary data suggest that the increase in TMP-SMX resistance is associated with poorer bacteriologic and clinical outcomes when TMP-SMX is used for therapy. As a result, these trends have necessitated a change in the management approach to community-acquired UTI. The use of TMP-SMX as a first-line agent for empiric therapy of uncomplicated cystitis is only appropriate in areas where TMP-SMX resistance prevalence is <10% to 20%. In areas where resistance to TMP-SMX exceeds this rate, alternative agents need to be considered.

Topics: Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Urinary; Community-Acquired Infections; Drug Resistance, Multiple, Bacterial; Female; Humans; Middle Aged; Pyelonephritis; Risk Factors; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Urinary tract infections (UTIs) are common bacterial infections, particularly in women. Antimicrobial therapy is seldom indicated for asymptomatic infection, but antimicrobial therapy is usually indicated for amelioration of symptoms. Management of acute uncomplicated UTI (cystitis) is generally straightforward, with a predictable distribution of uropathogens isolated. First-line treatment of acute uncomplicated UTI has traditionally involved a 3-day regimen of trimethoprim-sulfamethoxazole (TMP-SMX) or TMP alone for patients with sulfa allergies. Increasing resistance among community-acquired Escherichia coli to TMP-SMX worldwide has led to a reassessment of the most appropriate empiric therapy for these infections. Alternative first-line agents include the fluoroquinolones, nitrofurantoin, and fosfomycin. Factors to be considered in the selection of appropriate antimicrobial therapy include pharmacokinetics, spectrum of activity of the antimicrobial agent, resistance prevalence for the community, potential for adverse effects, and duration of therapy. Ideal antimicrobial agents for UTI management have primary excretion routes through the urinary tract to achieve high urinary drug levels. In addition, there are special considerations in the management of UTI among selected populations, including postmenopausal and pregnant women, and for women with frequent recurrent UTIs.

Topics: Adolescent; Adult; Anti-Infective Agents, Urinary; Drug Administration Schedule; Evidence-Based Medicine; Female; Humans; Middle Aged; Pyelonephritis; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

There has been a growing rate of resistance among common urinary tract pathogens, such as Escherichia coli, to traditional antimicrobial therapies including the "gold standard" trimethoprim-sulfamethoxazole (TMP-SMX). Consequently, fluoroquinolone antimicrobial agents have taken on an expanding management role for UTIs. In fact, the recent Infectious Diseases Society of America clinical management guidelines for UTI recommend fluoroquinolones as first-line therapy for uncomplicated UTI in areas where resistance is likely to be of concern. Fluoroquinolones have demonstrated high bacteriologic and clinical cure rates, as well as low rates of resistance, among most common uropathogens. There are currently 7 fluoroquinolones with indications for UTI in the United States. However, only 3 are commonly used: levofloxacin, ciprofloxacin, and, to a lesser extent, gatifloxacin. Many of the fluoroquinolone agents have once-daily dosing regimens, enhancing patient adherence. In addition, levofloxacin and gatifloxacin have same-dose bioequivalency between their intravenous and oral formulations, allowing for "switch" or step-down therapy from parenteral to oral formulations of the same agent at the same dose. Fluoroquinolones are indicated for the management of acute uncomplicated UTIs, as well as complicated and severe UTI and pyelonephritis, in adults. They are the first-line treatment of acute uncomplicated cystitis in patients who cannot tolerate sulfonamides or TMP, who live in geographic areas with known resistance >10% to 20% to TMP-SMX, or who have risk factors for such resistance. Fluoroquinolone properties include a broad spectrum of coverage, low rates of resistance, and good safety profiles.

Topics: Anti-Infective Agents; Anti-Infective Agents, Urinary; Drug Administration Schedule; Fluoroquinolones; Half-Life; Humans; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; 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

Management of uncomplicated urinary tract infections (UTIs) has traditionally been based on 2 important principles: the spectrum of organisms causing acute UTI is highly predictable (Escherichia coli accounts for 75% to 90% and Staphylococcus saprophyticus accounts for 5% to 15% of isolates), and the susceptibility patterns of these organisms have also been relatively predictable. As a result, empiric therapy with short-course trimethoprim-sulfamethoxazole (TMP-SMX) has been a standard management approach for uncomplicated cystitis.However, antibiotic resistance is now becoming a major factor not only in nosocomial complicated UTIs, but also in uncomplicated community-acquired UTIs. Resistance to TMP-SMX now approaches 18% to 22% in some regions of the United States, and nearly 1 in 3 bacterial strains causing cystitis or pyelonephritis demonstrate resistance to amoxicillin. Fortunately, resistance to other agents, such as nitrofurantoin and the fluoroquinolones, has remained low, at approximately 2%. Preliminary data suggest that the increase in TMP-SMX resistance is associated with poorer bacteriologic and clinical outcomes when TMP-SMX is used for therapy. As a result, these trends have necessitated a change in the management approach to community-acquired UTI. The use of TMP-SMX as a first-line agent for empiric therapy of uncomplicated cystitis is only appropriate in areas where TMP-SMX resistance prevalence is <10% to 20%. In areas where resistance to TMP-SMX exceeds this rate, alternative agents need to be considered.

Topics: Anti-Bacterial Agents; Drug Resistance, Bacterial; Escherichia coli; Humans; Prevalence; Pyelonephritis; Risk Factors; Staphylococcus; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

Urinary tract infections (UTIs) are common bacterial infections, particularly in women. Antimicrobial therapy is seldom indicated for asymptomatic infection, but antimicrobial therapy is usually indicated for amelioration of symptoms. Management of acute uncomplicated UTI (cystitis) is generally straightforward, with a predictable distribution of uropathogens isolated. First-line treatment of acute uncomplicated UTI has traditionally involved a 3-day regimen of trimethoprim-sulfamethoxazole (TMP-SMX) or TMP alone for patients with sulfa allergies. Increasing resistance among community-acquired Escherichia coli to TMP-SMX worldwide has led to a reassessment of the most appropriate empiric therapy for these infections. Alternative first-line agents include the fluoroquinolones, nitrofurantoin, and fosfomycin. Factors to be considered in the selection of appropriate antimicrobial therapy include pharmacokinetics, spectrum of activity of the antimicrobial agent, resistance prevalence for the community, potential for adverse effects, and duration of therapy. Ideal antimicrobial agents for UTI management have primary excretion routes through the urinary tract to achieve high urinary drug levels. In addition, there are special considerations in the management of UTI among selected populations, including postmenopausal and pregnant women, and for women with frequent recurrent UTIs.

Topics: Adolescent; Adult; Anti-Infective Agents, Urinary; Cephalosporins; Drug Resistance, Bacterial; Female; Fluoroquinolones; Fosfomycin; Humans; Middle Aged; Nitrofurantoin; Postmenopause; Pregnancy; Pregnancy Complications, Infectious; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Women's Health

Urinary tract infections (UTIs) are common and generally benign conditions among healthy, sexually active young women without long-term medical sequelae. In contrast, UTIs are more complicated among those individuals at either end of the age spectrum: infants/young children and geriatrics. UTI in children younger than 2 years has been associated with significant morbidity and long-term medical consequences, necessitating an extensive and somewhat invasive imaging evaluation to identify possible underlying functional or anatomic abnormalities. Pediatric UTI should be considered complicated until proved otherwise, and treatment should reflect the severity of signs and symptoms. Management in the acutely ill child frequently involves parenteral broad-spectrum antimicrobial agents, and less ill children can be treated with trimethoprim- sulfamethoxazole (TMP-SMX), beta-lactams, and cephalosporins.UTI among older patients (>65 years) may be complicated by comorbidities, the baseline presence of asymptomatic bacteriuria, and benign urinary symptoms that can complicate diagnosis. The etiology of UTI encompasses a broader spectrum of infecting organisms than is seen among younger patients and includes more gram-positive organisms. Symptomatic UTI is generally more difficult to treat than among younger populations. Management should be conservative, of longer treatment durations, and cover a broad spectrum of possible uropathogens. Oral or parenteral treatment with a fluoroquinolone for 7 days is the preferred empiric approach. TMP-SMX can also be considered a first-line agent in women only, but only if the pathogen is known to be TMP-SMX sensitive.

Topics: Age Factors; Aged; Anti-Infective Agents, Urinary; Cephalosporins; Child; Female; Geriatrics; Humans; Lactams; Male; Pediatrics; Practice Guidelines as Topic; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The increase in resistance rates to TMP/SMX among E. coli causing community-acquired UTI has resulted in consideration of alternative agents as first line therapy for these infections. However, there has been little study of the clinical significance of the in vitro trends in resistance which have been reported. We review studies that address the correlation between in vitro resistance to TMP/SMX and clinical outcome in uncomplicated UTI. From these data, it is clear that in vitro resistance does translate into therapeutic failure for 50-60% of patients with a TMP/SMX resistant uropathogen. Thus, it is reasonable to consider an agent other than TMP/SMX when the TMP/SMX resistance prevalence reaches 20%.

Topics: Anti-Infective Agents, Urinary; Community-Acquired Infections; Humans; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

This article deals with many options in utilizing drugs commonly used in the therapy of uncomplicated urinary tract infections (UTIs), their doses and recommended durations of treatment. In addition, it discusses general and specific accompanying measures related to the decrease in prevalence, relapses and recurrences of UTIs, including some of the factors involved in patient adherence or discontinuation of drug regimens.

Topics: 4-Quinolones; Anti-Infective Agents; Cephalosporins; Drug Administration Schedule; Female; Fosfomycin; Humans; Nitrofurantoin; Penicillins; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Community-acquired urinary tract infections (UTIs) are among the most common bacterial infections in women. Therapy for these infections is usually begun before results of microbiological tests are known. Furthermore, in women with acute uncomplicated cystitis, empirical therapy without a pretherapy urine culture is often used. The rationale for this approach is based on the highly predictable spectrum of etiologic agents causing UTI and their antimicrobial resistance patterns. However, antimicrobial resistance among uropathogens causing community-acquired UTIs, both cystitis and pyelonephritis, is increasing. Most important has been the increasing resistance to trimethoprim-sulfamethoxazole (TMP-SMX), the current drug of choice for treatment of acute uncomplicated cystitis in women. What implications do these trends have for treatment of community-acquired UTIs? Preliminary data suggest that clinical cure rates may be lower among women with uncomplicated cystitis treated with TMP-SMX when the infecting pathogen is resistant to TMP-SMX. Women with pyelonephritis also have less bacterial eradication and lower clinical cure rates when treated with TMP-SMX for an infection that is resistant to the drug. Therefore, in the outpatient setting, identifying risk factors for TMP-SMX resistance and knowing the prevalence of TMP-SMX resistance in the local community are important steps in choosing an appropriate therapeutic agent. When choosing a treatment regimen, physicians should consider such factors as in vitro susceptibility, adverse effects, cost-effectiveness, and selection of resistant strains. Using a management strategy that takes these variables into account is essential for maintaining the safety and efficacy of treatment for acute UTI.

Topics: Anti-Infective Agents, Urinary; Bacterial Infections; Community-Acquired Infections; Drug Resistance, Microbial; Female; Humans; Microbial Sensitivity Tests; Risk Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The objective was to compare the efficacies of single-dose, short-course (4 days or less), and standard course (5 days or greater) antimicrobial therapy for uncomplicated childhood cystitis.. Prospective, randomized, controlled trials comparing 4 days or less of therapy (short courses) with 5 days or more of therapy (conventional therapy) were included if all of the subjects were <18 years of age, the initial infection was documented by urine culture, at least 1 subsequent culture was obtained between 3 and 30 days of enrollment, and some attempt was made to separate upper tract from lower tract infection. Composite differences among treatment groups were compared with a fixed or random effects model, depending on the test for heterogeneity.. Of the 517 citations identified by literature search, 37 were selected for detailed review, and 22 were included in the final meta-analysis. The overall difference in cure rates between short and conventional courses of therapy was significant (6.38%; 95% CI: 1.88% to 10.89%), favoring the conventional course. Similar results were obtained when only studies comparing the same agents in the short and conventional courses were included (7.92%; 95% CI: 2.09% to 13.8%). Short-course amoxicillin was inferior to conventional length course (difference in cure rate, 13%; 95% CI: 4% to 24%); no difference was found between short-course and conventional length courses of trimethoprim-sulfamethoxazole (difference in cure rate, 6.24%; 95% CI = -3.74% to 16.2%).. We conclude that single-dose amoxicillin is inadequate therapy for uncomplicated cystitis of childhood. Three days of trimethoprim-sulfamethoxazole therapy appears to be as effective as conventional length courses of the drug.

Topics: Adolescent; Amoxicillin; Anti-Infective Agents, Urinary; Child; Child, Preschool; Cystitis; Drug Administration Schedule; Humans; Infant; Penicillins; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Urinary tract infections (UTIs) are among the most commonly encountered bacterial infections. Acute uncomplicated UTIs in adults include episodes of cystitis and pyelonephritis. The main uropathogens causing uncomplicated UTIs have, in the past, been fairly predictable and they have generally been susceptible to several commonly used oral antimicrobials. There has been a trend, however, towards increasing antimicrobial resistance among uropathogens over the past few years, especially to beta-lactams and trimethoprim-sulfamethoxazole (TMP-SMX). The current standard of therapy for the empiric treatment of acute uncomplicated cystitis is TMP-SMX for 3 days. Since the prevalence of resistance to TMP-SMX among uropathogens is increasing, however, fluoroquinolones, with their low side effect profile, convenient pharmacokinetics and effectiveness, are increasingly being used first-line for the management of cystitis. Treatment of acute pyelonephritis is less controversial and fluoroquinolones are recommended as first-line agents in the empiric treatment of community-acquired pyelonephritis. Of concern, the increased use of fluoroquinolones for the treatment of UTIs and other infectious processes has resulted in an increasing prevalence of fluoroquinolone-resistant uropathogens worldwide. In light of these changing resistance patterns, prudent use of fluoroquinolones for the treatment of UTIs is warranted.

Topics: Adult; Anti-Infective Agents; Anti-Infective Agents, Urinary; Cystitis; Female; Fluoroquinolones; Humans; Pyelonephritis; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Recurrent urinary tract infections (UTIs) are observed in 30-50% of children after the first UTI. Of these, approximately 90% occur within 3 months of the initial episode. The basic aim of antibiotic prophylaxis in children with malformative uropathy and/or recurrent UTIs, is to reduce the frequency of UTIs. The bacteria most frequently responsible for UTI are gram-negative organisms, with Escherichia coli accounting for 80% of urinary tract pathogens. In children with recurrent UTIs and in those treated with antibiotic prophylaxis there is a greater incidence of UTI due to Proteus spp., Klebsiella spp. and Enterobacter spp., whereas Pseudomonas spp., Serratia spp. and Candida spp. are more frequent in children with urogenital abnormalities and/or undergoing invasive instrumental investigations. Several factors are involved in the pathogenesis of UTI, the main ones being circumcision, periurethral flora, micturition disorders, bowel disorders, local factors and hygienic measures. Several factors facilitate UTI relapse: malformative uropathies, particularly of the obstructive type; vesico-ureteric reflux (VUR); previous repeated episodes of cystitis and/or pyelonephritis (3 or more episodes a year), even in the absence of urinary tract abnormalities; a frequently catheterized neurogenic bladder; kidney transplant. The precise mechanism of action of low-dose antibiotics is not yet fully known. The characteristics of the ideal prophylactic agent are presented in this review, as well as indications, dosages, side effects, clinical data of all molecules. While inappropriate use of antibiotic prophylaxis encourages the emergence of microbial resistance, its proper use may be of great value in clinical practice, by reducing the frequency and clinical expression of UTIs and, in some cases such as VUR, significantly helping to resolve the underlying pathology.

Topics: Anti-Infective Agents; Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Cephalosporins; Child; Escherichia coli Infections; Fluoroquinolones; Humans; Nitrofurantoin; Penicillins; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract; Urinary Tract Infections

Topics: Anti-Infective Agents; Bacterial Infections; Child; Drug Interactions; Humans; Sulfonamides; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To determine practicing physicians' strategies for diagnosing and managing uncomplicated urinary tract infection, we surveyed physicians in general internal medicine, family practice, obstetrics and gynecology, and emergency medicine in four states. Responses differed significantly by respondents' specialty. For example, nitrofurantoin was the antibiotic of first choice for 46% of obstetricians, while over 80% in the other specialties chose trimethoprim-sulfamethoxazole. Most surveyed said they do not usually order urine culture, but the percentage who do varied by specialty. Most use a colony count of 10(5) colony-forming units or more for diagnosis although evidence favors a lower threshold, and 70% continue antibiotic therapy even if the culture result is negative. This survey found considerable variation by specialty and also among individual physicians regarding diagnosis and treatment of urinary tract infection and also suggests that some of the new information from the literature has not been translated to clinical practice.

Topics: Adult; Anti-Infective Agents, Urinary; Data Collection; Female; Humans; Medicine; Nitrofurantoin; Practice Patterns, Physicians'; Specialization; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

We report a case of severe hypoglycaemia following co-trimoxazole therapy. An 88-year-old woman was admitted with urinary tract infection and treated with co-trimoxazole (960 mg bid). Seven days after initiation of the treatment she became comatose. Blood sugar was 1.3 mmol/l and C-peptide at the upper limit of normal range. Glucose infusion restored normal consciousness and no hypoglycaemia recurred after interruption of co-trimoxazole therapy. Advanced aged was the only risk factor identified. Other risk factors described in previous case reports are renal failure, poor nutritional state and high doses of co-trimoxazole.

Topics: Aged; Blood Glucose; C-Peptide; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Humans; Hypoglycemia; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Urinary tract infections (UTIs) are very common in medical practice. Women have a high prevalence of UTIs, approximately 50 times higher than men. A large proportion of this prevalence is probably caused by anatomic and physical factors Chemical analysis of urine composition, examination of the urinary sediment and the bacterial colony counts are of great value for diagnosis and therapy. The patients may be benefit from antibiotic doses. In addition to trimethoprimsulfamethoxazole (TMP/SMZ), amoxicillin and cephalosporins, the authors observed a new drug: fluoroquinolones. These drugs derived by nalidixic acid and included: ciprofloxacin, enoxacin, lomefloxacin, norfloxacin, pefloxacin and rufloxacin. They are sinergistic against most Gram positives and negatives including Pseudomonas aeruginosa and Proteus mirabilis. Fluoroquinolone is an antibacterial agent that is effective in treating urinary tract infections. It is usually administered orally and is well absorbed after oral ingestion. Quinolones are preferable to TMP/SMZ because of their greater antibacterial activity that occurred in about 82% of women. A dose of quinolones (400 mg daily for 3 days) has been particularly effective in the treatment of UTIs. The amoxicillin-clavulanic acid can be used for treatment even if increased antibiotic resistance. The efficacy, relative safety and low cost of quinolones predispose to utilize its like the first treatment choice.

Topics: Anti-Infective Agents; Anti-Infective Agents, Urinary; Female; Fluoroquinolones; Humans; Male; Quinolones; Risk Factors; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Urinary tract infections in boys and men are common causes of significant morbidity and, when coupled with urinary tract abnormalities, loss of renal function. Careful and prompt urological assessment is mandatory for proper treatment and prevention of serious and/or chronic sequelae.

Topics: 4-Quinolones; Anti-Infective Agents; Bacteriuria; Gram-Negative Bacteria; Humans; Male; Nitrofurantoin; Prostatitis; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To establish and recommend a therapeutic regimen for the treatment of urinary tract infection (UTI) in pregnancy based on the published studies.. An English-language literature search employing MEDLINE, Index Medicus, and bibliographic reviews of the references obtained were searched (key terms: urinary tract infection, UTI, pregnancy, bacteriuria).. All identified human studies dealing with bacteriuria or UTI in pregnancy were analyzed.. Limited data are available regarding the appropriate antibiotic management of UTI in pregnancy. Single-dose cure rates with amoxicillin are approximately 80 percent. Trimethoprim/sulfamethoxazole provides cure rates of greater than 80 percent. Cephalosporins and nitrofurantoin produce variable results.. We recommend separating pregnant subjects with UTI into two groups. Those with asymptomatic bacteriuria can be treated with a single dose of an antimicrobial to which the organism is susceptible. For those with symptomatic UTI, we recommend amoxicillin 500 mg tid for three days. Urine cultures should be repeated seven days following therapy to assess cure or failure. Well-designed studies need to be performed, comparing single-dose and three-day therapy for UTI in pregnancy.

Topics: Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Infective Agents; Cephalexin; Clavulanic Acids; Drug Therapy, Combination; Female; Humans; Nitrofurantoin; Pregnancy; Pregnancy Complications, Infectious; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Most urinary tract infections (UTIs) present as bacterial cystitis in healthy women in the sexually active age group. The commonest pathogen is Escherichia coli and most of the remainder are due to Staphylococcus saprophyticus. Many women are prone to recurrent UTIs and these are invariably due to a reinfection with a different organism. After diagnosis, a curative course of treatment should be given, but the approach should be different if the infection is uncomplicated (normal urinary tract and normal renal function) as opposed to complicated (male patient, abnormal urinary tract, impaired host defence mechanisms, impaired renal function, infection with a virulent organism). It is believed that traditional dosage regimens for uncomplicated UTIs are extravagant. There is no convincing evidence that a long course of medication is more effective than a short one; in fact, the use of single dose therapy for uncomplicated UTIs is gaining support. Trimethoprim 600mg, cotrimoxazole (trimethoprim/sulfamethoxazole) 1.92g, fosfomycin trometamol 3g and the 4-quinolones are the preferred agents for single dose treatment. Failure of single dose therapy is a simple guide for the need for further urinary tract investigation or more intensive therapy. If UTIs recur, it may be necessary to consider long term, low dose prophylaxis. The most effective drugs for this type of treatment include nitrofurantoin 50mg, trimethoprim 100mg and norfloxacin 200mg, given at night. More recent studies show that a dose administered on alternate nights, 3 nights a week or after intercourse is just as effective.

Topics: 4-Quinolones; Anti-Bacterial Agents; Anti-Infective Agents; Female; Humans; Pregnancy; Pregnancy Complications, Infectious; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Questions concerning the clinical picture, diagnosis and treatment of uncomplicated urinary tract infections in women related to daily practice are discussed on the basis of personal experience and a review of the literature. Indications and rationale for a single-dose therapy with Cotrimoxazole, Trimethoprim or Fosfomycin are detailed. Special considerations are given to therapeutical approaches to recurrent infection as well as special situations like asymptomatic bacteriuria, acute urethral syndrome, bacteriuria in pregnancy and nosocomial, catheter-associated infections are discussed.

Topics: Algorithms; Bacteriuria; Drug Therapy, Combination; Family Practice; Female; Fosfomycin; Humans; Pregnancy; Pregnancy Complications, Infectious; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Urinary tract infections continue to be a major health problem for women. Understanding of the pathogenesis of urinary tract infections has improved; Staphylococcus saprophyticus has been recognized as a common causative agent, and low-colony-count infections are misdiagnosed less often. Traditional therapy with 10 days of amoxicillin (Amoxil, Wymox) or ampicillin (Omnipen, Totacillin) is no longer considered optimal. For women who fulfill certain clinical criteria, short-course therapy is recommended--preferably 3 days of trimethoprim-sulfamethoxazole, or trimethoprim alone (Proloprim, Trimpex) if the woman is allergic to sulfonamides. Longer therapy is indicated for women with complicated, prolonged, or recurrent infections. To appropriately treat patients and avoid overtreatment that would increase both costs and the incidence of side effects, physicians need to stay abreast of information about pathogens, mechanisms of disease, new drugs, and common resistance patterns.

Topics: Acute Disease; Amoxicillin; Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents; Cost-Benefit Analysis; Drug Administration Schedule; Drug Therapy, Combination; Female; Fluoroquinolones; Humans; Nitrofurantoin; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The clinical features of three patients with a life-threatening reaction to trimethoprim-sulfamethoxazole (TMP-SMZ) are presented along with seven other cases from the literature. All patients developed sudden fever and hypotension immediately after the administration of TMP-SMZ; usually this reaction occurred within approximately 2 weeks of completion of a previous course of the drug. All but one patient had a rash. Most patients were hypoxemic and developed diffuse pulmonary infiltrates. All patients responded rapidly to supportive care, while bacterial cultures remained negative. The presence, absence, or character of previous adverse reactions to TMP-SMZ did not predict subsequent severe reactions. Although its mechanism remains unclear, this reaction has features of both IgE-mediated anaphylaxis and cytokine (tumor necrosis factor)-mediated effects. We advise extreme caution, with close observation, when this drug is first readministered to patients who have experienced any TMP-SMZ-associated toxicity within the previous 6-8 weeks.

Topics: Adult; Diarrhea; Dyspnea; Fever; HIV Infections; Humans; Hypotension; Hypoxia; Male; Middle Aged; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Child; Humans; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The published studies of the use of single-dose antimicrobial therapy for the treatment of urinary tract infection have been reviewed. In women a single dose of any of several antimicrobial agents is as effective as a course of treatment for uncomplicated urinary tract infections caused by Escherichia coli. Trimethoprim or co-trimoxazole are currently the preferred agents for single-dose therapy. Fosfomycin trometamol and the 4-quinolones are promising agents. Failure of single-dose therapy may prove to be a simple guide as to the need for further urinary tract investigation or more intensive therapy. Single-dose antimicrobial therapy is now the treatment of choice for uncomplicated urinary tract infections in general practice.

Topics: Bacteriuria; Cystitis; Drug Administration Schedule; Female; Humans; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In the treatment of uncomplicated urinary tract infection, single-dose therapy has appeared to be as efficacious as traditional 7-14 day therapy in women with cystitis without renal involvement. Current localizing techniques to differentiate between lower- and upper-tract disease are inadequate for routine clinical practice. As a result we have proposed that failure of cure with single-dose treatment may be the most specific test available to diagnose renal infection. Most of the published data on single-dose therapy involves treatment with either amoxicillin or trimethoprim-sulfamethoxazole. Single-dose therapy offers advantages over traditional therapy, including improved compliance, reduced adverse effects, and decreased cost. Appropriate patient selection is critical if the outcome of single-dose therapy is to be effective.

Topics: Amoxicillin; Anti-Infective Agents, Urinary; Drug Administration Schedule; Drug Combinations; Female; Humans; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Aminoglycosides; Anti-Bacterial Agents; Anti-Infective Agents; Cephalosporins; Drug Combinations; Humans; Male; Penicillins; Premedication; Prostatectomy; Risk; Sepsis; Sulfamethoxazole; Surgical Wound Infection; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents; Bacterial Infections; Drug Combinations; Drug Utilization; Humans; Pneumonia, Pneumocystis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adult; Aminoglycosides; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Cephalosporins; Child; Clinical Trials as Topic; Drug Combinations; Female; Humans; Male; Penicillins; Pregnancy; Sulfamethoxazole; Sulfonamides; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The reasons for combining trimethoprim (TMP) with sulfonamides (SUL) are still mainly theoretical but are supported by results from experimental infections and treatment of specific pathogens in humans, such as Branhamella catarrhalis, Neisseria gonorrhoeae, Brucella, Nocardia asteroides and perhaps Bordetella pertussis and Chlamydia trachomatis. Addition of SUL to TMP confers a therapeutic advantage also in patients with complicated urinary tract infection but probably not in young women with acute cystitis. Conditions that may enable TMP-SUL synergy in vivo can be expected to occur only in occasional cases of infection due to staphylococci, streptococci, Haemophilus or enteric bacteria. This fact together with ethical problems and availability of alternative therapies make further evaluations of the clinical significance of the SUL component of TMP-SUL very difficult. Although the use of TMP alone has shown promise in exacerbations of chronic bronchitis the role of the SUL component in TMP-SUL treatment of infections outside the urinary tract remains to be defined in comparative clinical trials.

Topics: Aged; Anti-Bacterial Agents; Brucellosis; Clinical Trials as Topic; Drug Combinations; Drug Synergism; Female; Gonorrhea; Humans; Kinetics; Lymphogranuloma Venereum; Male; Microbial Sensitivity Tests; Nocardia Infections; Sulfamethoxazole; Tissue Distribution; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Antibody-Coated Bacteria Test, Urinary; Cystitis; Drug Combinations; Female; Humans; Recurrence; Staphylococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Vaginitis, cystitis, urethritis, and cervicitis are common diagnoses made in women attending family physicians' offices. Recent research has fundamentally altered available information on the diagnosis and management of these common genitourinary infections. This clinical review discusses presenting symptoms, physical findings, laboratory diagnostic aids, treatment, and follow-up for each lower genitourinary syndrome in women concluding with a summary flow chart illustrating an overall recommended approach.

Topics: Amoxicillin; Anti-Infective Agents, Urinary; Cystitis; Diagnosis, Differential; Drug Combinations; Family Practice; Female; Humans; Metronidazole; Pregnancy; Pregnancy Complications, Infectious; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urethritis; Urinary Tract Infections; Uterine Cervicitis; Vaginitis

Topics: Anti-Bacterial Agents; Bacterial Infections; Child; Chloramphenicol; Drug Combinations; Haemophilus Infections; Haemophilus influenzae; Humans; Infant, Newborn; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vancomycin

Topics: Amoxicillin; Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Cross Infection; Drug Combinations; Escherichia coli Infections; Female; Humans; Penicillin Resistance; Premedication; Proteus Infections; Pseudomonas Infections; Pyelonephritis; Sulfamethoxazole; Surgical Wound Infection; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Although controversies remain regarding the definition, diagnosis, and management of urinary tract infections, such infections can pose a major risk to a child's well-being. Bacteriuria or recurrent urinary tract infections often pose difficult management problems. Symptomatic and asymptomatic bacteriuria during infancy are generally characterized by a benign outcome. In some children repeated episodes and, possibly, renal scarring result. The prognosis in young boys may be guarded if neonatal bacteriuria, with or without symptoms, occurs in the presence of anatomic defects. Although a variety of pathogens have been identified as causing urinary tract infections, Enterobacteriaceae are usually the cause of initial uncomplicated lower tract infections. Accepted therapy for such infections is reviewed, as are the combination therapies used for hospitalized patients with upper tract infections. An investigation of piperacillin, a new, extended-spectrum acylaminopenicillin, raises the hope that it may provide effective monotherapy for upper tract infections. The criteria for selecting patients who require radiologic evaluation in the management of urinary tract infections are reviewed.

Topics: Acute Disease; Adolescent; Anti-Bacterial Agents; Bacteriuria; Child; Child, Preschool; Drug Combinations; Female; Humans; Long-Term Care; Male; Piperacillin; Prognosis; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Bacteriuria is much more common in the elderly than in younger individuals for a variety of reasons. Women have a greater prevalence than men, but the trend to increased prevalence with age in over 65 year olds is greater in men. The acquisition rate for bacteriuria in the elderly is extremely high but information about the sequelae of bacteriuria is scanty. However there is good evidence that bacteriuria is associated with increased mortality. In clinical practice, subjects found to be bacteriuric tend to be treated and there are a variety of problems in this, not only with regard to efficacy but also in suitability of antimicrobials by virtue of resistance patterns and side effects. A small comparative study shows that norfloxacin may be a suitable drug for use in the elderly, but further studies are required to confirm this in larger numbers of unselected patients. A transient but significant rise in serum creatinine was observed in subjects on cotrimoxazole.

Topics: Aged; Anti-Infective Agents, Urinary; Bacteriuria; Drug Combinations; Female; Humans; Male; Middle Aged; Nalidixic Acid; Norfloxacin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adult; Bacteria; Bacterial Infections; Child; Drug Combinations; Drug Resistance; Female; Humans; Kinetics; Male; Plasmids; Protozoan Infections; Sexually Transmitted Diseases; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

While trimethoprim-sulfamethoxazole (TMP-SMX) is recommended as one of the first-line empiric therapies for treatment of acute uncomplicated cystitis, institutions that observe resistance rates exceeding 20% for Escherichia coli (E. coli) should utilize alternative empiric antibiotic therapy per the Infectious Diseases Society of America (IDSA). Identifying risk factors associated with TMP-SMX resistance in E. coli may help guide empiric antibiotic prescribing for urinary tract infections (UTIs).. This multicenter, retrospective study included adult patients who were discharged from 12 emergency departments (EDs) with a urine culture positive for E. coli between January 1, 2019 and December 31, 2019. Logistic regression was used to assess the relationship between potential risk factors and TMP-SMX resistance. The overall institutional antimicrobial resistance rates for E. coli were compared to the rates seen in the study population of ED urinary isolates.. Among 427 patients included from a randomized sample of 500 with a urine culture positive for E. coli, 107 (25.1%) were resistant to TMP-SMX. Three predictors of TMP-SMX resistance were identified: recurrent UTI (OR 2.27 [95% CI 1.27-3.99]), genitourinary abnormalities (OR 2.31 [95% CI 1.17-4.49]), and TMP-SMX use within 90 days (OR 8.77 [95% CI 3.19-28.12]). When the antibiotic susceptibilities for this ED cohort were compared to the institutional antibiogram, the TMP-SMX resistance rate was found to be higher in the ED population (25.1% vs 20%).. TMP-SMX should likely be avoided as first-line therapy for UTI in patients who have recurrent UTIs, genitourinary abnormalities, or have previously received TMP-SMX within the past 90 days. The use of an ED-specific antibiogram should be considered for assessing local resistance rates in this population.

Topics: Adult; Anti-Bacterial Agents; Cystitis; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Humans; Retrospective Studies; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Determination of optimal treatment durations for common infectious diseases is an important strategy to preserve antibiotic effectiveness.. To determine whether 7 days of treatment is noninferior to 14 days when using ciprofloxacin or trimethoprim/sulfamethoxazole to treat urinary tract infection (UTI) in afebrile men.. Randomized, double-blind, placebo-controlled noninferiority trial of afebrile men with presumed symptomatic UTI treated with ciprofloxacin or trimethoprim/sulfamethoxazole at 2 US Veterans Affairs medical centers (enrollment, April 2014 through December 2019; final follow-up, January 28, 2020). Of 1058 eligible men, 272 were randomized.. Participants continued the antibiotic prescribed by their treating clinician for 7 days of treatment and were randomized to receive continued antibiotic therapy (n = 136) or placebo (n = 136) for days 8 to 14 of treatment.. The prespecified primary outcome was resolution of UTI symptoms by 14 days after completion of active antibiotic treatment. A noninferiority margin of 10% was selected. The as-treated population (participants who took ≥26 of 28 doses and missed no more than 2 consecutive doses) was used for the primary analysis, and a secondary analysis included all patients as randomized, regardless of treatment adherence. Secondary outcomes included recurrence of UTI symptoms and/or adverse events within 28 days of stopping study medication.. Among 272 patients (median [interquartile range] age, 69 [62-73] years) who were randomized, 100% completed the trial and 254 (93.4%) were included in the primary as-treated analysis. Symptom resolution occurred in 122/131 (93.1%) participants in the 7-day group vs 111/123 (90.2%) in the 14-day group (difference, 2.9% [1-sided 97.5% CI, -5.2% to ∞]), meeting the noninferiority criterion. In the secondary as-randomized analysis, symptom resolution occurred in 125/136 (91.9%) participants in the 7-day group vs 123/136 (90.4%) in the 14-day group (difference, 1.5% [1-sided 97.5% CI, -5.8% to ∞]) Recurrence of UTI symptoms occurred in 13/131 (9.9%) participants in the 7-day group vs 15/123 (12.9%) in the 14-day group (difference, -3.0% [95% CI, -10.8% to 6.2%]; P = .70). Adverse events occurred in 28/136 (20.6%) participants in the 7-day group vs 33/136 (24.3%) in the 14-day group.. Among afebrile men with suspected UTI, treatment with ciprofloxacin or trimethoprim/sulfamethoxazole for 7 days was noninferior to 14 days of treatment with regard to resolution of UTI symptoms by 14 days after antibiotic therapy. The findings support the use of a 7-day course of ciprofloxacin or trimethoprim/sulfamethoxazole as an alternative to a 14-day course for treatment of afebrile men with UTI.. ClinicalTrials.gov identifier: NCT01994538.

Topics: Aged; Anti-Bacterial Agents; Ciprofloxacin; Double-Blind Method; Drug Administration Schedule; Duration of Therapy; Humans; Male; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urine

It is a common practice to monitor blood tests in patients receiving long-term trimethoprim-sulfamethoxazole (TMP-SMZ) prophylaxis for recurrent urinary tract infections. This multicenter, randomized, placebo-controlled trial enrolled 607 children aged 2 to 71 months with vesicoureteral reflux diagnosed after symptomatic urinary tract infection. Study participants received TMP-SMZ (n = 302) or placebo (n = 305) and were followed for 2 years. Serum electrolytes (n ≥ 370), creatinine (n = 310), and complete blood counts (n ≥ 206) were measured at study entry and at the 24-month study conclusion. We found no significant electrolyte, renal, or hematologic abnormalities when comparing the treatment and placebo groups. We observed changes in several laboratory parameters in both treatment and placebo groups as would normally be expected with physiologic maturation. Changes were within the normal range for age. Long-term use of TMP-SMX had no treatment effect on complete blood count, serum electrolytes, or creatinine. Our findings do not support routine monitoring of these laboratory tests in children receiving long-term TMP-SMZ prophylaxis.

Topics: Anti-Infective Agents, Urinary; Biomarkers; Child; Child, Preschool; Drug Monitoring; Female; Follow-Up Studies; Humans; Infant; Male; Prospective Studies; Recurrence; Secondary Prevention; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

Transurethral resection of the prostate (TURP) and Greenlight laser vaporisation (GL) of the prostate are frequently performed urological procedures. For TURP, a single-dose antimicrobial prophylaxis (AP) is recommended to reduce postoperative urinary tract infections. So far, no international recommendations for AP have been established for GL. In a survey-based study in Switzerland, Germany and Austria, urologists reported routinely extending AP primarily for 3 days after both interventions. We therefore aim to determine whether single-dose AP with cotrimoxazole is non-inferior to 3-day AP with cotrimoxazole in patients undergoing TURP or GL of the prostate.. We will conduct an investigator-initiated, multicentre, randomised controlled trial. We plan to assess the non-inferiority of single-dose AP compared to 3-day AP. The primary outcome is the occurrence of clinically diagnosed symptomatic urinary tract infections which are treated with antimicrobial agents within 30 days after randomisation. The vast majority of collected outcomes will be assessed from routinely collected data. The sample size was estimated to be able to show the non-inferiority of single-dose AP compared to 3-day AP with at least 80% power (1 - β = 0.8) at a significance level of α = 5%, applying a 1:1 randomisation scheme. The non-inferiority margin was determined in order to preserve 70% of the effect of usual care on the primary outcome. For an assumed event rate of 9% in both treatment arms, this resulted in a non-inferiority margin of 4.4% (i.e. 13.4% to 9%). To prove non-inferiority, a total of 1574 patients should be recruited, in order to have 1416 evaluable patients. The study is supported by the Swiss National Science Foundation.. For AP in TURP and GL, there is a large gap between usual clinical practice and evidence-based guidelines. If single-dose AP proves non-inferior to prolonged AP, our study findings may help to reduce the duration of AP in daily routine-potentially reducing the risk of emerging resistance and complications related to AP.. Clinicaltrials.gov, NCT03633643 . Registered 16 August 2018.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Drug Administration Schedule; Equivalence Trials as Topic; Humans; Laser Therapy; Male; Multicenter Studies as Topic; Prostatic Hyperplasia; Prostatic Neoplasms; Switzerland; Time Factors; Transurethral Resection of Prostate; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To assess whether antibiotic reduces voiding cystourethrogram (VCUG)-associated urinary tract infection (UTI).. Open-labelled randomised controlled trial.. Tertiary paediatric nephrology centre.. 120 children (age 2 months-5 years) undergoing VCUG.. Children were randomised into group A (antibiotic, n=72) or group B (no antibiotic, n=48) in 3:2 ratio. Group A received oral antibiotic (cephalexin if <6 months or co-trimoxazole if >6 months old) a day prior to VCUG and continued for 1 day post VCUG.. The main outcome measure is incidence of VCUG-associated UTI. Urine was checked on day 3 after VCUG and UTI was defined as significant growth of a single organism in a symptomatic child.. The median age was 8 months (IQR 13 months) with 68% male. Indication for undertaking VCUG was history of UTI (first UTI in infancy=43, recurrent UTI=49) and congenital anomaly of kidney and urinary tract without any UTI (n=28). Post-VCUG UTI was significantly higher among group B in comparison to group A (17% (n=8) vs 1.4% (n=1); p=0.01, OR=14.2 (95% CI 1.7 to 117)). Multivariate binary logistic regression analysis found an abnormal pre-VCUG ultrasound scan to be a significant independent risk factor for post-VCUG UTI (p=0.02, OR=9.51, 95% CI 1.43 to 63.4). The number needed to treat with antibiotic to prevent one post-VCUG UTI was 6.5, which reduced to 4 if only the group with abnormal pre-VCUG ultrasound scan was included.. Antibiotic significantly reduces post-VCUG-acquired UTI especially in those with abnormal ultrasound scans.. Clinical Trial Registry of India: CTRI/2017/03/00824.

Topics: Anti-Bacterial Agents; Cephalexin; Child, Preschool; Female; Humans; Infant; Male; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urination; Urogenital Abnormalities; Urography; Vesico-Ureteral Reflux

Repeated symptomatic urinary tract infections (UTIs) affect 25% of people who use clean intermittent self-catheterisation (CISC) to empty their bladder. We aimed to determine the benefits, harms, and cost-effectiveness of continuous low-dose antibiotic prophylaxis for prevention of recurrent UTIs in adult users of CISC.. In this randomised, open-label, superiority trial, we enrolled participants from 51 UK National Health Service organisations. These participants were community-dwelling (as opposed to hospital inpatient) users of CISC with recurrent UTIs. We randomly allocated participants (1:1) to receive either antibiotic prophylaxis once daily (prophylaxis group) or no prophylaxis (control group) for 12 months by use of an internet-based system with permuted blocks of variable length. Trial and laboratory staff who assessed outcomes were masked to allocation but participants were aware of their treatment group. The primary outcome was the incidence of symptomatic, antibiotic-treated UTIs over 12 months. Participants who completed at least 6 months of follow-up were assumed to provide a reliable estimate of UTI incidence and were included in the analysis of the primary outcome. Change in antimicrobial resistance of urinary and faecal bacteria was monitored as a secondary outcome. The AnTIC trial is registered at ISRCTN, number 67145101; and EudraCT, number 2013-002556-32.. Between Nov 25, 2013, and Jan 29, 2016, we screened 1743 adult users of CISC for eligibility, of whom 404 (23%) participants were enrolled between Nov 26, 2013, and Jan 31, 2016. Of these 404 participants, 203 (50%) were allocated to receive prophylaxis and 201 (50%) to receive no prophylaxis. 1339 participants were excluded before randomisation. The primary analysis included 181 (89%) adults allocated to the prophylaxis group and 180 (90%) adults in the no prophylaxis (control) group. 22 participants in the prophylaxis group and 21 participants in the control group were not included in the primary analysis because they were missing follow-up data before 6 months. The incidence of symptomatic antibiotic-treated UTIs over 12 months was 1·3 cases per person-year (95% CI 1·1-1·6) in the prophylaxis group and 2·6 (2·3-2·9) in the control group, giving an incidence rate ratio of 0·52 (0·44-0·61; p<0·0001), indicating a 48% reduction in UTI frequency after treatment with prophylaxis. Use of prophylaxis was well tolerated: we recorded 22 minor adverse events in the prophylaxis group related to antibiotic prophylaxis during the study, predominantly gastrointestinal disturbance (six participants), skin rash (six participants), and candidal infection (four participants). However, resistance against the antibiotics used for UTI treatment was more frequent in urinary isolates from the prophylaxis group than in those from the control group at 9-12 months of trial participation (nitrofurantoin 12 [24%] of 51 participants from the prophylaxis group vs six [9%] of 64 participants from the control group with at least one isolate; p=0·038), trimethoprim (34 [67%] of 51 vs 21 [33%] of 64; p=0·0003), and co-trimoxazole (26 [53%] of 49 vs 15 [24%] of 62; p=0·002).. Continuous antibiotic prophylaxis is effective in reducing UTI frequency in CISC users with recurrent UTIs, and it is well tolerated in these individuals. However, increased resistance of urinary bacteria is a concern that requires surveillance if prophylaxis is started.. UK National Institute for Health Research.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Catheter-Related Infections; Female; Humans; Male; Middle Aged; Nitrofurantoin; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

PURPOSE OF THE STUDY A very serious complication following joint replacement surgery is periprosthetic joint infection that can be caused by a urinary tract infection. Insertion of an indwelling urinary catheter constitutes a risk factor that may result in urinary tract infections. The aim of this prospective randomised study was to compare the occurrence of significant bacteriuria and symptomatic urinary tract infections during antibiotic prophylaxis at the time of removal of an indwelling urinary catheter by cotrimoxazole in two doses and with no administration of antibiotics. We also monitored the incidence of potential periprosthetic infection following the endoprosthesis implantation. The findings of preoperative urine tests were compared with the declared negative preoperative examination. MATERIAL AND METHODS The study included patients indicated for a total hip or knee replacement with a negative urine culture as a part of the preoperative testing. Where leukocyteria was detected, urine culture by mid-stream clean catch urine was obtained. The second part included patients, in whom an indwelling urinary catheter had to be inserted postoperatively for urine retention and/or monitoring of fluid balance and who were divided into two groups on a rota basis. No antibiotics were administered to the first group, whereas Cotrimoxazol 960 mg tablets p.o. was administered to the second group, 14 and 2 hours before the removal of the catheter. The urine culture test was performed 4 hours after the removal of the indwelling urinary catheter, in both the groups. The test was repeated after 14 days and a questionnaire was filled in to report urinary tract complications. Considered as significant bacteriuria by urinalysis was the laboratory finding of > 10x4 CFU/ml in case of a single pathogen or > 10x5 in case of multiple pathogens. The results were statistically processed by Fischer's exact test with the level of significance = 0.05. RESULTS In the first part of the study leukocyturia was detected by a test strip in 112 of the total of 478 patients. In 10 women, significant bacteriuria was found. Altogether 50 women and 50 men were randomly assigned to the second part of the study. The indwelling urinary catheter was in place for 4 days on average. In men, no statistically significant difference was detected in significant bacteriuria findings, in women a statistically significant difference of p = 0.00162 was found after the removal and after 14 days the bord

Topics: Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Bacteriuria; Catheters, Indwelling; Device Removal; Female; Hip Prosthesis; Humans; Knee Prosthesis; Male; Postoperative Care; Prospective Studies; Prosthesis-Related Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Catheterization; Urinary Catheters; Urinary Tract Infections

An association between antibiotic use and excessive weight gain or obesity in healthy infants and young children has been reported, but evidence is inconsistent and based on observational studies of growth in relation to incidental antibiotic exposures.. To evaluate whether prolonged antibiotic exposure is associated with weight gain in children participating in a clinical trial of antibiotic prophylaxis to prevent recurrent urinary tract infection.. Secondary analysis of data from the Randomized Intervention for Children With Vesicoureteral Reflux Study, a 2-year randomized clinical trial that enrolled participants from 2007 to 2011. All 607 children who were randomized to receive antibiotic (n = 302) or placebo (n = 305) were included. Children with urinary tract anomalies, premature birth, or major comorbidities were excluded from participation.. Trimethoprim-sulfamethoxazole or placebo taken orally, once daily, for 2 years.. Weight gain as measured by change in weight-for-age z score from baseline to the end-of-study visit at 24 months. Secondary outcomes included weight gain at 6, 12, and 18 months and the prevalence of overweight or obesity at 24 months.. Participants had a median age of 12 months (range, 2-71 months) and 558 of 607 (91.9%) were female. Anthropometric data were complete at the 24-month visit for 428 children (214 in the trimethoprim-sulfamethoxazole group and 214 in the placebo group). Weight gain in the trimethoprim-sulfamethoxazole group and the placebo group was similar (mean [SD] change in weight-for-age z score: +0.14 [0.83] and +0.18 [0.85], respectively; difference, -0.04 [95% CI, -0.19 to 0.12]; P = .65). There was no significant difference in weight gain at 6, 12, or 18 months or in the prevalence of overweight or obesity at 24 months (24.8% vs 25.7%; P = .82). Subgroup analyses showed no significant interaction between weight gain effect and age, sex, history of breastfeeding, prior antibiotic use, adherence to study medication, or development of urinary tract infection during the study.. Based on a secondary analysis of data from a large clinical trial of trimethoprim-sulfamethoxazole prophylaxis, there was no evidence that prolonged exposure to this antibiotic has a concurrent effect on weight gain or the prevalence of overweight or obesity in healthy infants and young children.

Topics: Antibiotic Prophylaxis; Child; Child, Preschool; Female; Humans; Infant; Male; Obesity; Prevalence; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux; Weight Gain

Bacterial resistance to antibiotics is an increasingly threatening consequence of antimicrobial exposure for many decades now. In urinary tract infections (UTIs), antibiotic prophylaxis (AP) increases bacterial resistance. We studied the resistance patterns of positive urinary cultures in spina bifida children on clean intermittent catheterization, both continuing and stopping AP.. In a cohort of 176 spina bifida patients, 88 continued and 88 stopped using AP. During 18 months, a fortnightly catheterized urine sample for bacterial pathogens was cultured. UTIs and significant bacteriuria (SBU) were defined as a positive culture with a single species of bacteria, respectively with and without clinical symptoms and leukocyturia. We compared the percentage of resistance to commonly used antibiotics in the isolated bacteria in both groups.. In a total of 4917 cultures, 713 (14.5%) had a positive monoculture, 54.3% of which were Escherichia coli. In the group stopping AP, the resistance percentage to antibiotics in UTI / SBU bacteria was lower than in the group remaining on AP, even when excluding the administered prophylaxis.. Stopping antibiotic prophylaxis for urinary tract infections is associated with reduced bacterial resistance to antibiotics in children with spina bifida.. ISRCTN ISRCTN56278131 . Registered 20 December 2005.

Topics: Adolescent; Aminoglycosides; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacteriuria; Child; Deprescriptions; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Fluoroquinolones; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Male; Nitrofurantoin; Penicillins; Spinal Dysraphism; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Antimicrobial prophylaxis is recommended for the prevention of urinary tract infections (UTI) in high-risk children. However, there is growing concern about the use of β-lactams as prophylaxis and subsequent development of antibiotic resistance.. In this prospective, randomized, crossover controlled trial we compared cotrimoxazole (SXT) and second-generation cephalosporins (2GC) as UTI prophylaxis in children ranging in age from 1 to 60 months. Eligible patients were 1:1 randomized to receive either SXT or 2GC for the initial 6-month period (1 course), then switched to the other antimicrobial agent class for the subsequent course, with switching continuing after each course until the end of the study. Urethral orifice cultures (UOCs) were obtained at the time of switching antimicrobial prophylaxis.. Among 97 children (mean age 13.6 months) on prophylaxis, breakthrough UTIs occurred during 13.3 % (10/75) of SXT courses and 10.3 % (8/78) of 2GC courses (p = 0.62). 2GC failed earlier than SXT (mean ± standard error: 0.81 ± 0.1 vs. 2.37 ± 0.36 months, respectively; p = 0.028). Pseudomonas aeruginosa and Enterococcus spp. were more frequently isolated after 2GC courses than after SXT courses [22.6 vs. 4.8 % (p = 0.02) and 20.7 vs. 4.8 % (p = 0.035), respectively]. Prophylaxis with 2GC significantly increased resistance to both 2GC and SXT, while SXT prophylaxis did not affect susceptibility to 2GC.. While SXT and 2GC appear to be equally efficacious as UTI prophylaxis in children, the latter exert a broader effect on patients' flora and development of bacterial resistance, suggesting that SXT may be more appropriate for UTI prophylaxis than 2GC.

Topics: Anti-Infective Agents, Urinary; Cephalosporins; Child, Preschool; Cross-Over Studies; Drug Resistance, Bacterial; Female; Humans; Infant; Infant, Newborn; Male; Microbial Sensitivity Tests; Prospective Studies; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Child; Child, Preschool; Cicatrix; Humans; Infant; Kidney; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

The benefits of long-term low-dose antibiotics in preventing urinary tract infection (UTI) and renal damage in children with primary vesicoureteric reflux (VUR) are unclear.. Children aged between 1 and 12 years with VUR grade I-IV and a microbiologically proven UTI were randomized into two groups to receive either antibiotic prophylaxis [2 mg/kg trimethoprim + sulfamethoxazole (TMP-SMX)] daily or placebo, respectively, for 12 months. Primary outcome was microbiologically confirmed symptomatic UTI. Intention-to-treat analysis using time-to-event data was performed.. A total of 93 children (66.7 % boys) with a median age of 4.6 years were enrolled in this study; VUR grade III-IV was present in 73.1 % of these children. At least one symptomatic UTI occurred in ten (21.3 %) patients receiving antibiotic prophylaxis and in three (6.5 %) patients receiving placebo [hazard ratio in antibiotic group 3.9; 95 % confidence interval (CI) 1- 14; log rank test P = 0.02). Compared to the group receiving placebo, the antibiotic group had a 14.8 % increased risk for developing UTI (95 % CI 1-28; P = 0.03). Of the total number of episodes of UTI, 58.3 % of those in the antibiotic group were caused by TMP-SMX-resistant bacteria compared to 20 % in the placebo group (P = 0.15). A renal scan at 12 months revealed that six of 37 (16.2 %) patients in the antibiotic group and seven of 43 (16.3 %) patients in the placebo group had new or worsening of pre-existing scar.. Long-term antibiotic prophylaxis with TMP-SMX is associated with increased risk of symptomatic UTI compared to placebo in children with grade I-IV VUR.

Topics: Anti-Infective Agents, Urinary; Chemoprevention; Child; Child, Preschool; Double-Blind Method; Female; Humans; Infant; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

To compare the bacteriological cure rate of short-course (3-day) treatment of uncomplicated urinary tract infection (UTI) using co-trimoxazole, norfloxacin and levofloxacin, patients with uncomplicated UTI were randomized to receive either co-trimoxazole (960 mg) twice a day or norfloxacin (400 mg) twice a day or levofloxacin (250 mg) once a day for three days. Urine culture was done at the end of treatment and evaluated for bacteriological cure rate in each group. Among a total of 175 patients, Escherichia coli (74.29%) was the most common organism isolated followed by Klebsiella (11.43%), Streptococcus (6.29%), Staphylococcus saphrophyticus (5.14%), and Pseudomonas (2.86%). At the end of three days' treatment, bacteriological cure rates were 86.2%, 87.7% and 83.3% for co-trimoxazole, norfloxacin and levofloxacin, respectively (p>0.05). Therefore short-course treatment with co-trimoxazole 960 mg twice a day, norfloxacin 400 mg twice a day and levofloxacin 250 mg once a day are almost equally effective for treatment of uncomplicated UTI.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Dose-Response Relationship, Drug; Double-Blind Method; Drug Therapy, Combination; Female; Humans; India; Levofloxacin; Male; Middle Aged; Norfloxacin; Outpatients; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Women suffering from recurrent urinary tract infections (rUTIs) are routinely treated for asymptomatic bacteriuria (AB), but the consequences of this procedure on antibiotic resistance are not fully known. The aim of this study was to evaluate the impact of AB treatment on antibiotic resistance among women with rUTIs.. The study population consisted of 2 groups of women who had previously been enrolled in a randomized clinical trial: group A was not treated, and group B was treated. All women were scheduled for follow-up visits every 6 months, or more frequently if symptoms arose. Microbiological evaluation was performed only in symptomatic women. All women were followed up for a mean of 38.8 months to analyze data from urine cultures and antibiograms.. The previous study population consisted of 673 women, but 123 did not attend the entire follow-up period. For the final analysis, 257 of the remaining 550 patients were assigned to group A, and 293 to group B. At the end of follow-up, the difference in recurrence rates was statistically significant (P < .001): 97 (37.7%) in group A versus 204 (69.6%) in group B. Isolated Escherichia coli from group B showed higher resistance to amoxicillin-clavulanic acid (P = .03), trimethoprim-sulfamethoxazole (P = .01), and ciprofloxacin (P = .03) than that from group A.. This study shows that AB treatment is associated with a higher occurrence of antibiotic-resistant bacteria, indicating that AB treatment in women with rUTIs is potentially dangerous.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Asymptomatic Infections; Bacteriuria; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Follow-Up Studies; Humans; Italy; Microbial Sensitivity Tests; Middle Aged; Prevalence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinalysis; Urinary Tract Infections

Urinary tract infections (UTIs) are common and result in an enormous economic burden. The increasing prevalence of antibiotic-resistant microorganisms has stimulated interest in non-antibiotic agents to prevent UTIs.. To evaluate the cost-effectiveness of cranberry prophylaxis compared to antibiotic prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) over a 12 month period in premenopausal women with recurrent UTIs.. An economic evaluation was performed alongside a randomized trial. Primary outcome was the number of UTIs during 12 months. Secondary outcomes included satisfaction and quality of life. Healthcare utilization was measured using questionnaires. Missing data were imputed using multiple imputation. Bootstrapping was used to evaluate the cost-effectiveness of the treatments.. Cranberry prophylaxis was less effective than TMP-SMX prophylaxis, but the differences in clinical outcomes were not statistically significant. Costs after 12 months in the cranberry group were statistically significantly higher than in the TMP-SMX group (mean difference €249, 95% confidence interval 70 to 516). Cost-effectiveness planes and cost-effectiveness acceptability curves showed that cranberry prophylaxis to prevent UTIs is less effective and more expensive than (dominated by) TMP-SMX prophylaxis.. In premenopausal women with recurrent UTIs, cranberry prophylaxis is not cost-effective compared to TMP-SMX prophylaxis. However, it was not possible to take into account costs attributed to increased antibiotic resistance within the framework of this randomized trial; modeling studies are recommended to investigate these costs. Moreover, although we based the dosage of cranberry extract on available evidence, this may not be the optimal dosage. Results may change when this optimal dosage is identified.. ISRCTN.org ISRCTN50717094.

Topics: Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Beverages; Cost-Benefit Analysis; Female; Humans; Middle Aged; Premenopause; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vaccinium macrocarpon; Young Adult

Children with febrile urinary tract infection commonly have vesicoureteral reflux. Because trial results have been limited and inconsistent, the use of antimicrobial prophylaxis to prevent recurrences in children with reflux remains controversial.. In this 2-year, multisite, randomized, placebo-controlled trial involving 607 children with vesicoureteral reflux that was diagnosed after a first or second febrile or symptomatic urinary tract infection, we evaluated the efficacy of trimethoprim-sulfamethoxazole prophylaxis in preventing recurrences (primary outcome). Secondary outcomes were renal scarring, treatment failure (a composite of recurrences and scarring), and antimicrobial resistance.. Recurrent urinary tract infection developed in 39 of 302 children who received prophylaxis as compared with 72 of 305 children who received placebo (relative risk, 0.55; 95% confidence interval [CI], 0.38 to 0.78). Prophylaxis reduced the risk of recurrences by 50% (hazard ratio, 0.50; 95% CI, 0.34 to 0.74) and was particularly effective in children whose index infection was febrile (hazard ratio, 0.41; 95% CI, 0.26 to 0.64) and in those with baseline bladder and bowel dysfunction (hazard ratio, 0.21; 95% CI, 0.08 to 0.58). The occurrence of renal scarring did not differ significantly between the prophylaxis and placebo groups (11.9% and 10.2%, respectively). Among 87 children with a first recurrence caused by Escherichia coli, the proportion of isolates that were resistant to trimethoprim-sulfamethoxazole was 63% in the prophylaxis group and 19% in the placebo group.. Among children with vesicoureteral reflux after urinary tract infection, antimicrobial prophylaxis was associated with a substantially reduced risk of recurrence but not of renal scarring. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; RIVUR ClinicalTrials.gov number, NCT00405704.).

Topics: Anti-Infective Agents, Urinary; Child; Child, Preschool; Double-Blind Method; Drug Resistance, Microbial; Female; Fever; Humans; Infant; Kaplan-Meier Estimate; Kidney; Male; Secondary Prevention; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

Vesicoureteral reflux (VUR) is diagnosed in ∼30% to 40% of children who have imaging studies after urinary tract infections (UTIs). Our goal is to characterize children enrolled in the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) trial and to compare our study cohort with those from previously published studies.. RIVUR investigators from 19 pediatric sites in the United States recruited 607 children with grade I through IV VUR. Children were enrolled after a first or second UTI. This cross-sectional report of baseline data includes extensive clinical, parental report, and imaging study results.. RIVUR recruited 607 children (558 girls, 49 boys) with grade I (11%), II (42%), III (38%), or IV (8%) reflux. The median age was 12 months, and most children (91%) were enrolled after their first UTI. The UTI leading to enrollment was both febrile and symptomatic for 323 children, febrile only in 197 children, and symptomatic only in 86. Renal involvement at baseline as documented by a (99m)Tc dimercaptosuccinic acid scan was uncommon with cortical defects identified in 89 (15%) children. Bladder and bowel dysfunction was identified in 71 (56%) of 126 toilet-trained subjects assessed.. RIVUR is the largest prospective, randomized trial for children with primary VUR to date, comparing prophylaxis with placebo. The study sample comprises patients from 19 pediatric clinical sites in the United States, whose demographic and clinical characteristics may differ from those of children enrolled in previous trials from other countries.

Topics: Anti-Infective Agents, Urinary; Child, Preschool; Cohort Studies; Cross-Sectional Studies; Double-Blind Method; Female; Humans; Infant; Kidney Cortex; Long-Term Care; Male; Mass Screening; Patient Selection; Prospective Studies; Secondary Prevention; Technetium Tc 99m Dimercaptosuccinic Acid; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography; United States; Urinary Tract Infections; Urography; Vesico-Ureteral Reflux

We conducted a double-blind, placebo-controlled randomized trial to assess the effect of single-dose prophylaxis using co-trimoxazole (960 mg) (n = 46) or ciprofloxacin (500 mg) (n = 43) vs. placebo (n = 51) before urinary catheter removal on significant bacteriuria (SBU) (primary outcome) and urinary tract infection (UTI) in surgical patients with scheduled bladder drainage for 3-14 days. SBU was determined directly after catheter removal, and UTI 12-14 days after catheter removal. After 12-14 days, incidences of SBU were 19%, 19% and 33% for patients receiving ciprofloxacin, co-trimoxazole and placebo, respectively (p ns), and incidences of UTI were 3%, 0% and 3% for patients receiving ciprofloxacin, co-trimoxazole and placebo, respectively (p ns).

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacteriuria; Catheters, Indwelling; Ciprofloxacin; Double-Blind Method; Female; Humans; Incidence; Male; Middle Aged; Placebos; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The increasing prevalence of uropathogens resistant to antimicrobial agents has stimulated interest in cranberries to prevent recurrent urinary tract infections (UTIs).. In a double-blind, double-dummy noninferiority trial, 221 premenopausal women with recurrent UTIs were randomized to 12-month prophylaxis use of trimethoprim-sulfamethoxazole (TMP-SMX), 480 mg once daily, or cranberry capsules, 500 mg twice daily. Primary end points were the mean number of symptomatic UTIs over 12 months, the proportion of patients with at least 1 symptomatic UTI, the median time to first UTI, and development of antibiotic resistance in indigenous Escherichia coli.. After 12 months, the mean number of patients with at least 1 symptomatic UTI was higher in the cranberry than in the TMP-SMX group (4.0 vs 1.8; P = .02), and the proportion of patients with at least 1 symptomatic UTI was higher in the cranberry than in the TMP-SMX group (78.2% vs 71.1%). Median time to the first symptomatic UTI was 4 months for the cranberry and 8 months for the TMP-SMX group. After 1 month, in the cranberry group, 23.7% of fecal and 28.1% of asymptomatic bacteriuria E coli isolates were TMP-SMX resistant, whereas in the TMP-SMX group, 86.3% of fecal and 90.5% of asymptomatic bacteriuria E coli isolates were TMP-SMX resistant. Similarly, we found increased resistance rates for trimethoprim, amoxicillin, and ciprofloxacin in these E coli isolates after 1 month in the TMP-SMX group. After discontinuation of TMP-SMX, resistance reached baseline levels after 3 months. Antibiotic resistance did not increase in the cranberry group. Cranberries and TMP-SMX were equally well tolerated.. In premenopausal women, TMP-SMX, 480 mg once daily, is more effective than cranberry capsules, 500 mg twice daily, to prevent recurrent UTIs, at the expense of emerging antibiotic resistance.. isrctn.org Identifier: ISRCTN50717094.

Topics: Adult; Amoxicillin; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Capsules; Ciprofloxacin; Double-Blind Method; Drug Administration Schedule; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Middle Aged; Plant Preparations; Premenopause; Secondary Prevention; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vaccinium macrocarpon

A randomized, open, coordinated multi-center trial compared the bacteriological and clinical efficacy and safety of orally administered ceftibuten and trimethoprim-sulfamethoxazole (TMP-SMX) in children with febrile urinary tract infection (UTI). Children aged 1 month to 12 years presenting with presumptive first-time febrile UTI were eligible for enrollment. A 2:1 assignment to treatment with ceftibuten 9 mg/kg once daily (n = 368) or TMP-SMX (3 mg + 15 mg)/kg twice daily (n = 179) for 10 days was performed. Escherichia coli was recovered in 96% of the cases. Among the E. coli isolates, 14% were resistant to TMP-SMX but none to ceftibuten. In the modified intention-to-treat population, the bacteriological elimination rates at follow-up did not differ significantly between patients treated with ceftibuten and those treated with TMP-SMX [91 vs. 95%, with a 95% confidence interval (CI) for difference of -9.7 to 1.0]. However, the clinical cure rate was significantly higher among those treated with ceftibuten (93 vs. 83%, with a 95% CI for difference of 2.4 to 17.0). Adverse events were similar for both regimens and consisted mainly of gastrointestinal disturbances. In conclusion, ceftibuten is a safe and effective drug for the empirical treatment of febrile UTI in young children.

Topics: Anti-Infective Agents; Ceftibuten; Cephalosporins; Child; Child, Preschool; Female; Fever; Humans; Infant; Male; Prospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To assess whether antibiotic prophylaxis at urinary catheter removal reduces the rate of urinary tract infections.. Urinary tract infections are among the most common nosocomial infections. Antibiotic prophylaxis at urinary catheter removal is used as a measure to prevent them, albeit without supporting evidence.. A prospective randomized study enrolled 239 patients undergoing elective abdominal surgery, who were randomized either for receiving 3 doses of trimethoprim-sulfamethoxazole at urinary catheter removal, or not. Urinary tract infections were diagnosed according to Center of Disease Control definitions. Urinary cultures were obtained before and 3 days after catheter removal. Subjective symptoms were assessed by an independent study-blind urologist.. Patients who received antibiotic prophylaxis showed significantly fewer urinary tract infections (5/103, 4.9%) than those without prophylaxis (22/102, 21.6%), P < 0.001. The absolute risk reduction for the occurrence of a urinary tract infection was 16.7%; the relative risk reduction was 77.5%, and the number needed to treat was 6. Patients with antibiotic prophylaxis also had less significant bacteriuria 3 days after catheter removal (17/103, 16.5%) than those without (42/102, 41.2%), P < 0.001.. Antibiotic prophylaxis with trimethoprim-sulfamethoxazole on urinary catheter removal significantly reduces the rate of symptomatic urinary tract infections and bacteriuria in patients undergoing abdominal surgery with perioperative transurethral urinary catheters.

Topics: Aged; Antibiotic Prophylaxis; Catheter-Related Infections; Ciprofloxacin; Confidence Intervals; Device Removal; Female; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; Preoperative Care; Probability; Prospective Studies; Reference Values; Risk Assessment; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Catheterization; Urinary Tract Infections

Antibiotics are widely administered to children with the intention of preventing urinary tract infection, but adequately powered, placebo-controlled trials regarding efficacy are lacking. This study from four Australian centers examined whether low-dose, continuous oral antibiotic therapy prevents urinary tract infection in predisposed children.. We randomly assigned children under the age of 18 years who had had one or more microbiologically proven urinary tract infections to receive either daily trimethoprim-sulfamethoxazole suspension (as 2 mg of trimethoprim plus 10 mg of sulfamethoxazole per kilogram of body weight) or placebo for 12 months. The primary outcome was microbiologically confirmed symptomatic urinary tract infection. Intention-to-treat analyses were performed with the use of time-to-event data.. From December 1998 to March 2007, a total of 576 children (of 780 planned) underwent randomization. The median age at entry was 14 months; 64% of the patients were girls, 42% had known vesicoureteral reflux (at least grade III in 53% of these patients), and 71% were enrolled after the first diagnosis of urinary tract infection. During the study, urinary tract infection developed in 36 of 288 patients (13%) in the group receiving trimethoprim-sulfamethoxazole (antibiotic group) and in 55 of 288 patients (19%) in the placebo group (hazard ratio in the antibiotic group, 0.61; 95% confidence interval, 0.40 to 0.93; P = 0.02 by the log-rank test). In the antibiotic group, the reduction in the absolute risk of urinary tract infection (6 percentage points) appeared to be consistent across all subgroups of patients (P > or = 0.20 for all interactions).. Long-term, low-dose trimethoprim-sulfamethoxazole was associated with a decreased number of urinary tract infections in predisposed children. The treatment effect appeared to be consistent but modest across subgroups. (Australian New Zealand Clinical Trials Registry number, ACTRN12608000470392.)

Topics: Adolescent; Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Patient Compliance; Secondary Prevention; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

Febrile urinary tract infections are common in children and associated with the risk for renal scarring and long-term complications. Antimicrobial prophylaxis has been used to reduce the risk for recurrence. We performed a study to determine whether no prophylaxis is similar to antimicrobial prophylaxis for 12 months in reducing the recurrence of febrile urinary tract infections in children after a first febrile urinary tract infection.. The study was a controlled, randomized, open-label, 2-armed, noninferiority trial comparing no prophylaxis with prophylaxis (co-trimoxazole 15 mg/kg per day or co-amoxiclav 15 mg/kg per day) for 12 months. A total of 338 children who were aged 2 months to <7 years and had a first episode of febrile urinary tract infection were enrolled: 309 with a confirmed pyelonephritis on a technetium 99m dimercaptosuccinic acid scan with or without reflux and 27 with a clinical pyelonephritis and reflux. The primary end point was recurrence rate of febrile urinary tract infections during 12 months. Secondary end point was the rate of renal scarring produced by recurrent urinary tract infections on technetium 99m dimercaptosuccinic acid scan after 12 months.. Intention-to-treat analysis showed no significant differences in the primary outcome between no prophylaxis and prophylaxis: 12 (9.45%) of 127 vs 15 (7.11%) of 211. In the subgroup of children with reflux, the recurrence of febrile urinary tract infections was 9 (19.6%) of 46 on no prophylaxis and 10 (12.1%) of 82 on prophylaxis. No significant difference was found in the secondary outcome: 2 (1.9%) of 108 on no prophylaxis versus 2 (1.1%) of 187 on prophylaxis. Bivariate analysis and Cox proportional hazard model showed that grade III reflux was a risk factor for recurrent febrile urinary tract infections. Whereas increasing age was protective, use of no prophylaxis was not a risk factor.. For children with or without primary nonsevere reflux, prophylaxis does not reduce the rate of recurrent febrile urinary tract infections after the first episode.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Child; Child, Preschool; Humans; Infant; Multivariate Analysis; Proportional Hazards Models; Secondary Prevention; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

Antibiotic prophylaxis is given to children at risk for urinary tract infection. However, evidence concerning its effectiveness in grade I to III vesicoureteral reflux is lacking. The objective of this study was to determine whether antibiotic prophylaxis reduces the incidence of urinary tract infection in young children with low grade vesicoureteral reflux.. Children 1 month to 3 years old with grade I to III vesicoureteral reflux were assigned randomly to receive daily cotrimoxazole or no treatment, and followed for 18 months. A urinary tract infection constituted an exit criterion. Infection-free survival rates were calculated using the Kaplan-Meier method and compared using the log rank test.. A total of 225 children were enrolled in the study. Distribution of gender, age at inclusion and reflux grade were similar between the 2 groups. There was no significant difference in the occurrence of urinary tract infection between the 2 groups (17% vs 26%, p = 0.2). However, a significant association was found between treatment and patient gender (p = 0.017). Prophylaxis significantly reduced urinary tract infection in boys (p = 0.013), most notably in boys with grade III vesicoureteral reflux (p = 0.042).. These data suggest that antibiotic prophylaxis does not reduce the overall incidence of urinary tract infection in children with low grade vesicoureteral reflux. However, such a strategy may prevent further urinary tract infection in boys with grade III reflux.

Topics: Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Disease-Free Survival; Female; Follow-Up Studies; Humans; Infant; Male; Prospective Studies; Secondary Prevention; Sex Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

The purpose of this study was to assess the pretherapy microbiology and fluoroquinolone susceptibility of pathogens from 650 patients with complicated urinary tract infection (cUTI) or acute pyelonephritis (AP) as part of a multicenter, randomized, controlled clinical trial.. In this post hoc analysis of a multicenter, randomized, double-blind study, adults with a clinical diagnosis of cUTI or AP were recruited from 130 community-based and institution-based study centers in the United States from November 2004 through April 2006. Urine and blood culture specimens were identified and tested for susceptibility according to Clinical and Laboratory Standards Institute methods. Presence of a pathogen in the urine culture was confirmed by a colony count of =105 colony-forming units per milliliter. Susceptibility to nonstudy drugs (trimethoprim/sulfamethoxazole [TMP/SMX] and ampicillin) and to study drugs (levofloxacin and ciprofloxacin) was categorized as susceptible, intermediate, or resistant.. Six hundred fifty patients (417 women, 233 men; age range, 18-94 years) with a diagnosis of cUTI or AP were recruited. A total of 68.2% patients (224 men, 219 women) were diagnosed with cUTI, and 31.8% (198 women, 9 men), with AP. Most (646/650 [99.4%]) infections were community acquired. The most common pathogen was Escherichia coli (65.6%), although 12.2% of patients had gram-positive pathogens. Testing for susceptibility to ampicillin and TMP/SMX found that 50.1% and 22.1% of gramnegative pathogens were fully resistant to ampicillin and TMP/SMX, respectively. However, 91.9% of isolates were susceptible to levofloxacin and ciprofloxacin, with 6.5% of isolates resistant or intermediately resistant to levofloxacin, and 9.7% of isolates resistant or intermediately resistant to ciprofloxacin at study entry (P < 0.001 [Stuart-Maxwell test]). All isolates resistant to levofloxacin were also resistant to ciprofloxacin, whereas 6 isolates that were fully susceptible to levofloxacin were fully resistant to ciprofloxacin.. In this study, the level of fluoroquinolone susceptibility of urinary pathogens was high (90.6% in cUTI; 98.1% in AP).

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Ciprofloxacin; Double-Blind Method; Drug Resistance, Multiple, Bacterial; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Levofloxacin; Male; Microbial Sensitivity Tests; Middle Aged; Ofloxacin; Pyelonephritis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

Urinary tract infection (UTI), a major cause of morbidity in renal transplant recipients, has also been found to increase mortality. The first month post-kidney transplantation is considered the critical time, with most UTI episodes during this period. The aim of this study was to compare the efficacy of various doses of trimethoprim-sulfamethoxazole (TMP/SXT) for the prophylaxis of the posttransplant UTI within the first month after kidney transplantation. In a prospective, double-blind, randomized, clinical trial, 95 kidney allograft recipients were divided into two groups: group 1 (n = 63) received low to moderate doses of TMP/SXT (either 80/400 mg or 160/800 mg, daily) and group 2 (n = 32), high doses of TMP/SXT (320/1600 mg, daily in two divided doses). These groups were comparable regarding age, gender, type of donor, and ureteral anastomosis and immunosuppressive therapy. UTI was defined as a urine culture containing more than 10(5) colonies. The mean age of the patients was 37 +/- 12.2 years with a male/female ratio of 0.98/1. The urine culture was positive in 39 patients (41.1%). UTI was more common among female than male patients (P = .003). Escherichia coli was the most common isolated organism in both groups (53.8%). UTI was observed in about 25% of patients on the high-dose versus 49.2% of those on low- to moderate-dose prophylaxis (P < .05). In conclusion, prophylaxis with high-dose TMP/SXT (320/1600 mg, daily) is preferred for renal transplant recipients during the first month posttransplantation.

Topics: Adult; Anti-Infective Agents; Dose-Response Relationship, Drug; Double-Blind Method; Escherichia coli Infections; Female; Humans; Iran; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Prospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urine

of this study was to comprise the efficacy of chronic therapy with nitrofuarntoin in the treatment and prevention of recurrent urinary tract infections (NIM) in type 2 diabetic women.. The study comprised 105 women aged 50-70 years, who suffered from the NIM (isolated bacterial uropathogen sensitive to nitrofurantoin and cotrimoxazole). Women were divided into two groups. Group 1 (n=55) consisted of patients, who have been treated with nitrofurantoin and group 2 - control group (n=50) with cotromixazole. Observation period lasted 12 months and for the 9 months patients were treated with antimicrobial agents. Efficacy of antimicrobial treatment was estimated when both clinical cure and bacteriological eradication of uropathogens were achieved.. There were no significant differences in the percentage of patients between study groups, who achieved therapeutic successes after three, six and nine months of the antimicrobial treatment (NS). Three months after discontinuation of this treatment episodes of NIM were observed in similar frequency in two study groups (NS).. Nitrofurantoin is the effective antimicrobial method to cure and prevent NIM.

Topics: Aged; Anti-Infective Agents, Urinary; Chronic Disease; Diabetes Mellitus, Type 2; Escherichia coli; Female; Humans; Middle Aged; Nitrofurantoin; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The aim of this study was to compare the efficacy of prophylactic trimethoprim-sulfamethoxazole (TMP/SMZ), cefprozil and cephadroxil treatments in children who have recurrent urinary tract infection, but no urinary tract pathology. After acute urinary tract infections (UTIs) were treated, the patients were divided into 3 groups randomly and TMP/SMZ was given to 21 patients, cephadroxil was given to 25 patients and cefprozil was given to 34 patients for 3 months--one dose at night. All patients were followed for 6 months following prophylaxis. The frequency of symptomatic UTIs among groups during prophylaxis was not statistically different, however the number of symptomatic UTIs in the cephadroxil group was lower than the other groups. Asymptomatic bacteriuria episodes were detected in TMP/SMZ and cefprozil groups, whereas no asymptomatic bacteriuria episodes were seen in the cephadroxil group. The number of patients with symptomatic UTI during the follow-up period was not different between groups, however all the asymptomatic bacteriuria episodes were encountered in the cefprozil group. In conclusion, in this study cephadroxil was found to be slightly superior to TMP/SMZ and cefprozil in preventing asymptomatic bacteriuria episodes and symptomatic UTIs in children with recurrent UTI and normal urinary tract system.

Topics: Administration, Oral; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Cefadroxil; Cefprozil; Cephalosporins; Child; Drug Administration Schedule; Female; Humans; Male; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To determine whether the addition of a single dose of ceftriaxone sodium to a 10-day course of trimethoprim and sulfamethoxazole hastens urine sterilization or resolution of clinical symptoms in febrile children with urinary tract infections.. Prospective, single-blind, randomized study.. Tertiary care children's hospital emergency department.. Febrile children aged 6 months to 12 years with a presumptive urinary tract infection based on history, physical examination, and urinalysis findings.. A history was taken, a physical examination and urinalysis and culture were performed, and a white blood cell count and erythrocyte sedimentation rate were obtained. Children were randomized to receive an intramuscular dose of ceftriaxone then 10 days of trimethoprim-sulfamethoxazole (IM + PO group) or oral trimethoprim-sulfamethoxazole alone (PO group). After receiving study medication, patients were discharged from the hospital to return in 48 hours for a follow-up evaluation and urine culture. Treatment failure was defined as the persistence of a positive culture at 48 hours or the need for hospital admission for intravenous rehydration or antibiotic therapy.. Sixty-nine children were enrolled, 34 in the IM + PO group and 35 in the PO group. The 2 groups were similar at the initial visit with respect to age, sex, clinical degrees of illness, white blood cell count, and erythrocyte sedimentation rate (P>.05). At the 48-hour follow-up visit, there were no differences between the 2 treatment groups in resolution of vomiting, fever, general appearance, abdominal tenderness, and hydration state (P>.05). There were 9 treatment failures, 4 in the IM + PO group and 5 in the PO group (P =.93).. The addition of a single dose of intramuscular ceftriaxone to a 10-day course of oral trimethoprim-sulfamethoxazole for urinary tract infection with fever resulted in no difference at 48 hours in the urine sterilization rate, degree of clinical improvement, or subsequent hospital admission rate.

Topics: Administration, Oral; Anti-Infective Agents, Urinary; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Drug Therapy, Combination; Female; Fever; Humans; Infant; Injections, Intramuscular; Male; Outcome Assessment, Health Care; Single-Blind Method; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The aim of the study was to determine the efficacy of cotrimoxazole administration after urodynamic testing to prevent urinary tract infections. In a single-blind prospective randomized study 94 women who attended for urodynamic evaluation were included. After multichannel urodynamic testing, including two catheterizations, the women received a single dose of cotrimoxazole or placebo. A clean-catch urine specimen was tested for infection after 1 week. Seventy women returned a urine specimen after 1 week: 2/37 (5.4%) in the treatment and 2/33 (6.1%) in the placebo group had acquired a new urinary tract infection after urodynamics. One major and one minor adverse reaction to cotrimoxazole were reported. The power of the sample size was unfortunately too small to draw conclusions as to the efficacy of prophylaxis.

Topics: Adult; Aged; Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Enterococcus; Escherichia coli; Female; Humans; Middle Aged; Morganella morganii; Prospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Catheterization; Urinary Tract Infections; Urodynamics

To compare the efficacy and safety of ciprofloxacin (CIP) oral suspension to trimethoprim/sulfamethoxazole (TMP/SMX) oral suspension among older women with acute urinary tract infections (UTIs).. Prospective, randomized, open-label, multicenter study of older women (age 65 and older).. Community and nursing home.. A total of 261 older women were evaluable for safety. Of these, 172 (86 community, 86 nursing home) were evaluable for clinical and bacteriological efficacy.. Patients were randomized to a 10-day regimen of either CIP (250 mg/5 mL twice daily) or TMP/SMX (160/800 mg/20 mL twice daily).. Clinical response 4 to 10 days posttherapy.. For the efficacy-valid population, posttherapy clinical resolution was statistically superior following CIP (97%) versus TMP/SMX (85%) (95% CI=2.0-21.3; P= .009). Eradication of pretreatment bacterial isolates posttherapy was also higher following CIP (95%) versus TMP/SMX (84%) (95% CI=2.7-21.3; P= .019). For the intent-to-treat population, posttherapy clinical resolution was significantly higher in the CIP group (96%) than in the TMP/SMX group (87%) (95% CI=0.2-16.7; P= .025). Safety was assessed in the intent-to-treat population and the incidence of drug-related adverse events were significantly lower following CIP (17%) than following TMP/SMX (27%) (P= .047). Premature discontinuation due to these events was also less prevalent with CIP than with TMP/SMX (2% vs 11%, respectively) (P= .004).. CIP suspension showed higher clinical success and bacteriological eradication rates than did TMP/SMX for both community-based and nursing home-residing older women with acute UTIs. Furthermore, CIP suspension was associated with significantly lower rates of adverse events and premature discontinuations compared with TMP/SMX suspension.

Topics: Acute Disease; Administration, Oral; Aged; Aged, 80 and over; Anti-Infective Agents; Anti-Infective Agents, Urinary; Ciprofloxacin; Female; Humans; Middle Aged; Nursing Homes; Outcome Assessment, Health Care; Prospective Studies; Suspensions; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Forty two paraplegic and quadriplegic hospitalized spinal cord injured patients with urinary tract infections (UTI) were included in a double blind, randomized treatment study comparing 7 days ofloxacin (300 mg bd) with trimethoprim-sulphamethoxazole (TMPSMX; 160-800 mg bd) or an alternative, chosen because of resistance to TMPSMX. The 4-day clinical cure rate, defined as an asymptomatic patient with sterile urine, was 90% (19/21) with ofloxacin, significantly greater than 48% (10/21) for the comparison group (P=0.003) and the rate at end of therapy was 90% (19/21) with ofloxacin, against 57% (12/21) (P=0.015). Bacterial biofilms were detected on bladder epithelial cells in 39/41 (95%) patients. The biofilm score fell significantly following ofloxacin therapy (P < 0.001) or alternative therapy (P < 0.001). Ofloxacin treatment led to significantly more biofilm eradication than the other antibiotic group on day 4 (62 vs. 24%) (P=0.005) and day 7 (67 vs. 35%) (P=0.014). The study showed that ofloxacin was better than TMPSMX and alternatives at relieving clinical infection and eradicating bladder cell biofilms.

Topics: Administration, Oral; Adolescent; Adult; Aged; Anti-Infective Agents, Urinary; Biofilms; Double-Blind Method; Female; Humans; Male; Middle Aged; Ofloxacin; Spinal Cord Injuries; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder; Urinary Tract Infections; Urothelium

Bladder infections are very common in otherwise healthy women, and short-course antimicrobial treatment appears effective for many episodes of cystitis. This study reports the results of short-course ciprofloxacin, ofloxacin, and trimethoprim/sulfamethoxazole therapy.. We performed a randomized, double-blind study of the efficacy and safety of a 3-day course of oral ciprofloxacin 100 mg twice daily, ofloxacin 200 mg twice daily, or trimethoprim/sulfamethoxazole 160/800 mg twice daily in women with acute, uncomplicated, symptomatic lower urinary tract infection.. A total of 866 patients were enrolled, of whom 688 (79%) were evaluated for the efficacy of treatment (229 treated with ciprofloxacin, 228 treated with trimethoprim/sulfamethoxazole, and 231 treated with ofloxacin). The most frequent reason for exclusion was the failure to identify a pretreatment pathogen. The most commonly isolated pathogen was Escherichia coli (81%). Eradication of the pretreatment pathogen at the end of therapy occurred in 94% of ciprofloxacin, 93% of trimethoprim/sulfamethoxazole, and 97% of ofloxacin-treated patients. At follow-up evaluation at 4 to 6 weeks, recurrence rates (relapse or reinfection) were 11% in the ciprofloxacin, 16% in the trimethoprim/sulfamethoxazole, and 13% in the ofloxacin treatment group. Clinical success at the end of therapy was 93% in the ciprofloxacin, 95% in the trimethoprim/sulfamethoxazole, and 96% in the ofloxacin treatment groups. The frequency of all adverse events was 31% for ciprofloxacin, 41% for trimethoprim/sulfamethoxazole, and 39% for ofloxacin-treated patients (P = 0.03). Premature discontinuation of study drug due to an adverse event was more common in trimethoprim/sulfamethoxazole-treated patients (n = 9) compared with those given ciprofloxacin (n = 2) or ofloxacin (n = 1; P = 0.02).. Ciprofloxacin, ofloxacin, and trimethoprim/sulfamethoxazole had similar efficacy when given for 3 days to treat acute, symptomatic, uncomplicated lower urinary tract infection in women.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Anti-Infective Agents, Urinary; Ciprofloxacin; Double-Blind Method; Drug Administration Schedule; Female; Humans; Middle Aged; Ofloxacin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The study was undertaken to compare the safety and efficacy of twice-daily ciprofloxacin for 3 days with standard 7 day therapy with either co-trimoxazole or nitrofurantoin in the treatment of women with acute, uncomplicated urinary tract infections (UTI). This multicentre, prospective, randomized, double-blind trial compared oral ciprofloxacin (100 mg bd) for 3 days with co-trimoxazole (160/800 mg bd) or nitrofurantoin (100 mg bd) for 7 days. Bacteriological and clinical evaluations were performed at study entry, during therapy and 4-10 days and 4-6 weeks after the completion of therapy. The primary efficacy parameter was eradication of the causative organism 4-10 days following treatment. Of 713 women enrolled and evaluable for safety, 521 were evaluable for efficacy (168 ciprofloxacin, 174 co-trimoxazole, 179 nitrofurantoin). Escherichia coli (83%) was the most frequently isolated pathogen in all treatment groups. Bacteriological eradication was reported in 88% of ciprofloxacin patients, 93% of co-trimoxazole patients and 86% of nitrofurantoin patients. At the 4-6 week follow-up, ciprofloxacin had statistically significantly higher eradication rates (91%) than co-trimoxazole (79%; 95% confidence limit (CL) = -20.6%, -3.9%) and nitrofurantoin (82%; 95% CL = -17.1%, -0.9%). Clinical resolution 4-10 days after therapy and at the 4-6 week follow-up was similar among the three treatment groups. The overall incidence of treatment-emergent adverse events was not significantly different (P = 0.093) among the three drug regimens, although co-trimoxazole was associated with a greater number of adverse events than ciprofloxacin (P < or = 0.05). Ciprofloxacin also caused fewer episodes of nausea than either of the other agents (P < or = 0.01).

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Anti-Infective Agents, Urinary; Ciprofloxacin; Cystitis; Dose-Response Relationship, Drug; Double-Blind Method; Escherichia coli Infections; Female; Humans; Middle Aged; Nitrofurantoin; Prospective Studies; Staphylococcal Infections; Streptococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We investigated the efficacy of prophylactic use of single dose oral ofloxacin and trimethoprim-sulfamethoxazole regimens for transrectal prostate biopsy in 110 men. In the ofloxacin, trimethoprim-sulfamethoxazole and control groups, urinary infection was found in 2 (4.76%), 3 (6.66%) and 6 (26.08%) patients, respectively. Both of these antibiotic regimens produced a statistically significant reduction in urinary infection (p<0.02, p<0.05). Our study indicates that single dose fluoroquinolone or trimethoprim-sulfamethoxazole prophylaxis seems to be effective, practical and economical.

Topics: Administration, Oral; Aged; Anti-Infective Agents; Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Biopsy; Endosonography; Humans; Male; Middle Aged; Ofloxacin; Prospective Studies; Prostatic Neoplasms; Rectum; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The effectiveness of intermittent low-dose trimethoprim-sulfamethoxazole (TMP-SMZ) for the prophylaxis of recurrent urinary infection is well established in adults. The present study assessed the effectiveness and safety of intermittent low-dose TMP-SMZ in 35 children (24 boys, 11 girls, aged 1 month to 9 years, median age 5 months) with vesicoureteral reflux; 18 children had bilateral reflux. A total of 53 refluxing ureters were graded as I in 2, II in 16, III in 19, IV in 14, and V in 2 cases. The children were given 1 mg/kg body weight of trimethoprim together with 5 mg/kg of sulfamethoxazole at bedtime every other day for 6-50 months (mean +/- SD, 22.9 +/- 11.7 months). None of the boys had a recurrence of urinary infection, while 2 of the 11 girls had a total of 7 recurrences during the prophylaxis period, with a recurrence rate of 0.027 per patient month in girls. Both girls were over 3 years and had a mildly unstable bladder. Transient neutropenia (< 1,000/microliter) developed in 2 infants during the prophylaxis period, but disappeared spontaneously. Intermittent low-dose TMP-SMZ seemed very effective for the prevention of recurrent urinary infection in children with ureteral reflux even of higher grades.

Topics: Anti-Infective Agents, Urinary; Child; Child, Preschool; Creatinine; Female; Humans; Infant; Infant, Newborn; Kidney Function Tests; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

The effects of antibiotics used for prophylaxis in women with recurrent urinary tract infections (UTIs) on the aerobic intestinal flora were investigated. Twenty-one patients with recurrent UTIs were randomly divided into three groups. The patients of each group received monotherapy with oral norfloxacin, trimethoprim-sulfamethoxazole or nitrofurantoin for one month. Urine and stool quantitative aerobic cultures were performed before prophylaxis, 2 and 4 weeks after the initiation of therapy, and 2 weeks after antibiotics were discontinued. The gram-negative aerobic flora was strongly suppressed during the administration of norfloxacin and trimethoprim-sulfamethoxazole, while Enterococcus spp. were not affected. Resistant strains of Escherichia coli were detected in two patients, one in the norfloxacin and one in the trimethoprim-sulfamethoxazole group. The aerobic intestinal flora was not affected by nitrofurantoin. These findings help in the selection of the most appropriate antimicrobial agent for prophylaxis in recurrent UTIs, so as to reduce the possibility of emergence of resistant bacterial strains.

Topics: Adult; Anti-Infective Agents, Urinary; Enterobacteriaceae; Enterococcus; Feces; Female; Humans; Middle Aged; Nitrofurantoin; Norfloxacin; Prospective Studies; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Spinal cord injured patients are highly prone to urinary tract infections. The high frequency of recurrences, the problems with drug resistance and the difficulties associated with diagnosis complicate the management. In a preliminary retrospective study of 30 patient files, we discovered that prophylactic antimicrobial therapy with trimethoprim-sulfamethoxazole, significantly reduced the incidence of symptomatic urinary tract infections. The prevention of infection resulted in cheaper healthcare expenses than treatment. ONe problematic outcome was that antibiotic therapy resulted in a dramatic change in the population of uropathogens infecting the host, from a predominantly Gram negative type to one dominated by Enterococcus faecalis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Urinary; Child; Costs and Cost Analysis; Female; Humans; Male; Middle Aged; Retrospective Studies; Spinal Cord Injuries; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Catheterization; Urinary Tract Infections

The efficacy and safety of ofloxacin in the treatment of upper and lower urinary tract infections were studied with the drug use according to 4 regimens by comparison with nitrofurantoin in the treatment of lower urinary tract infections and trimethoprim/sulfamethoxazole in the treatment of upper urinary tract infections. Ofloxacin was used in doses of 100 to 200 mg once or twice a day for 3, 5 and 10 days. In a separate group of 30 female patients with frequent recurring noncomplicated lower urinary tract infections ofloxacin was used in a dose of 50 mg once a day for 6 months. Ofloxacin was shown to be highly efficient in the treatment of medium and severe infections of the upper and lower urinary tracts. The following regimens were recommended: 200 mg once a day in the treatment of medium urinary tract infections, 100 mg twice a day for 3 to 7 days in the treatment of severe infections of the lower urinary tract and 200 mg twice a day for 7 to 10 days in the treatment of severe upper urinary tract infections. The use of ofloxacin in a daily dose of 50 mg for 6 months proved to be efficient in the treatment of frequent acute recurring infections of the urinary tracts.

Topics: Anti-Infective Agents, Urinary; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Humans; Male; Nitrofurantoin; Ofloxacin; Recurrence; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The efficacy and adverse event profile of a single 3.25 g dose of co-amoxiclav as treatment of acute uncomplicated lower urinary tract infection in women was compared with that of co-trimoxazole 960 mg bd for 7 days in a prospective, randomized, double-blind multicentre clinical trial. Of the 666 patients enrolled, 279 (144 in the co-amoxiclav group and 135 in the co-trimoxazole group) were eligible for evaluation of clinical and bacteriological responses. At the follow-up assessment 42 days after study entry, the successful clinical response rate was 73.8% for patients who received co-amoxiclav, compared with 85.1% for patients given co-trimoxazole (P < or = 0.05); the corresponding rates for successful bacteriological response were 64.1% and 79.6% (P < or = 0.05). Both treatment regimens were well-tolerated, with 15% of patients in the co amoxiclav group and 12% of patients in the co-trimoxazole group reporting adverse events (P > or = 0.05). The adverse event profiles for the two groups differed, gastrointestinal disturbances predominating amongst patients who received co-amoxiclav and rashes being commonest amongst those given co-trimoxazole.

Topics: Adolescent; Adult; Aged; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Clavulanic Acids; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Middle Aged; Prospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A prospective, double-blinded crossover study was carried out to test whether a brief course of antibiotic therapy could eliminate bacteria adherent to uroepithelial cells and thus prolong the interval between urinary tract infections (UTIs). Thirty-two women with frequent Gram-negative urinary tract infections were randomized to receive either co-trimoxazole or enoxacin twice a day for 10 days to treat their UTI. Their urines were collected for 30 days after the onset of their UTI and quantitatively analyzed for bacteria, antibiotics, and bacteria adherent to uroepithelial cells (UECs). A subsequent infection caused the patient to be treated with the alternative antibiotic. A third infection terminated the study. Both regimens were indistinguishable in the rate of elimination of bacteria and in their inhibition of bacterial adherence to UECs for up to five days after stopping treatment. The interval between infections was inversely correlated with the number of adherent bacteria per UEC 30 days after the onset of the first UTI. Both regimens were equally effective in preventing subsequent UTI and the effect of 10 days therapy on the inhibition of bacterial adherence to UEC's did not extend beyond five days after stopping treatment.

Topics: Bacterial Adhesion; Cross-Over Studies; Double-Blind Method; Enoxacin; Epithelium; Female; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Prospective Studies; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract; Urinary Tract Infections

Suppressive therapy with antibiotics has long been thought to decrease the number of complications from the neuropathic bladder in spinal cord injury patients, but it may also induce resistance to antibiotics which subsequently causes difficulties in treating symptomatic urinary tract infections. Forty-three chronic spinal cord injury patients were randomized to continue to receive daily trimethoprim-sulfamethoxazole (TMP-SMX) urinary tract prophylaxis versus discontinuing antibiotic prophylaxis. Patients were all at least 6 months after spinal cord injury. Patients were followed for a minimum of 3 months, with weekly catheter urine cultures. The difference in the colonization rate at onset and after 3 months (percent of cultures with asymptomatic bacteriuria) between the control and prophylaxis group was not statistically significant (P > 0.1). There was a significant decrease in the percentage of TMP-SMX resistant asymptomatic bacteriuria in the control group, 78.8%, compared to 94.1% in the suppressive group (P < 0.05). There was no significant difference in the number of symptomatic urinary tract infections following the withdrawal of suppressive therapy between the control group, 0.035/week, and the prophylaxis group, 0.043/week (P > 0.5). There was a larger percentage of TMP-SMX resistant symptomatic urinary tract infections in the treated group, 42.5% versus 37.5% in the control group, but the difference was not significant (P > 0.5). Irrespective of the method of bladder management, suppressive therapy with TMP-SMX did not reduce the incidence of symptomatic bacteriuria and did increase the percentage of cultures resistant to TMP-SMX in asymptomatic patients.

Topics: Adult; Aged; Aged, 80 and over; Bacteriuria; Chronic Disease; Humans; Male; Middle Aged; Spinal Cord Injuries; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A total of 538 patients from 45 different general practice centres across the UK was admitted to an open study and randomized to one of the following treatment groups: nitrofurantoin modified release (MR) 100 mg bd, trimethoprim 200 mg bd or co-trimoxazole 960 mg bd. Each patient received seven days of medication. Clinical cure, defined as relief from symptoms at visit 2, occurred in 87.2% of the patients treated with nitrofurantoin MR, 84.5% of the co-trimoxazole group and 86.5% of the trimethoprim group. The bacteriological cure rate for nitrofurantoin MR was comparable to co-trimoxazole at 82.3% and 83.2%, respectively, with trimethoprim the lowest at 76.8%. Whilst the cure rate for Escherichia coli infection was similar, 81.5% cured with nitrofurantoin MR, 82.5% with co-trimoxazole and 78.4% by trimethoprim, for non-E. coli pathogens nitrofurantoin MR was equivalent to co-trimoxazole with 86.7% cure but higher than trimethoprim at 72.0%. In-vitro sensitivity to all pathogens isolated at baseline was very high for nitrofurantoin at 96.1%, significantly higher than either co-trimoxazole or trimethoprim at 87.5% (P < 0.01). The test drugs were equally well tolerated with 28 patients (15.7%) reporting adverse events with nitrofurantoin MR, 28 (15.5%) with co-trimoxazole and 28 (15.6%) with trimethoprim. However, nitrofurantoin MR showed fewer patients with drug-related adverse events (5.6%) as judged by the investigator, compared to co-trimoxazole (8.8%) or trimethoprim (7.3%). (ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Delayed-Action Preparations; Family Practice; Female; Humans; Microbial Sensitivity Tests; Middle Aged; Nitrofurantoin; Treatment Outcome; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

There were three objectives to the present study: (1) compare the bladder infection rate and extent of biofilm formation for seven untreated spinal cord injured (SCI) patients and seven given prophylactic co-trimoxazole, (2) identify a level of bacterial adhesion to bladder cells which could be used to help predict symptomatic infection, and (3) determine from in vivo and in vitro studies whether fluoroquinolones were effective at penetrating bacterial biofilms. The results showed that the infection rate had not changed with the introduction of prophylaxis. However, the uropathogenic population had altered subsequent to the introduction of prophylaxis with E. coli being replaced by E. faecalis as the most common cause of infection. In 63% of the specimens from asymptomatic patients, the bacterial counts per cell were < 20, while 81% of specimens from patients with at least one sign and one symptom of urinary tract infection (UTI) had > 20 adherent bacteria per bladder cell. Therefore, it is proposed that counts of > 20 bacteria adherent to sediment transitional epithelial bladder cells may be predictive of symptomatic UTI. Clinical data showed that fluoroquinolone therapy reduced the adhesion counts to < 20 per cell in 63% of cases, while trimethoprim-sulfamethoxazole only did so in 44%. Further in vitro testing showed that ciprofloxacin (0.1, 0.5 and 1.0 micrograms/ml) partially or completely eradicated adherent biofilms from 92% of spinal cord injured patients' bladder cells, while ofloxacin did so in 71% cases and norfloxacin in 56%. These findings have important implications for the detection and treatment of bacteriuria in spinal cord injured patients.

Topics: Adult; Aged; Anti-Infective Agents; Bacterial Adhesion; Biofilms; Epithelial Cells; Female; Fluoroquinolones; Humans; Male; Microscopy, Electron, Scanning; Middle Aged; Spinal Cord Diseases; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder Diseases; Urinary Tract Infections

The efficacy of lomefloxacin given at 400 mg once daily for 14 days compared with that of trimethoprim-sulfamethoxazole at 160 and 800 mg, respectively, given twice daily for 14 days in the treatment of symptomatic complicated urinary tract infections was studied in a prospective, randomized, single-blind multicenter study. A total of 133 subjects presenting with signs and symptoms of urinary tract infection and an underlying abnormality consistent with complicated urinary tract infection were enrolled in the study. Bacteriologic cure was significantly better in 68 subjects randomized to lomefloxacin than in 65 subjects randomized to trimethoprim-sulfamethoxazole at short-term follow-up (88 versus 52%; 95% confidence intervals [CIs] 77 and 94% and 39 and 65%, respectively) this difference was no longer significant at long-term follow-up (64 versus 47%; CIs, 52 and 75% and 32 and 57%, respectively). Clinical outcomes were similar for both therapeutic regimens at short- and long-term follow-ups. The organisms that infected the subjects pretherapy were more frequently resistant to trimethoprim-sulfamethoxazole, and drug therapy was discontinued more frequently in subjects treated with trimethoprim-sulfamethoxazole because of adverse antimicrobial effects. In secondary analyses, outcomes did not differ with age or underlying genitourinary abnormality.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Female; Fluoroquinolones; Humans; Male; Middle Aged; Prospective Studies; Quinolones; Single-Blind Method; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To determine the efficacy of trimethoprim-sulfamethoxazole (TMP-SMX) for prophylaxis of urinary tract infection in persons with recent spinal cord injury, during the first 4 months of intermittent catheterization.. One hundred twenty-nine adults (112 men, 17 women) with recent acute spinal cord injury participated in a randomized, double-blind, placebo-controlled trial, and were studied for up to 16 weeks. Low-dose TMP-SMX (TMP 40 mg, SMX 200 mg) or placebo was given once daily. Clinical observations, urine cultures, and cultures of rectal and urethral swabs were made weekly. Subjects who developed breakthrough bacteriuria received conventional antimicrobial therapy and prophylaxis was continued.. Sixty-six TMP-SMX recipients (57 men, 9 women) and 60 placebo recipients (52 men, 8 women) are evaluable for efficacy. Among male subjects, bacteriuria was present during 50% or more of study weeks in 30% of TMP-SMX recipients and in 56% of placebo recipients (p = 0.003). The interval to the onset of bacteriuria was prolonged in TMP-SMX recipients (p < 0.0001). TMP-SMX recipients without bacteriuria in any given week had a lower probability of having bacteriuria the subsequent week (0.26) than did placebo recipients (0.49) (p < 0.0001). At least 1 episode of definite symptomatic bacteriuria (bacteriuria and fever and at least 1 classical manifestation of urinary infection) occurred in 4 of 57 TMP-SMX-treated men and in 18 of 52 placebo-treated men (p < 0.0003). We observed similar trends in women, but differences did not reach statistical significance, perhaps because the number of females was small. Adverse events suspected to be due to medications were frequent in this population of patients with recent severe injuries and led to discontinuation of the study in 10% of the TMP-SMX group and 8% of the placebo group. Adverse events included neutropenia (TMP-SMX: two; placebo: three), pseudomembranous colitis (TMP-SMX: one), severe skin rash (TMP-SMX: two; placebo: one), and drug fever (TMP-SMX: one). The proportion of all episodes of bacteriuria that were due to TMP-SMX-resistant organisms was unexpectedly high in the placebo group (51%), and increased progressively according to year of enrollment in the study. By Year 3, all subjects in the placebo group had at least one episode of TMP-SMX-resistant bacteriuria. Gram-negative enteric bacilli resistant to TMP-SMX were recovered from rectal swabs (TMP-SMX 49%, placebo 42%) and urethral swabs (TMP-SMX 33%, placebo 26%) in similar proportions of subjects in the two study groups.. Prophylaxis with TMP-SMX significantly reduces bacteriuria and symptomatic urinary tract infection in persons with recent acute spinal cord injury during bladder retraining using intermittent catheterization. However, adverse reactions attributable to TMP-SMX are common in this population. Colonization and breakthrough bacteriuria with TMP-SMX-resistant organisms are frequent and may seriously limit the usefulness of this strategy, particularly in an institutional setting.

Topics: Adolescent; Adult; Aged; Bacteriuria; Double-Blind Method; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Prospective Studies; Sex Factors; Spinal Cord Injuries; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder; Urinary Catheterization; Urinary Tract Infections

In a multicentric study comparing oral single-dose therapy of fosfomycin trometamol (3 g as fosfomycin) versus co-trimoxazole (1.92 g) or ofloxacin (200 mg) as many as possible of the pathogens were sent to and analysed in a central laboratory. The pathogens were identified and minimal inhibitory concentrations (MIC) of fosfomycin, trimethoprim alone and in combination with sulfamethoxazole, ofloxacin, ampicillin, amoxicillin combined with clavulanic acid, and cephadroxil were determined. The eradication of pathogens (cfu < 10(3)/ml at one week after single-dose therapy) was analysed according to species and MIC of the antibiotic used. Urine cultures of 349 patients were analysed. Escherichia coli was the predominating species followed by staphylococci and Proteus mirabilis. Enterococci were mostly found in mixed culture. Baseline pathogens of monoinfections were eradicated in 87.1%, in 88.9% and in 86.4% of 284 patients treated with fosfomycin trometamol, co-trimoxazole and ofloxacin, respectively. The MICs of the five antibacterial agents and the two antibiotic combinations for 253 baseline pathogens showed that of the E. coli strains none was resistant to ofloxacin, three (MIC = 128 mg/l) were resistant to fosfomycin, 3.6% to co-trimoxazole, 6.2% to trimethoprim, 8.8% to ampicillin, and 5.7% to amoxicillin/clavulanic acid. The eradication rates according to the MICs of the corresponding drugs showed equally good eradication rates for fosfomycin up to an MIC of 64 mg/l. Above this level two out of three strains were also eradicated by fosfomycin trometamol. For co-trimoxazole and ofloxacin no intermediately sensitive or resistant strains were found. Within the range of MICs found there were equally good eradication rates for both antibacterial agents.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acute Disease; Adolescent; Adult; Aged; Drug Administration Schedule; Female; Fosfomycin; Humans; Microbial Sensitivity Tests; Middle Aged; Ofloxacin; Single-Blind Method; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Lomefloxacin, a new difluorinated quinolone, and trimethoprim/sulfamethoxazole (TMP/SMX) were compared in the treatment of adults with uncomplicated urinary tract infections. The study was conducted as a multicenter, controlled, prospectively randomized, single-blind study in five countries (Argentina, Belgium, Brazil, Mexico, and Venezuela). A total of 254 patients were enrolled: 129 in the lomefloxacin group and 125 in the TMP/SMX group. Patients received either 400 mg lomefloxacin orally once daily or 160 mg/800 mg TMP/SMX orally twice daily for 7-10 days. Escherichia coli and Proteus mirabilis were the pathogens most frequently isolated. At 5-9 days post-therapy, satisfactory bacteriologic results were noted in 98.4% of patients treated with lomefloxacin and in 95.8% of patients in the TMP/SMX group (p = 0.2153). Clinical success 5-9 days post-therapy was noted in 99.2% of patients in the lomefloxacin group and in 98.3% of patients in the TMP/SMX group (p = 0.5138). Adverse events probably related to treatment occurred in 6% of those treated with lomefloxacin and in 7% of patients treated with TMP/SMX. Once-daily oral lomefloxacin is a well-tolerated and effective treatment of uncomplicated urinary tract infections caused by susceptible pathogens.

Topics: Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Female; Fluoroquinolones; Humans; Male; Middle Aged; Prospective Studies; Quinolones; Single-Blind Method; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Data were collected from 14 French centres which participated in a randomized study to compare the safety and efficacy of 400 mg lomefloxacin taken orally once daily by 62 patients with 160/800 mg trimethoprim/sulphamethoxazole (TMP/SMX) taken orally twice daily by 64 patients with uncomplicated urinary tract infections. Most patients were infected with Escherichia coli at baseline (72.4% in the lomefloxacin group and 69.0% in the TMP/SMX group) and all patients were treated for 5 days. At 5-9 days post-treatment, lomefloxacin had eradicated the causative organism of infection in 100% of evaluable patients treated with lomefloxacin compared with 86.7% of those treated with TMP/SMX. At 4-6 weeks post-treatment, there were no marked differences in eradication rates between the two treatment groups: 83.3% and 80.0% for the lomefloxacin and TMP/SMX groups, respectively. Clinical cure rates showed no marked differences between treatment groups at 5-9 days or at 4-6 weeks post-treatment. At 5-9 days post-treatment, lomefloxacin achieved a clinical cure rate of 78.6% compared with 86.7% for TMP/SMX evaluable patients. At 4-6 weeks post-treatment, the clinical cure rates were 66.7% and 86.7% for the evaluable lomefloxacin- and TMP/SMX-treated patients, respectively. Both treatment regimens were well tolerated with a low incidence of adverse events. In conclusion, once-daily oral dosing with lomefloxacin is a safe and efficacious alternative to twice-daily dosing with TMP/SMX in the treatment of uncomplicated urinary tract infections.

Topics: Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Drug Administration Schedule; Enterobacteriaceae Infections; Escherichia coli Infections; Female; Fluoroquinolones; Humans; Male; Middle Aged; Prospective Studies; Quinolones; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Prophylaxis with low-dose trimethoprim-sulfamethoxazole has been shown to be cost-effective in the prevention of urinary tract infections, pyelonephritis, urosepsis, and pneumocystis pneumonia in renal transplant recipients. Ciprofloxacin, effective against almost all urinary tract pathogens in this patient population, represents a promising alternative prophylactic agent for patients unable to tolerate trimethoprim-sulfamethoxazole due to toxicity.. We conducted a randomized, double-blind trial to compare low-dose trimethoprim-sulfamethoxazole with ciprofloxacin for the prevention of urinary tract infections in renal transplant recipients. Patients received either ciprofloxacin (250 mg) or trimethoprim-sulfamethoxazole (80 mg trimethoprim, 400 mg sulfamethoxazole) daily for 6 months following transplantation. Treatment was considered successful if patients completed the 6-month course and 3-month follow-up period without evidence of urinary tract infection or drug-related toxicities.. Of 103 eligible patients, 51 received ciprofloxacin and 52 received trimethoprim-sulfamethoxazole. At 6 months, treatment was successful in 75% (38 of 51) receiving ciprofloxacin and 71% (37 of 52) treated with trimethoprim-sulfamethoxazole (P = 0.87, relative risk 1.04, 95% confidence limits 0.83 to 1.33). Thirteen patients (25%) receiving trimethoprim-sulfamethoxazole withdrew from the study-4 for resistant urinary tract infection and 9 for drug-related toxicity, while 3 (6%) of the patients receiving ciprofloxacin withdrew because of drug-related toxicity (P = 0.016, relative risk of urinary tract infection or adverse event 0.24, 95% confidence limits 0.07 to 0.78). At 9 months, all 38 patients who completed the 6-month course of ciprofloxacin remained free of urinary tract infection, while an additional 4 patients who had received trimethoprim-sulfamethoxazole prophylaxis (total of 8 patients over the 9 months) developed urinary tract infections (P = 0.006, Fisher's exact test for urinary tract infection alone). Pneumocystis pneumonia occurred in a total of 7 (14%) patients who were randomized to ciprofloxacin, but 2 of the 7 had withdrawn from the study at least 2 weeks prior to the diagnosis of pneumocystis pneumonia. There were no cases of pneumocystis pneumonia in patients receiving trimethoprim-sulfamethoxazole (P = 0.006). Following completion of the study, monthly aerosolized pentamidine administered in conjunction with ciprofloxacin has provided complete protection against urinary tract infection and pneumocystis pneumonia in 30 transplant recipients unable to tolerate trimethoprim-sulfamethoxazole therapy.. Ciprofloxacin is at least as effective as trimethoprim-sulfamethoxazole in the prevention of urinary tract infection in renal transplant recipients, and is better tolerated. Ciprofloxacin prophylaxis is associated with a higher incidence of pneumocystis pneumonia than is trimethoprim-sulfamethoxazole therapy. An uncontrolled follow-up study suggests that ciprofloxacin prophylaxis combined with monthly aerosolized pentamidine may be efficacious in preventing both urinary tract infection and pneumocystis pneumonia in renal transplant recipients.

Topics: Adult; Aerosols; Ciprofloxacin; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Kidney Transplantation; Male; Middle Aged; Pentamidine; Pneumonia, Pneumocystis; Postoperative Complications; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A large-scale, randomised, multicentre single-blind clinical trial was conducted to assess the comparative efficacy and tolerance of ofloxacin, trimethoprim and co-trimoxazole in the treatment of uncomplicated urinary tract infection in general practice. A total of 1,069 patients from 76 centres across the UK were enrolled in the study, and randomised to one of the following treatment groups: ofloxacin (200 mg od), trimethoprim (200 mg bd) or co-trimoxazole (trimethoprim 160 mg and sulphamethoxazole 800 mg bd). Each patient received five days of medication. Clinically, ofloxacin was as effective as trimethoprim and co-trimoxazole. However, the bacteriological cure rate was significantly better for ofloxacin, with eradication of the initial causative pathogen by the end of treatment in 92% of patients in the ofloxacin group, compared with 81% for trimethoprim and co-trimoxazole (P = 0.0002). There was also a lower relapse rate for ofloxacin. Ofloxacin was well tolerated: adverse events were reported by 67 (12.4%) patients in the ofloxacin group, compared with 48 (18.7%) patients in the co-trimoxazole group and 37 (13.6%) patients in the trimethoprim group. Ofloxacin can therefore be considered a suitable alternative for the treatment of uncomplicated urinary tract infection.

Topics: Adult; Aged; Escherichia coli Infections; Family Practice; Female; Humans; Male; Middle Aged; Ofloxacin; Single-Blind Method; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In this study, we determined the safety and efficacy of the treatment of adults with urinary tract infection with ciprofloxacin hydrochloride (250 mg twice daily for 10 days) in comparison with trimethoprim-sulfamethoxazole (160 mg of trimethoprim and 800 mg of sulfamethoxazole twice daily for 10 days). Patients with signs and symptoms of urinary tract infection were randomized to receive ciprofloxacin (98 women and 5 men) or trimethoprim-sulfamethoxazole (92 women and 8 men). The success rate of therapy was 91% for both treatment arms of the study. Among seven failures after ciprofloxacin therapy, three were due to relapse of infection and two to side effects that necessitated a change in medication; in addition, two patients had persistent symptoms and required hospitalization. Among the six failures associated with trimethoprim-sulfamethoxazole therapy, four were due to relapse, one to persistence of infection, and one to a side effect that necessitated a change in medication. Among the patients treated with trimethoprim-sulfamethoxazole, 32% had mild or moderate adverse reactions; in comparison, 17% of the ciprofloxacin-treated patients had adverse reactions (P = 0.026). For the treatment of urinary tract infection in adult patients in this study, ciprofloxacin and trimethoprim-sulfamethoxazole were equally effective, but ciprofloxacin was associated with fewer adverse reactions.

Topics: Adult; Aged; Ciprofloxacin; Double-Blind Method; Female; Humans; Male; Middle Aged; Prospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We conducted a randomized prospective multicenter study to compare the safety and efficacy of once daily oral cefixime (8 mg/kg) to twice daily oral trimethoprim/sulfamethoxazole (TMP/SMX) (8/40 mg/kg/day) for the treatment of acute urinary tract infection in children ages 6 months to 13 years. Seventy-six patients (38 in each group) were studied. Thirty-seven percent were younger than 3 years of age. Escherichia coli was the most common isolate in both groups (85%). Eighty-five percent of all Gram-negative organisms were susceptible to TMP/SMX and all were susceptible to cefixime. Seventy-two percent of all patients were febrile at the time of diagnosis. Both groups were treated for 7 to 10 days. Peripheral white blood cell counts, erythrocyte sedimentation rate, body temperature and urinalysis returned to normal at the same rate in both groups. No failures were observed and relapse occurred in 3 cases within the 4 weeks after treatment (2 in the cefixime group and one in the TMP/SMX group). Side effects were observed in 14% of the cefixime group and 16% of the TMP/SMX group and were all mild enough not to necessitate discontinuation of therapy. We conclude that the efficacy and safety of cefixime administered once daily compared favorably with TMP/SMX administered twice daily for acute uncomplicated urinary tract infection.

Topics: Administration, Oral; Anti-Infective Agents, Urinary; Cefixime; Cefotaxime; Child; Child, Preschool; Drug Administration Schedule; Female; Humans; Infant; Male; Prospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Forty females (ages 15-74) with community-acquired, uncomplicated urinary tract infections were studied. Clinical and microbiological efficacy of cefuroxime (250 mg td) and trimethoprim sulfamethoxazole (160/800 mg td) used for 7 days were evaluated. The microorganisms found in the pre-treatment urinary cultures were: Escherichia Coli (85%), Klebsiella Pneumoniae (12.5%), and E. Agglomerans (2.5%). They were all susceptible to cefuroxime, and 42.5% were resistant to trimethoprim sulfamethoxazole (Kirby-Bauer). These findings show that trimethoprim sulfamethoxazole should not be used empirically while waiting for the results of urinary cultures, and that cefuroxime is a good alternative in these cases. Clinical cure was observed in all, and bacteriological cure in 75% of the pts treated with both antimicrobial agents. Relapses and reinfections were detected during follow-up emphasizing the importance of intra and post-treatment urinary cultures.

Topics: Adolescent; Adult; Aged; Cefuroxime; Female; Humans; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

An open randomized study was done to compare the prophylactic value of single doses of netilmycin-metronidazole versus trimethoprim-sulfamethoxazole in the prevention of postoperative infections associated with transrectal prostatic biopsy. Of 117 patients enrolled in the study 101 were evaluated and of these patients 47 received netilmycin-metronidazole and 54 received trimethoprim-sulfamethoxazole. The bacteremia rate in the netilmycin-metronidazole group was 28% (13 of 47 patients) with a 95% confidence interval of 18 to 42% and in the trimethoprim-sulfamethoxazole group it was 37% (20 of 54) with a confidence interval of 26 to 50% (p = 0.43). None of the patients with bacteremia was symptomatic. Urinary tract infection rates were greater in the netilmycin-metronidazole group: 17% (8 of 47 patients) versus 2% (1 of 54) in the trimethoprim-sulfamethoxazole group, p = 0.01. Trimethoprim-sulfamethoxazole (cotrimoxazole) is a better choice as an antimicrobial prophylaxis for patients undergoing transrectal prostatic biopsy.

Topics: Aged; Aged, 80 and over; Biopsy; Drug Combinations; Humans; Infection Control; Infections; Male; Metronidazole; Middle Aged; Netilmicin; Premedication; Prostate; Sepsis; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In a double-blind, randomized, multicenter study, 400 women with symptoms of acute urinary tract infections were treated with either a 7-day course of temafloxacin hydrochloride (400 mg once a day; n = 204) or a 10-day course of trimethoprim (160 mg) and sulfamethoxazole (800 mg) (TMP-SMZ) twice daily (n = 196). The bacteriologic cure rates at 5 to 9 days posttherapy were 100% in the temafloxacin group and 97% in the TMP-SMZ group (P = 0.035). The clinical cure rates were 93% in the temafloxacin group and 95% in the TMP-SMZ group (P greater than 0.1). Adverse events, including nausea, vomiting, rash, headache, and dizziness, were experienced by 19.6% of the temafloxacin group and 23.5% of the TMP-SMZ group. Transient leukopenia occurred in 0.5 and 4.1% of the temafloxacin and TMP-SMZ groups, respectively. Temafloxacin, 400 mg once a day for 7 days, appears to be at least as safe and effective as a 10-day course of TMP-SMZ in the management of acute urinary tract infection in women.

Topics: 4-Quinolones; Adult; Anti-Infective Agents; Double-Blind Method; Female; Fluoroquinolones; Humans; Middle Aged; Prospective Studies; Quinolones; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The efficacy and safety of ofloxacin taken orally once a day for three days was compared with a combination of trimethoprim and sulfamethoxazole (TMP/SMX) taken orally twice a day for seven days in the treatment of uncomplicated urinary tract infection. The diagnosis was established by the presence of symptoms including dysuria, frequency, suprapubic pain, and urgency. Bacteriuria was confirmed by a urine culture of a minimum of 10(5) organisms per mL, of at least one species. A treatment course of ofloxacin, once-a-day for three days, was as safe and effective as a standard course of TMP/SMX, twice a day for seven days.

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Ofloxacin; Superinfection; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To determine the efficacy of long-term prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMZ) for prevention of bacterial infection following renal transplantation, the absorption of TMP-SMZ in transplant patients, the effects of prophylaxis on the microflora, and the cost-benefit of prophylaxis.. One hundred thirty-two adult patients selected to undergo renal transplantation participated in a randomized, double-blind, placebo-controlled trial.. Patients randomized to receive TMP-SMZ experienced fewer hospital days with fever (3.3% versus 7.7%, p less than 0.001) and significantly fewer bacterial infections during the transplant hospitalization after removal of a urethral catheter (0.76 versus 1.88 per 100 days, p less than 0.005) and following discharge from the hospital (0.08 versus 0.30 per 100 days, p less than 0.001). During the transplant hospitalization, a daily dose of 320/1,600 mg was highly effective for prophylaxis whereas 160/800 mg daily gave unexpectedly low blood levels and was effective only for prevention of urinary tract infections after catheter removal. Prophylaxis was most effective in prevention of infections of the urinary tract (24 versus 54, p less than 0.005) and bloodstream (one versus nine, p less than 0.01) and infections caused by enteric gram-negative bacilli (four versus 46, p less than 0.001), enterococci (six versus 22, p = 0.006), or Staphylococcus aureus (one versus nine, p = 0.01). Prophylaxis did not prevent urinary tract infection associated with urethral catheters in the early posttransplant period, but after catheter removal, reduced the risk of urinary tract infection threefold (p less than 0.001). No significant differences in colonization by TMP-SMZ-resistant gram-negative bacilli were identified between the two groups; patients given TMP-SMZ were, paradoxically, less likely to become colonized by candida, probably because of less exposure to antibiotics for treatment of infection. Recipients of prophylaxis did not have a higher rate of infection caused by TMP-SMZ-resistant bacteria or Candida; however, their infections were more likely to be caused by resistant bacteria than infections in patients in the placebo group (62% versus 18%, p less than 0.001).. Prophylaxis with TMP-SMZ, which is well tolerated, significantly reduces the incidence of bacterial infection following renal transplantation, especially infection of the urinary tract and bloodstream, can provide protection against Pneumocystis carinii pneumonia, and is cost-beneficial. Subnormal absorption of TMP-SMZ in the early posttransplant period mandates 320/1,600 mg daily for optimal benefit. Prophylaxis has little discernible effect on the microflora.

Topics: Absorption; Adolescent; Adult; Bacteria; Bacterial Infections; Candidiasis; Clinical Trials as Topic; Cost-Benefit Analysis; Double-Blind Method; Female; Humans; Kidney Transplantation; Male; Middle Aged; Placebos; Prospective Studies; Random Allocation; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Catheterization; Urinary Tract Infections

We conducted a randomized controlled trial of orally administered amifloxacin versus trimethoprimsulfamethoxazole (TMP-SMX) as treatments of acute uncomplicated urinary tract infection in women. Amifloxacin at a dosage of 200 mg twice a day appeared as safe and effective as TMP-SMX, but amifloxacin at 400 mg twice a day tended to cause adverse events more frequently than did TMP-SMX.

Topics: Administration, Oral; Adult; Anti-Infective Agents; Ciprofloxacin; Dose-Response Relationship, Drug; Female; Fluoroquinolones; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Randomized Controlled Trials as Topic; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In a controlled, randomized trial of 133 patients with proven urinary tract infections (UTIs), significantly more pathogens were found to be susceptible to norfloxacin than to trimethoprim-sulfamethoxazole (TMP-SMZ) (p less than 0.01). Among patients with pathogens susceptible to both drugs, more of those treated with norfloxacin were cured or improved (p = 0.06). When at least one patient variable, i.e., prior history of therapy, was corrected for, this difference became significant (p = 0.03). Norfloxacin eradicated 11 of 13 infections due to Pseudomonas aeruginosa and 6 of 7 due to enterococci. Five patients treated with norfloxacin and two treated with TMP-SMZ had relapses within 6 weeks. Significantly fewer adverse experiences occurred in patients receiving norfloxacin (p less than 0.01).

Topics: Adult; Aged; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Multicenter Studies as Topic; Norfloxacin; Randomized Controlled Trials as Topic; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We conducted a randomized, double-blind, placebo-controlled study to determine the efficacy of postcoital antibiotic prophylaxis in healthy young women prone to recurrent urinary tract infections. Sixteen patients were randomized to receive postcoital administration of a combination product of trimethoprim and sulfamethoxazole, while 11 received postcoital placebo. The treatment groups were similar with respect to age, parity, diaphragm use, history of lifetime urinary tract infections, frequency of intercourse, and number of lifetime sexual partners. In over 6 months of observation, postcoital administration of trimethoprim-sulfamethoxazole was highly effective in preventing recurrent urinary tract infections. Nine of 11 patients who took the placebo developed urinary tract infections (infection rate, 3.6 per patient-year), compared with only two of 16 patients who received postcoital trimethoprim-sulfamethoxazole (infection rate, 0.3 per patient-year). Postcoital administration of trimethoprim-sulfamethoxazole was effective in patients with both low (two or fewer times per week) and high (three or more times per week) intercourse frequencies. Side effects were few and compliance was excellent. We conclude that postcoital trimethoprim-sulfamethoxazole is a safe, effective, and inexpensive approach to management of recurrent urinary tract infections in young women.

Topics: Adult; Coitus; Double-Blind Method; Escherichia coli; Female; Follow-Up Studies; Humans; Patient Compliance; Randomized Controlled Trials as Topic; Rectum; Recurrence; Regression Analysis; Trimethoprim, Sulfamethoxazole Drug Combination; Urethra; Urinary Tract Infections; Vagina

20 urologists took part in a single blind, randomized study. Female patients with acute uncomplicated UTI were recruited. The patients received either a single dose of 3 g fosfomycin trometamol versus 200 mg ofloxacin or 1.92 g co-trimoxazole. Follow-up examinations were carried out after one and four weeks. Of 562 patients 446 could be evaluated for efficacy and 496 for tolerance. Patients were analysed according to the amount of bacteriuria: "significant" (greater than or equal to 10(5)/ml), "low count" (10(2) - 10(4) ml) and "no bacteriuria" (less than or equal to 10(1)/ml), as well as according to the sensitivity of the infecting organisms: sensitive (resistant): fosfomycin trometamol less than or equal to 16 mg/l (greater than or equal to 128 mg/l), ofloxacin less than or equal to 1 mg/l (greater than or equal to 8 mg/l), co-trimoxazole less than or equal to 2/38 mg/l (greater than or equal to 16/304 mg/l). Up to one week the following results could be achieved: clinical improvement was attained in patients with "significant" bacteriuria (fosfomycin trometamol-150, ofloxacin-89, co-trimoxazole-69) in 94.7% for fosfomycin trometamol, in 95.4% for ofloxacin, and in 94% for co-trimoxazole; in patients with "low count" bacteriuria (fosfomycin trometamol-44, ofloxacin-18, co-trimoxazole-30) in 95.2% for fosfomycin trometamol, in 93.7% for ofloxacin, and in 96.4% for co-trimoxazole; and in patients with no bacteriuria (fosfomycin trometamol-11, ofloxacin-6, co-trimoxazole-4) in 81.8% for fosfomycin trometamol, in 100% for ofloxacin and in 100% for co-trimoxazole.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Bacteriuria; Drug Administration Schedule; Drug Therapy, Combination; Drug Tolerance; Escherichia coli; Female; Fosfomycin; Humans; Middle Aged; Ofloxacin; Single-Blind Method; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Norfloxacin, a broad-spectrum antimicrobial analog of nalidixic acid, was evaluated by comparing it to trimethoprim-sulfamethoxazole in 93 office patients with recurrent urinary tract infections. In this prospective randomized study, norfloxacin and trimethoprim-sulfamethoxazole were given on the same dosage schedule with the former drug given as a 400-mg tablet twice daily and the latter drug given as a double strength tablet twice daily. Overall, 50 patients received norfloxacin and 43 patients received trimethoprim-sulfamethoxazole with a cure rate of 96 percent and 79 percent, respectively. Whether a patient had one infection or multiple previous infections, norfloxacin appeared to be superior to trimethoprim-sulfamethoxazole. Only minor side effects were noted in either group, and no patient withdrew from this study as a direct result of these side effects. Minor complaints of nausea, dizziness, and headache were found in the norfloxacin group (24%) and in the trimethoprim-sulfamethoxazole group (16%). Both agents are effective in treating urinary tract infections but norfloxacin is superior to trimethoprim-sulfamethoxazole in patients with either recurrent complicated infections or one previous uncomplicated urinary tract infection.

Topics: Adult; Aged; Aged, 80 and over; Escherichia coli Infections; Female; Humans; Male; Middle Aged; Norfloxacin; Prospective Studies; Randomized Controlled Trials as Topic; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In this study the results of single-dose amoxicillin TMP-SMX, and ofloxacin therapy in ürinary tract infections have been presented. The study is held in Sağlik Sosyal Yardim Bakanliği - Hacettepe Universitesi Tip Fakültesi Cubuk Study Group Research and Training Hospital. The treatments were successful in 33% of 15 women treated with single-dose oral amoxicillin, in 60% of 15 women treated with 2 tablets DS single-dose TMP-SMX and 100% of 20 women treated with 400 mg oral single-dose ofloxacin.

Topics: Adult; Amoxicillin; Female; Humans; Middle Aged; Ofloxacin; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To compare three days' and seven days' treatment with co-trimoxazole in women with acute dysuria, strangury, and urinary frequency or urgency.. Randomised double blind placebo controlled trial.. General practices in the south east of The Netherlands.. 327 Non-pregnant female patients aged 12 to 65.. 161 Women were allocated to three days' treatment (co-trimoxazole 960 mg twice a day), and 166 women were allocated to seven days' treatment (co-trimoxazole 960 mg twice a day).. Resolution of symptoms at one, two, and six weeks.. The rates for resolution of symptoms were not significantly different between the two groups. Cumulative rates of recurrence after three days' and seven days' treatment were 31/139 (22%) and 23/151 (15%) respectively six weeks after entry (p = 0.16). Adverse effects occurred in a quarter of women given three days' treatment compared with a third of women receiving seven days' treatment (p = 0.29). In only two patients did adverse effects necessitate stopping treatment.. Three days of co-trimoxazole seems to be as effective as a seven days' course for treating acute urinary tract infection in non-pregnant women.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Urinary; Child; Double-Blind Method; Drug Administration Schedule; Female; Humans; Middle Aged; Randomized Controlled Trials as Topic; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In a double-blind, randomized, controlled trial, 249 patients with complicated urinary tract infections received either 400 mg. enoxacin or 160 mg. trimethoprim plus 800 mg. sulfamethoxazole orally every 12 hours for 14 days. The clinical outcome at the end of treatment revealed that all 89 evaluable patients (100 per cent) in the enoxacin group and 88 of 90 (98 per cent) in the trimethoprim-sulfamethoxazole group had satisfactory clinical responses (cure or improvement). Bacteriological effectiveness was measured cumulatively based on responses during and at the end of treatment, and 7 days later at followup. Satisfactory bacteriological responses (eradication or superinfection at all evaluations throughout the study) were achieved in significantly more (p equals 0.03) patients treated with enoxacin (93 per cent) than in those treated with trimethoprim-sulfamethoxazole (83 per cent). Both study medications were well tolerated. These results indicate that oral enoxacin was more effective clinically and bacteriologically (the latter statistically so) than trimethoprim-sulfamethoxazole when given as empiric therapy in the treatment of complicated urinary tract infections.

Topics: Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Urinary; Double-Blind Method; Drug Combinations; Enoxacin; Escherichia coli Infections; Female; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Middle Aged; Multicenter Studies as Topic; Pseudomonas Infections; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A randomised clinical trial of single dose trimethoprim against a seven day course of co-trimoxazole (trimethoprim/sulphamethoxazole) for the treatment of uncomplicated urinary tract infection was carried out in 106 children aged between 2 and 16 years. Of the 50 children with confirmed urinary tract infections who were followed up 48 hours after treatment with a single dose of trimethoprim all were free of infection, whereas two of the 56 who received the course of co-trimoxazole (4%) had persisting infections. At follow up after 10 days, however, significantly more of the group treated with trimethoprim had evidence of recurrent urinary tract infection compared with those who had received co-trimoxazole (10 of 44, 23%, compared with one of 46, 2%). Of the recurrences in the trimethoprim group, six were asymptomatic. We conclude that single dose trimethoprim is effective in clearing the urine of bacteria, but the risk of asymptomatic bacteriuria soon after treatment is high.

Topics: Adolescent; Anti-Infective Agents, Urinary; Child; Child, Preschool; Clinical Trials as Topic; Drug Administration Schedule; Drug Combinations; Female; Humans; Male; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A double-blind controlled trial of norfloxacin versus cotrimoxazole in the treatment of urinary tract infections was conducted. Eighty-eight patients were recruited but data from 80 patients were analysed. Norfloxacin cured 93 per cent of the infections while the cure rate achieved by cotrimoxazole was only 70 per cent (p = 0.03, Fisher's exact test). The difference was attributable to a higher incidence of resistance to cotrimoxazole among the bacterial isolates. Escheria coli was the commonest pathogen and together with klebsiella accounted for 78 per cent of all isolates. Fifteen per cent of E coli and 15 per cent of klebsiella isolates were resistant to cotrimoxazole while all were sensitive to norfloxacin. Side effects were minimal and consisted mainly of nausea and non-specific dizziness.

Topics: Adult; Anti-Infective Agents, Urinary; Bacterial Infections; Double-Blind Method; Female; Humans; Male; Norfloxacin; Randomized Controlled Trials as Topic; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

One hundred six patients with acute, uncomplicated lower urinary tract infections participated in a randomized study that compared cefixime (one 400-mg tablet once daily) with trimethoprim (160 mg)/sulfamethoxazole (800 mg) (one tablet every 12 hours). Two cefixime recipients and 3 patients given trimethoprim/sulfamethoxazole had courses that were not evaluable for efficacy. At five to nine days post-therapy, 98 percent of the patients in each treatment group had clinical cure and bacteriologic eradication. At four to six weeks post-therapy, 87 percent (34/39) of the cefixime-treated patients and 83 percent (33/40) of those given trimethoprim/sulfamethoxazole had clinical cure and 90 percent (35/39) and 93 percent (37/40) of the patients in the respective treatment groups had bacteriologic eradication. Adverse clinical experiences or changes in the results of laboratory tests were few. Thus, a once-daily dose of cefixime was as safe and as effective as a twice-daily regimen of trimethoprim/sulfamethoxazole.

Topics: Anti-Infective Agents, Urinary; Cefixime; Cefotaxime; Drug Administration Schedule; Escherichia coli Infections; Female; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Middle Aged; Randomized Controlled Trials as Topic; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Studies of ofloxacin pharmacokinetics and pathogen susceptibilities suggested that this new fluoroquinolone might be particularly well suited to the treatment of urinary tract infections and prostatitis. Compared with carbenicillin and trimethoprim/sulfamethoxazole in separate studies of complicated urinary tract infection, ofloxacin achieved a significantly higher rate (p = 0.048) of microbiologic cures and more clinical cures than carbenicillin, while essentially matching the efficacy of the trimethoprim/sulfamethoxazole combination. Most common organisms were Pseudomonas aeruginosa in the first study and Escherichia coli in the second. In preliminary data from the prostatitis study comparing ofloxacin 300 mg given twice daily with carbenicillin 764 mg given every six hours, microbiologic cure rates were 100 percent with both medications. However, clinical cure rates were significantly higher (p = 0.048) with ofloxacin. Throughout these trials, ofloxacin has shown excellent safety and tolerability, with a lower incidence of nausea and diarrhea than with carbenicillin, and less nausea and rash than with trimethoprim/sulfamethoxazole. In all treatment groups, clinically significant laboratory abnormalities were uncommon and unrelated to the medications. Overall, these studies indicate that in complicated urinary tract infection the efficacy of ofloxacin is comparable with that of trimethoprim/sulfamethoxazole and superior to that of carbenicillin. In chronic bacterial prostatitis, results to date suggest that ofloxacin may be more effective clinically and as effective microbiologically as carbenicillin.

Topics: Administration, Oral; Adult; Aged; Bacterial Infections; Carbenicillin; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Multicenter Studies as Topic; Ofloxacin; Penicillin Resistance; Prostatitis; Random Allocation; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To investigate whether 10 days of rifampin-trimethoprim (RIF-TMP) or 6 weeks of sulfamethoxazole-trimethoprim (SMX-TMP) would decrease the relapse rate in patients with acute uncomplicated upper urinary tract infections in comparison with 10 days of SMX-TMP, we randomized 189 patients to receive RIF-TMP or SMX-TMP in a ratio of 1:2. After the site of infection was established by the antibody-coated bacterium (ACB) test, patients with upper-tract infections who received SMX-TMP were again randomized and received either a total of 6 weeks or 10 days of therapy. All patients who received RIF-TMP were treated for 10 days. Clinical and microbiological evaluations were repeated at 2 and 6 weeks posttreatment. Eighty-five patients (54 ACB positive) received 10 days of RIF-TMP, 71 patients (45 ACB positive) received 10 days of SMX-TMP, and 18 patients (18 ACB positive) received 6 weeks of SMX-TMP. The overall recurrence rates in patients who received 10 days of therapy were 32% for RIF-TMP and 23% for SMX-TMP (P = 0.13). There were 12 (14%) relapses in the RIF-TMP group compared with 2 (3%) relapses in the SMX-TMP group (P = 0.01). In patients with upper-tract infections, the relapse rates were not statistically significantly different (P = 0.13). There were two (11%) recurrences (one relapse and one reinfection) in the 6-week treatment group. This 6% relapse rate was not different from the 4% relapse rate observed in patients with upper-tract infections who received 10 days of SMX-TMP. The number of patients who discontinued treatment because of an adverse effect in the 6-week SMX-TMP treatment group was significantly greater than those in the 10-day SMX-TMP treatment group (P=0.003) and the RIF-TMP treatment group (P=0.05). Ten days of SMX-TMP was as effective as 6 weeks of SMP-TMP or 10 days of RIF-TMP in the treatment of uncomplicated upper urinary tract infections and caused the fewest untoward effects.

Topics: Adult; Aged; Anti-Infective Agents, Urinary; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Female; Humans; Male; Middle Aged; Random Allocation; Rifampin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adult; Anti-Infective Agents, Urinary; Bacterial Infections; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Female; Humans; Male; Middle Aged; Random Allocation; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adolescent; Adult; Aged; Ampicillin; Anti-Infective Agents, Urinary; Child; Clinical Trials as Topic; Drug Administration Schedule; Drug Combinations; Female; Humans; Male; Middle Aged; Nitrofurantoin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The study compared the efficacy and safety of norfloxacin to those of co-trimoxazole in the treatment of urinary tract infections (UTI). A total of 172 adults, 42 men and 130 women were recruited and randomly allocated to norfloxacin or co-trimoxazole using a double-blind study design. Patients with lower UTI received norfloxacin 200 mg or co-trimoxazole (160 mg of trimethoprim plus 800 mg of sulphamethoxazole) b.i.d. for seven days. In patients with upper UTI, the norfloxacin dose was 400 mg b.i.d. for seven days. Eleven to 14 days after treatment, the bacteriological cure rates were 96.8% and 83.3% and the clinical cure rates were 96.9% and 89.9% for norfloxacin and co-trimoxazole, respectively. A few patients complained of gastrointestinal symptoms but there were few other side-effects and the treatments were well tolerated. In conclusion, both norfloxacin and co-trimoxazole were well tolerated but norfloxacin gave higher cure rates.

Topics: Adult; Bacterial Infections; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Drug Resistance, Microbial; Female; Hong Kong; Humans; Male; Middle Aged; Norfloxacin; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The clinical and bacteriological efficacy of norfloxacin and co-trimoxazole was compared in patients with symptomatic upper urinary tract infections (UTI). Norfloxacin 400 mg or cotrimoxazole (160 mg of trimethoprim plus 800 mg of sulphamethoxazole) were given orally b.i.d. for seven days to 94 Thai patients. Clinical and bacteriological assessments were performed before and at 5, 14 and 21 days after start of treatment. Bacteriological outcome could be evaluated in 69 patients, 35 randomized to norfloxacin and 34 to co-trimoxazole. The bacteriological cure rate assessed four to seven days after treatment was significantly higher in the norfloxacin than in the co-trimoxazole group (94.3% vs. 73.5%; p less than 0.05). Few patients in each group reported mild and transient adverse effects. We conclude that norfloxacin was well tolerated and more effective than co-trimoxazole in the treatment of upper UTI.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Norfloxacin; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To compare single-dose and 10-day treatment regimens of trimethoprim-sulfamethoxazole in women with acute dysuria, urgency, or urinary frequency.. Double-blind, randomized, placebo-controlled trial.. Student health center at a major university.. Consecutive sample of 255 young women including 216 with a bacteriologically documented urinary tract infection.. Single-dose treatment (trimethoprim, 320 mg and sulfamethoxazole, 1600 mg) given to 116 women and 10-day treatment (trimethoprim, 160 mg and sulfamethoxazole, 800 mg, twice daily) given to 125 women. Women with a history of sulfonamide allergy were given trimethoprim alone: 10 received single-dose treatment (200 mg) and 5 received 10-day treatment (100 mg, twice daily).. The rates for resolution of symptoms at 3 days, 13 days, and 6 weeks after entry into the study were not significantly different between treatment groups. Among women with urinary tract infections, cumulative crude rates of recurrence in the single-dose and 10-day treatment groups, respectively, were 24% compared with 5% at 13 days after entry (P = 0.0002; 95% confidence interval [CI] for difference in proportions, 10%, 28%) and 32% compared with 21% at 6 weeks after entry (P = 0.07; 95% Cl, -2%, 24%). Factors independently associated with lower cure rates were a history of a urinary tract infection within the previous 6 weeks (adjusted odds ratio [OR], 3.8; 95% Cl, 1.4 to 10.6) and presence of 10(5) bacteria/mL or greater in an initial midstream culture (adjusted OR, 2.9; 95% Cl, 1.2 to 7.0). After controlling for these factors, the risk of failure after single-dose treatment was not statistically significantly different from 10-day treatment at 6 weeks (adjusted OR, 1.6; 95% Cl, 0.8 to 3.2; P = 0.21). Compared to 10-day treatment, single-dose treatment less effectively eradicated Escherichia coli from the vaginal flora (P less than 0.001) and led more often to early same-strain recurrences (P = 0.003). Meaningful adverse effects occurred in 12% of women given single-dose treatment compared with 25% of women receiving 10-day treatment (P = 0.009).. Compared with single-dose treatment, 10-day treatment yields a superior cure rate at 2 weeks after the start of treatment, but by 6 weeks the advantage of longer treatment no longer exists. This effect may be explained by the lesser effectiveness of single-dose treatment in eradicating vaginal E. coli, resulting in more frequent same-strain recurrences within 2 weeks of treatment.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Adult; Double-Blind Method; Drug Administration Schedule; Drug Combinations; Enterobacteriaceae Infections; Female; Follow-Up Studies; Humans; Random Allocation; Recurrence; Staphylococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urination Disorders

Fifty-six patients with complicated, recurrent urinary tract infections were entered in a study comparing the clinical and microbiological effectiveness of enoxacin with that of co-trimoxazole (trimethoprim/sulphamethoxazole). Forty-six patients (23 in each group) completed the study and, at the end of 14 days' treatment, all had negative urine cultures and were considered clinically cured. Microbiological cure was achieved in all 23 patients in the co-trimoxazole group and in 20 of 23 patients in the enoxacin group, the other three suffering reinfection approximately one week after the end of the treatment course. Ten patients (five in each group) did not complete the 14-day course of therapy: two because of negative initial cultures, one who was lost to follow-up, six because of adverse reactions, and one because of superinfection. Enoxacin is effective in treating complicated urinary tract infections caused by a variety of organisms and is comparable in effectiveness with co-trimoxazole.

Topics: Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Anti-Infective Agents, Urinary; Drug Combinations; Drug Evaluation; Enoxacin; Female; Humans; Male; Middle Aged; Naphthyridines; Random Allocation; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

One hundred thirty-two children with acute urinary tract infection were randomly assigned to receive trimethoprim-sulfamethoxazole in one dose, two doses daily for 3 days or two doses daily for 7 days. The patient characteristics, etiologic agents and frequency of roentgenologic abnormalities were similar for the three treatment groups. There was no significant difference in bacteriologic cure rates for the single dose regimen (93%) and multidose regimens (96%). The difference in rates of recurrent urinary tract infection between the single dose (20.5%) and 3-day (5.6%) and 7-day (8%) regimens was statistically significant (P = 0.033). A single dose of trimethoprim-sulfamethoxazole is inadequate treatment for infants and children with acute urinary tract infection.

Topics: Acute Disease; Child; Child, Preschool; Costa Rica; Drug Administration Schedule; Drug Combinations; Drug Resistance, Microbial; Escherichia coli; Female; Follow-Up Studies; Humans; Infant; Male; Random Allocation; Recurrence; Specimen Handling; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urography

In a coordinated, double-blind multicenter trial among general practitioners, 2,255 consecutive patients with symptoms suggesting urinary tract infection were screened; 886 were randomized to receive 200 mg of norfloxacin (333 patients), 400 mg of norfloxacin (335), or 160 mg/800 mg of trimethoprim-sulfamethoxazole (TMP-SMZ; 218) twice daily for seven days. We analyzed bacteriologic efficacy for 252, 240, and 141 of the patients receiving 200 mg of norfloxacin, 400 mg of norfloxacin, or TMP-SMZ, respectively. The short-term efficacy was 97.5%-98.6%, and the accumulated efficacy was 87.9%-88.8%. In patients with complicated infections and in men, the efficacy for the group receiving 200 mg of norfloxacin was lower than that for the other groups. In patients with recurrent infection, bacterial elimination was greater for those receiving TMP-SMZ. Significantly fewer adverse reactions occurred in patients receiving norfloxacin than in those treated with TMP-SMZ. The 200-mg dosage of norfloxacin seemed to cause fewer side effects than the 400-mg dosage.

Topics: Adult; Aged; Aged, 80 and over; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Female; Humans; Male; Middle Aged; Norfloxacin; Random Allocation; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In a randomized single blind study the efficiency of Trimethoprim as a monosubstance used in the therapy of urinary tract infections was compared to that of Cotrimoxazole. There was a total of 40 patients available 20 of whom were given 2 X 200 mg Trimethoprim throughout 10 days whereas the other 20 patients were given 2 X 160 mg Trimethoprim + 800 mg Sulphamethoxazole in the same period. All patients were hospitalized during treatment. The urine was bacteriologically checked at the beginning of the treatment and after 7, 14 and 28 days respectively. The therapy was equally successful in both groups, both from the clinical and the bacteriological point of view (Trimethoprim 17, Cotrimoxazole 18); a statistically significant difference was not to be proved. In the Trimethoprim group there was one relapse, in the Cotrimoxazole group there were two. Undesirable side effects occurred in both groups with a larger number of them occurring in the Cotrimoxazole group. Cotrimoxazole and Trimethoprim proved equally efficient from a clinical point of view. The proportion of side effects is more favourable for Trimethoprim alone; the cost of therapy is almost 50% lower than that of Cotrimoxazole.

Topics: Adult; Aged; Aged, 80 and over; Bacteriuria; Clinical Trials as Topic; Drug Combinations; Female; Humans; Male; Middle Aged; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In a multicenter, prospective treatment study, 59 patients with complicated or uncomplicated urinary tract infections (UTIs) were treated with norfloxacin (400 mg orally twice daily) and compared with 45 patients treated with trimethoprim/sulfamethoxazole. Norfloxacin was relatively safe and highly effective in treating both uncomplicated UTIs (86 percent cure rate) and complicated UTIs (75 percent cure rate). Failure of trimethoprim/sulfamethoxazole therapy was associated with initial bacterial resistance, e.g., from Pseudomonas aeruginosa and Serratia marcescens; such multiresistant bacteria were successfully treated with norfloxacin. Thus, norfloxacin appears to extend the range of oral agents available to treat UTIs.

Topics: Adult; Aged; Aged, 80 and over; Clinical Trials as Topic; Drug Combinations; Female; Humans; Male; Middle Aged; Norfloxacin; Prospective Studies; Random Allocation; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Kelfiprim (KP) is a new bactericidal agent containing trimethoprim (T) and sulfametopyrazine (S), a long-acting sulfonamide (ratio 5:4). The posology is one capsule (T 250 mg + S 200 mg) daily, after a loading dose of two capsules on the first day. To evaluate the clinical value of Kelfiprim (KP) vs co-trimoxazole (CO) in urinary tract infection (UTI) a controlled multicenter double-blind trial (MDBT) was carried out in 76 patients suffering from persistent and recurrent UTIs. About 90 per cent response rate (sterile urine at the end of treatment) was obtained for KP and about 85 per cent for CO in recurrent UTI. In persistent UTI the rate of recovery was 66.8 per cent and 53 per cent for KP and CO, respectively. Safety of treatments was excellent in 97 per cent of patients treated with Kelfiprim and 87 per cent treated with co-trimoxazole. Two patients, one in each group, were dropped from the study because of adverse reactions.

Topics: Anti-Infective Agents, Urinary; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Female; Humans; Male; Random Allocation; Recurrence; Sulfalene; Sulfamethoxazole; Sulfanilamides; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In a prospective, coordinated, double-blind multicentre trial, outpatients with urinary tract infections were randomized to 7 days b.i.d. treatment with norfloxacin 200 mg or 400 mg or trimethoprim/sulfamethoxazole. The most prevalent species was Escherichia coli (76.6%) followed by Staphylococcus saprophyticus (14.1%), the latter of which showed a marked seasonal variation with peak incidence during late summer. Minimum inhibitory concentrations (MICs) of 11 antibiotics for 651 pre-treatment bacterial strains were studied. Norfloxacin was found to be active against all isolates with MICs less than or equal to mg/l for gram-negative and less than or equal to 8 mg/l for gram-positive isolates. Reduced susceptibility to norfloxacin was seen in 2 strains of E. coli and 1 of Klebsiella pneumoniae from patients with persisting or relapsing infections following treatment with norfloxacin 400 mg b.i.d. Of other antibiotics tested, ampicillin, cephalothin and sulfamethoxazole were found to have poor activity against many gram-negative isolates while nalidixic acid and mecillinam lacked activity against all gram-positives. Cefotaxime, gentamicin, trimethoprim and trimethoprim/sulfamethoxazole were generally highly active against the isolated bacterial strains.

Topics: Anti-Bacterial Agents; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Escherichia coli Infections; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Microbial Sensitivity Tests; Norfloxacin; Prospective Studies; Random Allocation; Staphylococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A single dose of 100 mg ofloxacin was compared with a multiple dose of cotrimoxazole in lower urinary tract infections in 137 women. The elimination rate was significantly lower in the single dose treated group of patients in spite of all strains being in vitro susceptible in this group.

Topics: Anti-Infective Agents, Urinary; Clinical Trials as Topic; Drug Combinations; Escherichia coli Infections; Female; Humans; Ofloxacin; Oxazines; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Clinical Trials as Topic; Drug Combinations; Female; Humans; Statistics as Topic; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Amoxicillin; Bacterial Infections; Clinical Trials as Topic; Drug Combinations; Fosfomycin; Humans; Male; Postoperative Complications; Premedication; Prostate; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Acute Disease; Chile; Clinical Trials as Topic; Drug Combinations; Female; Humans; Nitrofurantoin; Prospective Studies; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We compared the efficacy of orally administered ampicillin, 2 g/d, with that of trimethoprim-sulfamethoxazole, 320 mg/d-1600 mg/d, given for 2 or 6 weeks for outpatient management of acute uncomplicated renal infection in women. Of 98 women participating in the trial, 60 had renal infections with susceptible strains, complied with drug therapy, and completed 6 weeks of follow-up. Before treatment, 39 women had symptoms and signs of acute pyelonephritis; 21 had symptoms of cystitis but positive tests for antibody-coated bacteria. All 60 women had alleviation of symptoms and resolution of bacteriuria after 7 days of therapy. Subsequent recurrences occurred in 12 of 27 women given ampicillin, compared with 4 of 33 given trimethoprim-sulfamethoxazole (p = 0.008). Serotyping showed that most recurrences were reinfections with ampicillin-resistant strains. With each drug, a 2-week regimen of therapy proved as efficacious as a 6-week regimen, but the longer regimen was less well tolerated. We conclude that a 2-week treatment regimen is sufficient to manage acute pyelonephritis in outpatients and that trimethoprim-sulfamethoxazole is preferable to ampicillin therapy.

Topics: Adult; Ampicillin; Drug Administration Schedule; Drug Combinations; Enterobacteriaceae Infections; Female; Humans; Random Allocation; Recurrence; Staphylococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A simple open randomized study was performed to evaluate the comparative efficacy and safety of ofloxacin and cotrimoxazole in 40 patients with complicated urinary tract infections. In these patients ofloxacin produced better clinical results than cotrimoxazole. The results were also excellent when cotrimoxazole-resistant strains were involved, even in immunocompromised hosts.

Topics: Adult; Aged; Anti-Infective Agents, Urinary; Drug Combinations; Female; Humans; Male; Middle Aged; Ofloxacin; Oxazines; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

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

53 women with acute, uncomplicated urinary tract infection proven clinically and bacteriologically were treated, after double-blind randomisation, with a single dose of norfloxacin (1200 mg) or a single dose of cotrimoxazole (480/2400 mg). Follow-up one week after treatment showed a comparable success rate (85%) for both antibiotics. Only few minor side effects were recorded in both patient groups. Most failures were due to gram positive bacteria (coagulase-negative staphylococci). These results suggest that single dose therapy for urinary tract infections due to gram positive germs should be reconsidered.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Urinary; Double-Blind Method; Drug Combinations; Drug Evaluation; Female; Humans; Middle Aged; Norfloxacin; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A prospective, randomized controlled study was carried out in 24 Italian urology wards in 675 patients undergoing transurethral prostatic resection, utilizing three different chemoprophylactic treatments with either amoxycillin (AMX), co-trimoxazole (CTX) or fosfomycin trometamol salt (FT) in order to prevent postoperative urinary tract infections. FT significantly lowered the incidence of both postoperative bacteriuria and symptomatic infections in comparison to AMX and CTX. Transient side effects, mild or moderate, were observed in 6.6% of cases. Similar safety and protective results were obtained in 233 patients undergoing different transurethral instrumentations who were chemoprophylactically treated with FT.

Topics: Aminoglycosides; Amoxicillin; Anti-Bacterial Agents; Clinical Trials as Topic; Drug Combinations; Fosfomycin; Humans; Male; Premedication; Prospective Studies; Prostatectomy; Random Allocation; Sulfamethoxazole; Surgical Wound Infection; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Single-dose therapy of uncomplicated urinary tract infection (UTI) has been shown to be effective in many trials in adult women. The question which will be explored in this presentation is what properties constitute the ideal agent for the therapy of UTI. Important microbiological properties include spectrum of activity to include all common urinary pathogens, bactericidal action in urine and low prevalence of resistant bacteria. The vital feature of an antibacterial drug useful in the therapy of UTI is prolonged urinary concentrations. The agent must therefore be well absorbed and have slow renal excretion. Most beta-lactam drugs do not have these combined properties. Aminoglycosides are effective drugs but cannot be administered orally. Quinolones and the calcium salt of fosfomycin are useful but do not have an ideal pharmacokinetic profile. Cotrimoxazole, trimethoprim alone and the trometamol salt of fosfomycin all have good antibacterial activity combined with slow urinary excretion.

Topics: Aminoglycosides; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Clinical Trials as Topic; Drug Combinations; Escherichia coli Infections; Fosfomycin; Humans; Kinetics; Lactams; Microbial Sensitivity Tests; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Thirty-two patients (18 men and 14 women), who ranged in age from 28 to 91 years (mean, 71.2 years), with urinary tract infections caused by Pseudomonas species or other organisms resistant to trimethoprim-sulfamethoxazole were treated with 500 mg of orally administered ciprofloxacin every 12 hours. Thirty patients completed at least five days of therapy and were evaluated for efficacy. Of these, the treatment of 28 (93 percent) patients was considered successful, with urine cultures yielding negative results five to nine days after cessation of therapy. Three of these patients were found to be reinfected with their primary pathogens when culture specimens were obtained again three to four weeks later. The two patients who received treatment that was classified as having failed had urine cultures that persistently grew Pseudomonas aeruginosa. Superinfections occurred in eight patients, four with diabetes and four with underlying central nervous system disease. Adverse reactions required discontinuation of therapy in two patients. Although the rates of reinfection and superinfection were somewhat high, these patients had a high frequency of underlying diseases that predisposed them to recurrent or difficult-to-treat infections. Despite these shortcomings, ciprofloxacin is a welcome addition to the oral antibiotic regimen for the treatment of antibiotic-resistant urinary infections.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Bacterial Infections; Ciprofloxacin; Clinical Trials as Topic; Drug Combinations; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Pseudomonas Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The efficacy of 3-day therapy with nalidixic acid in 16 children, and trimethoprim/sulphamethoxazole in 19 children, was studied prospectively in children with an acute infection of the lower urinary tract and compared with that of a conventional 10-day course with the same drugs. The immediate cure rate was 97% in the 3-day group and 90% in the 10-day group. During 3 months of follow-up there were altogether six re-infections in children given short-term treatment and six in the conventionally treated group. The results give further support for the suggestion that 3-day therapy is equivalent to 10-day treatment in uncomplicated urinary infections in children and that both nalidixic acid and trimethoprim/sulphamethoxazole are good alternatives in such an approach.

Topics: Adolescent; Anti-Infective Agents, Urinary; Child; Child, Preschool; Drug Combinations; Female; Humans; Infant; Male; Nalidixic Acid; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adult; Aged; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Ciprofloxacin; Clinical Trials as Topic; Drug Combinations; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Prospective Studies; Pseudomonas aeruginosa; Pseudomonas Infections; Quinolines; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We evaluated the following five treatment regimens for acute cystitis in nonpregnant women: cefadroxil, 1,000 mg single-dose; cefadroxil, 500 mg twice a day for three days; cefadroxil, 500 mg twice a day for seven days; trimethoprim-sulfamethoxazole (TMP-SMZ), 320-1,600 mg single-dose, and TMP-SMZ, 160-800 mg twice a day for three days. At four weeks after the end of treatment, 25%, 58%, 70%, 65%, and 88% of patients, respectively, remained cured of infection. The results indicated that three-day treatment (1) might improve cure rates (over single-dose), (2) would reduce incidence of relapse (vs. single-dose), and (3) may be as curative as seven-day treatment. The results of the antibody-coated bacteria test did not predict treatment failure or relapse.

Topics: Administration, Oral; Antibody-Coated Bacteria Test, Urinary; Bacteriuria; Cefadroxil; Cystitis; Drug Combinations; Enterobacteriaceae Infections; Female; Humans; Random Allocation; Recurrence; Staphylococcal Infections; Streptococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Norfloxacin is a lipid-soluble weak organic acid bound to plasma proteins to a low extent. Norfloxacin has a pKa1 from 6.2 to 6.4 and a pKa2 from 8.7 to 8.9. Mean concentrations of norfloxacin in prostatic tissue have been reported as 1.7 mg/kg. Recurrent urinary tract infection (UTI) in men is frequently associated with prostatic infection, and chronic prostatitis is both difficult to diagnose and to treat. One hundred and twenty-nine patients were entered into a randomized, open controlled, comparative multiclinic study of the efficacy and safety of norfloxacin vs. co-trimoxazole in male patients with recurrent UTI. Norfloxacin 400 mg and co-trimoxazole 160/800 mg were given twice daily for 4 to 6 weeks. One hundred and nine patients were considered evaluable for efficacy. Norfloxacin effected bacteriologic eradication in 56 of 60 (93%) patients; co-trimoxazole effected eradication in 39 of 49 (67%) patients. This difference in bacteriologic outcome had statistical significance (p less than 0.05). A subset of these patients had prostatic fluid cultures pre- and post-therapy. The eradication rate was 23 of 25 (92%) for norfloxacin and 10 of 15 (67%) for co-trimoxazole. Bacteria isolated were (norfloxacin/co-trimoxazole): E. coli 27/25; K-E-S 14/13; Proteus spp. 7/5; Ps. aeruginosa 2/0; other gram-negative bacilli 4/3; gram-positive cocci 7/3. Four patients, one on norfloxacin and three on co-trimoxazole had drug-related clinical and/or laboratory adverse experiences. None was serious. Norfloxacin appears to be an effective drug for the treatment of recurrent UTI in men.

Topics: Anti-Infective Agents, Urinary; Bacteria; Drug Combinations; Humans; Male; Microbial Sensitivity Tests; Norfloxacin; Prostatitis; Random Allocation; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Sixty-five women with uncomplicated urinary tract infection were evaluated in a prospective, randomized, double blind study comparing ciprofloxacin (250 mg twice daily for ten days) with co-trimoxazole (160 mg trimethoprim and 800 mg sulphamethoxazole twice daily for ten days). Results were analysed with respect to eradication of the urinary tract pathogen, resolution of clinical symptoms, incidence of relapse, and incidence of adverse effects. Among the 31 women who received ciprofloxacin, there was eradication of the micro-organism and complete resolution of clinical symptoms in 100% five to nine days after completion of therapy. Among the 34 patients who received co-trimoxazole, there was eradication in 94% and clinical resolution in 91%. Of the ciprofloxacin-treated women 6.5% (2/31) relapsed compared with 18% (6/34) of co-trimoxazole-treated women. Overall cure rates for 65 patients were 93.5% and 82.3% for ciprofloxacin and co-trimoxazole (difference not statistically significant), respectively. A statistically significant (P less than 0.05) increase in adverse side effects was noted in patients treated with co-trimoxazole. Based upon preliminary data it appears that ciprofloxacin is as effective and less toxic than co-trimoxazole for treatment of uncomplicated urinary tract infection in women.

Topics: Adult; Anti-Infective Agents, Urinary; Ciprofloxacin; Double-Blind Method; Drug Combinations; Female; Humans; Prospective Studies; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Seventy-five hospital inpatients with bacteriologically confirmed urinary tract infections were allocated to treatment with ciprofloxacin 100 mg, ciprofloxacin 250 mg or co-trimoxazole 960 mg, all given orally twice a day for five days. The patients were generally elderly, with many complicating factors including indwelling catheters; 24% of the infections were caused by Pseudomonas aeruginosa. The cure rates at 28 days were 94%, 88% and 87%, respectively. Side effects were few and minor. Ciprofloxacin appears to be an effective and safe orally-administrable treatment even for complicated urinary tract infection.

Topics: Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Urinary; Ciprofloxacin; Drug Combinations; Female; Humans; Male; Middle Aged; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adult; Aminoglycosides; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Cephalosporins; Child; Clinical Trials as Topic; Drug Combinations; Female; Humans; Male; Penicillins; Pregnancy; Sulfamethoxazole; Sulfonamides; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In a study comprising 116 patients at a hospital for general care, ofloxacin was tested in various doses and at various time intervals against pipemidic acid (for infections of the lower urinary tract) and co-trimoxazole forte (for infections of the upper urinary tract). Ofloxacin proved superior to the other drugs both clinically and, particularly, bacteriologically. Of 77 patients treated with ofloxacin, only one complained of diarrhoea as a side-effect of the drug.

Topics: Adult; Anti-Infective Agents, Urinary; Bacteria; Bacterial Infections; Clinical Trials as Topic; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Combinations; Humans; Nicotinic Acids; Ofloxacin; Oxazines; Pipemidic Acid; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The reasons for combining trimethoprim (TMP) with sulfonamides (SUL) are still mainly theoretical but are supported by results from experimental infections and treatment of specific pathogens in humans, such as Branhamella catarrhalis, Neisseria gonorrhoeae, Brucella, Nocardia asteroides and perhaps Bordetella pertussis and Chlamydia trachomatis. Addition of SUL to TMP confers a therapeutic advantage also in patients with complicated urinary tract infection but probably not in young women with acute cystitis. Conditions that may enable TMP-SUL synergy in vivo can be expected to occur only in occasional cases of infection due to staphylococci, streptococci, Haemophilus or enteric bacteria. This fact together with ethical problems and availability of alternative therapies make further evaluations of the clinical significance of the SUL component of TMP-SUL very difficult. Although the use of TMP alone has shown promise in exacerbations of chronic bronchitis the role of the SUL component in TMP-SUL treatment of infections outside the urinary tract remains to be defined in comparative clinical trials.

Topics: Aged; Anti-Bacterial Agents; Brucellosis; Clinical Trials as Topic; Drug Combinations; Drug Synergism; Female; Gonorrhea; Humans; Kinetics; Lymphogranuloma Venereum; Male; Microbial Sensitivity Tests; Nocardia Infections; Sulfamethoxazole; Tissue Distribution; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

One hundred and fifty one patients with symptoms of urinary tract infection were treated randomly in a double blind study with a slow release form of trimethoprim or with co-trimoxazole. Similar cure rates were seen. There was no difference between the proportions of patients in the two groups who acquired trimethoprim-resistant Enterobacteriaceae. Further clinical trials with slow release trimethoprim should be performed.

Topics: Adult; Aged; Aged, 80 and over; Delayed-Action Preparations; Double-Blind Method; Drug Combinations; Drug Resistance, Microbial; Enterobacteriaceae; Escherichia coli; Female; Humans; Intestines; Male; Middle Aged; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Five hundred and twenty-eight patients with presumptive acute uncomplicated urinary tract infection (UTI) were randomly assigned to receive cefixime 400 mg once daily, cefixime 200 mg twice daily or co-trimoxazole 2 tablets twice a day for 10 days; 477 completed at least 5 days of therapy. Of the patients 342 (65%) had positive baseline urine cultures, yielding 353 pathogens. A microbiological response was determined for 280 pathogens (79%), eradication being observed in over 94% of isolates; 153 pathogens (43%) were sensitive to both cefixime and co-trimoxazole and eradication was observed in over 96% of cases. Clinical response correlated well with microbiological response. The incidence of diarrhoea and stool changes was higher (P less than 0.005) in the patients who received cefixime once daily than in the other groups. There was a significantly higher incidence of stool changes with cefixime twice daily than with co-trimoxazole (P less than 0.05), but these did not necessitate discontinuation of therapy. Nausea was commoner with co-trimoxazole (P less than 0.05). The majority of pathogens isolated were Escherichia coli, Proteus mirabilis and staphylococci. Approximately 24% of E. coli were resistant in vitro to co-trimoxazole (P less than 0.005). Cefixime 200 mg twice daily is an effective and safe alternative to co-trimoxazole in the management of acute uncomplicated UTI.

Topics: Adult; Aged; Anti-Bacterial Agents; Cefixime; Cefotaxime; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Escherichia coli; Female; Humans; Male; Middle Aged; Proteus mirabilis; Random Allocation; Staphylococcus aureus; Staphylococcus epidermidis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Preliminary data from the U.S. regarding the safety and efficacy of ofloxacin in the treatment of urinary tract infections are presented. Treatment of uncomplicated urinary tract infections with either 200 mg or 300 mg ofloxacin b.i.d. was as effective as treatment with a standard therapy, co-trimoxazole. In another series of patients with underlying abnormalities of the urinary tract, ofloxacin therapy resulted in fewer failures and relapses than co-trimoxazole treatment. Ofloxacin was well tolerated in these studies.

Topics: Anti-Infective Agents; Clinical Trials as Topic; Drug Combinations; Female; Humans; Male; Ofloxacin; Oxazines; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract; Urinary Tract Infections

Three hundred seventy patients with upper or lower urinary tract infections were entered into a multicenter, open comparative study. A total of 190 patients were treated with norfloxacin, and 180 patients were treated with trimethoprim-sulfamethoxazole. The percentage of strains susceptible to norfloxacin (99%) was significantly greater (P less than 0.001) than the percentage of strains susceptible to trimethoprim-sulfamethoxazole (90%). The percentages of patients with bacteriological outcomes of eradication were greater in the norfloxacin group (97%) than in the trimethoprim-sulfamethoxazole group (90%). The difference was significant (P less than 0.05). Seven patients (three treated with norfloxacin, four treated with trimethoprim-sulfamethoxazole) experienced early reinfection. Of 370 patients entered into the study, 20 patients experienced clinical adverse effects that were probably or definitely related to the study drug; 6 patients were in the group that received norfloxacin, and 14 were in the group that received trimethoprim-sulfamethoxazole. Study antimicrobial agents were discontinued because of clinical adverse effects in eight patients (norfloxacin, one patient; trimethoprim-sulfamethoxazole, seven patients). Three patients receiving norfloxacin and four patients receiving trimethoprim-sulfamethoxazole had laboratory adverse effects which were classified as probably or definitely drug related. None of the clinical or laboratory adverse effects was serious.

Topics: Adult; Bacteria; Clinical Trials as Topic; Drug Combinations; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Nalidixic Acid; Norfloxacin; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In a prospective, randomized trial, norfloxacin (400 mg perorally, twice a day) was compared with trimethoprim-sulfamethoxazole (160-800 mg perorally, twice a day) in 45 patients with uncomplicated urinary tract infections. Escherichia coli was the most common isolate. Infections due to Enterobacter spp., Proteus mirabilis, Pseudomonas spp., and Staphylococcus spp. were also treated. Norfloxacin was equivalent in effectiveness and safety to trimethoprim-sulfamethoxazole, with a cure rate of 91% at the 5- to 9-day posttherapy visit and 88% at the 4- to 6-week posttherapy visit. It was well tolerated and had a low incidence of side effects.

Topics: Adult; Drug Combinations; Female; Humans; Nalidixic Acid; Norfloxacin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In a randomized crossover trial, 38 women with recurrent urinary tract infections were assigned to use either continuous prophylaxis with trimethoprim-sulfamethoxazole or intermittent self-administered therapy (single-dose trimethoprim-sulfamethoxazole taken for acute urinary symptoms). The infection rate for patients on prophylaxis was 0.2 episodes/patient-year compared with 2.2 infections/patient-year for patients on self-administered therapy (p less than 0.001). Thirty-five of thirty-eight symptomatic episodes diagnosed by patients as infection were confirmed microbiologically, and 30 of the 35 infections responded clinically and microbiologically to patient-administered therapy with single-dose trimethoprim-sulfamethoxazole. No complications were seen in the 5 patients in whom therapy failed. The annual costs of prophylaxis and self-therapy were similar ($256 and $239, respectively) and both were less expensive than conventional therapy in women having 2 or more infections per year. In selected women, self-therapy is efficacious and economical compared with conventional therapy or prophylaxis.

Topics: Adolescent; Adult; Costs and Cost Analysis; Drug Administration Schedule; Drug Combinations; Enterobacteriaceae; Evaluation Studies as Topic; Female; Humans; Male; Random Allocation; Rectum; Recurrence; Self Administration; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urethra; Urinary Tract Infections; Vagina

Fifty-four college women with symptoms of lower urinary tract infections were randomly treated, 25 with 500 mg of ceftriaxone in a single intramuscular dose and 29 with 160 mg of trimethoprim-800 mg of sulfamethoxazole orally twice daily for 7 days. At 1 week after treatment, 23 patients (92%) in the ceftriaxone group and 28 patients (96%) in the trimethoprim-sulfamethoxazole group were cured. Responses of the patients with positive or negative antibody-coated bacteria tests were not significantly different. Four patients (16%) in the ceftriaxone group developed diarrhea and malaise. One patient (4%) in the trimethoprim-sulfamethoxazole group had medication discontinued because of headaches. Leukopenia was found in one patient (4%) in the ceftriaxone group and four patients (14%) in the trimethoprim-sulfamethoxazole group.

Topics: Adult; Anti-Infective Agents, Urinary; Cefotaxime; Ceftriaxone; Drug Combinations; Enzymes; Female; Humans; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Two hundred three women from a primary care medical practice with symptoms of lower urinary tract infection and positive urine cultures were treated with trimethoprim-sulfamethoxazole. One hundred eleven women received a single dose and 92 were treated for ten days. Cure rates were 87 percent and 89 percent, respectively, one week after therapy. A narrow 95 percent confidence interval for the difference between the two cure rates (.02 +/- .09) suggests the treatments are equally effective. Patients were followed by chart audit and a self-reporting questionnaire. No difference in recurrence rates was found between the two groups six months after therapy. Single-dose trimethoprim-sulfamethoxazole is as effective as ten-day treatment in women with symptoms suggestive of lower urinary tract infection and has no greater relapse rate.

Topics: Adult; Aged; Anti-Infective Agents, Urinary; Bacterial Infections; Drug Administration Schedule; Drug Combinations; Drug Evaluation; Female; Follow-Up Studies; Humans; Middle Aged; Random Allocation; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adolescent; Adult; Aged; Amdinocillin; Amdinocillin Pivoxil; Amoxicillin; Ampicillin; Drug Combinations; Female; Humans; Male; Middle Aged; Otitis Media; Pivampicillin; Random Allocation; Respiratory Tract Infections; Sinusitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Urinary; Cinoxacin; Clinical Trials as Topic; Drug Combinations; Female; Humans; Middle Aged; Pyridazines; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urination Disorders

We report the hematologic changes in 90 black children who were randomized to receive a 10-day course of either trimethoprim-sulfamethoxazole (TMP-SMZ) or amoxicillin as therapy for acute otitis media. Absolute neutrophil counts less than 1500/mm3 developed at least once during the 23-day evaluation in 28 (57%) of the 49 children given TMP-SMZ and in 22 (54%) of the 41 who received amoxicillin. Incidence of leukopenia, thrombocytopenia, and anemia was negligible in both groups. Pancytopenia did not occur in any child. Absolute neutrophil counts had increased to greater than 1500/mm3 by the end of the study period in all of the patients but six, whose recovery required an additional 1 to 63 days. Decreased neutrophil counts in antibiotic-treated subjects remained within the range of findings for healthy black children, suggesting that a count less than 1500/mm3 may be an inappropriate criterion for an adverse drug effect. Neither TMP-SMZ nor amoxicillin produced hematologic effects that would detract from their continued use in children with infections caused by antibiotic-susceptible organisms.

Topics: Amoxicillin; Clinical Trials as Topic; Drug Combinations; Female; Humans; Infant; Leukocyte Count; Leukopenia; Male; Neutrophils; Otitis Media; Random Allocation; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Single-dose antibiotic therapy for urinary tract infections in which no underlying structural or neurologic lesions are present holds the promise of greater patient compliance and convenience. We present the results of a study comparing a single intramuscular dose of a long-acting, third-generation cephalosporin, ceftriaxone, with a standard, five-day regimen of trimethoprim-sulfamethoxazole (TMS). Fifty-two patients were entered into the study. After randomization, 26 were assigned to the TMS group and 26 were assigned to the ceftriaxone group. Of the patients who completed the study, 13 of the TMS group had positive cultures at the time of initial presentation, and 20 of the ceftriaxone group had positive cultures. There was no statistical difference between the groups in symptoms of dysuria, hematuria, frequency, flank pain, and nocturia (alpha = .05). The physical parameters of age, blood pressure, pulse, and temperature were similar in the two groups (alpha = .05), as were the types of infecting organisms (alpha = .05). When comparing the two regimens, the ceftriaxone group cure rate (18 of 20, 90%) was not found to be significantly different from that of the TMS-treated control group (13 of 13) (alpha = .05).

Topics: Administration, Oral; Cefotaxime; Ceftriaxone; Drug Combinations; Drug Evaluation; Escherichia coli Infections; Female; Humans; Injections, Intramuscular; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Clavulanic Acids; Clinical Trials as Topic; Drug Combinations; Humans; Middle Aged; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adult; Aged; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Clavulanic Acids; Clinical Trials as Topic; Drug Combinations; Female; Humans; Male; Middle Aged; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The efficacy of a preoperative single-dose of co-trimoxazole in reducing postoperative urinary tract infection and febrile morbidity after abdominal hysterectomy was evaluated in a randomized placebo-controlled study of 90 patients undergoing surgery. Among the co-trimoxazole patients, 6.2% developed urinary tract infection compared to 31% in the placebo group (p less than 0.001) and 12.5% febrile morbidity compared to 38% in the placebo patients (p less than 0.025). No adverse side effects of co-trimoxazole were observed and this regimen seems both safe and effective.

Topics: Adult; Clinical Trials as Topic; Drug Combinations; Female; Humans; Hysterectomy; Length of Stay; Middle Aged; Premedication; Random Allocation; Sulfamethoxazole; Surgical Wound Infection; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The efficacy and safety of amoxicillin-clavulanic acid were compared with those of co-trimoxazole in the treatment of acute urinary tract infections. A total of 104 patients (mean age, 52 years) with clinical and laboratory evidence of acute urinary tract infection were enrolled in the study. Characteristics and infecting organisms were equivalent in both groups of patients. Escherichia coli was the predominant bacteria pathogen in both groups. Both drugs resulted in clinical improvement in 100% of the patients; bacteriological cure after the termination of therapy was 95% with amoxicillin-clavulanic acid and 83% with co-trimoxazole (P less than 0.001). Side effects were not severe enough to necessitate discontinuation of the antimicrobial agents. Amoxicillin-clavulanic acid is effective and safe therapy for acute urinary tract infections caused by susceptible bacteria.

Topics: Acute Disease; Adolescent; Adult; Aged; Amoxicillin; Anti-Infective Agents, Urinary; Clavulanic Acid; Clavulanic Acids; Clinical Trials as Topic; Drug Combinations; Female; Humans; Male; Middle Aged; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Patients undergoing transurethral prostate resection received a 10-day or a 20-day treatment with a combination of pivmecillinam/pivampicillin or with co-trimoxazole starting 1 day before surgery. The results were evaluated in 139 patients. Fifty-three patients had bacteriuria prior to the operation, and the bacteriological cure rate was 22 out of 25 on pivmecillinam/pivampicillin and 22 out of 28 on co-trimoxazole. Eighty-six patients had no bacteriuria pre-operatively and received treatment prophylactically. Two out of 40 patients on co-trimoxazole developed urosepsis, while pivmecillinam/pivampicillin was effective in preventing septicaemic episodes in all 46 patients treated. Tolerance was good with mild side-effects in 5 patients on pivmecillinam/pivampicillin and in 2 patients on co-trimoxazole.

Topics: Aged; Amdinocillin Pivoxil; Ampicillin; Bacteriuria; Drug Combinations; Humans; Male; Middle Aged; Penicillanic Acid; Pivampicillin; Premedication; Prostate; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The results of clinical trials in which norfloxacin was used for 7 days compared with amoxycillin or cotrimoxazole, or for 3 days compared with citrated nalidixic acid, are presented. Additionally, the results of a concurrent open study of 3 days of norfloxacin in the management of simple urinary tract infections are discussed. Resistance to norfloxacin was only encountered in 0.2% of pathogens isolated. Norfloxacin was as effective in eradicating bacteriuria as amoxycillin, cotrimoxazole or citrated nalidixic acid. The response to 3 days of norfloxacin was similar to that seen after 7 days therapy with this compound, or to 7 days of cotrimoxazole. The incidence of adverse experiences to norfloxacin in 758 patients was below 10%.

Topics: Amoxicillin; Anti-Infective Agents, Urinary; Bacteria; Drug Administration Schedule; Drug Combinations; Humans; Nalidixic Acid; Norfloxacin; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

One hundred and twenty-two patients with uncomplicated urinary tract infections were treated with either 400 mg bd norfloxacin or 160/800 mg bd cotrimoxazole for 7 days. Follow-up examinations showed norfloxacin to be equally effective as cotrimoxazole in the eradication of bacteriuria and symptoms. Norfloxacin caused fewer and less severe side effects.

Topics: Anti-Infective Agents, Urinary; Bacteriuria; Drug Combinations; Female; Humans; Male; Nalidixic Acid; Norfloxacin; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Forty-three women with acute, symptomatic urinary tract infections were randomized to receive either norfloxacin (400 mg) twice daily or trimethoprim-sulfamethoxazole (160-800 mg) twice daily for 10 days. Of the 43 patients, 7 (16%) had low-count bacteriuria and pyuria and were included in the evaluation. Escherichia coli was isolated in 72% of the infections, whereas coagulase-negative staphylococci were isolated in 14%. All isolates were susceptible to the assigned study drug. The MICs for 90% of the strains susceptible to norfloxacin and trimethoprim-sulfamethoxazole were less than or equal to 2 and less than or equal to 0.8-16 micrograms/ml, respectively. The cure rates for norfloxacin and trimethoprim-sulfamethoxazole were 95 and 90%, respectively. There were 17 patients with presumptive upper tract infections; only 1 of these relapsed after therapy. The effects on the periurethral flora were similar in both groups, but the infecting organism was eradicated from the fecal flora in 93% of the patients treated with norfloxacin and in 57% of the patients treated with trimethoprim-sulfamethoxazole. More early reinfections occurred in the trimethoprim-sulfamethoxazole group, with resistant organisms appearing in urine and in the periurethral and fecal flora in all cases. Three patients in each group experienced adverse clinical effects, but these were more severe in the trimethoprim-sulfamethoxazole group. No adverse hematological or biochemical changes were noted. From these results, we concluded that norfloxacin is at least as effective as trimethoprim-sulfamethoxazole in the therapy of acute, symptomatic urinary tract infections in women.

Topics: Acute Disease; Adult; Aged; Anti-Infective Agents, Urinary; Bacteria; Drug Combinations; Feces; Female; Humans; Male; Middle Aged; Nalidixic Acid; Norfloxacin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urethra; Urinary Tract Infections

Women with uncomplicated urinary tract infections were randomly allocated to either a single 150 mg intramuscular dose of netilmicin or a standard five-day course of oral co-trimoxazole. Twenty-one of 22 were cured with netilmicin and all 20 with co-trimoxazole. No patient treated with netilmicin developed any side effects or obvious toxicity. Following co-trimoxazole one woman developed a severe skin rash and another nausea. Netilmicin is another drug which is highly effective when used in a single dose regimen for the treatment of uncomplicated urinary tract infections. There are many advantages of this approach to the management of a common clinical problem.

Topics: Administration, Oral; Adolescent; Adult; Clinical Trials as Topic; Drug Combinations; Escherichia coli Infections; Female; Gentamicins; Humans; Injections, Intramuscular; Middle Aged; Netilmicin; Prospective Studies; Random Allocation; Staphylococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The aetiology of acute epididymitis presenting to a surgical unit in a District General Hospital is presented. Patients over 45 years old frequently have a coliform urinary tract infection which may be associated with bladder neck obstruction. These patients require treatment with a suitable antibiotic (Co-trimoxazole) and further investigation. This condition occurs more commonly in patients under 45 years old in whom it is not associated with urinary tract infection. We have not demonstrated significant chlamydial infection and in a double blind study the antibiotic Co-trimoxazole did not hasten recovery. In this group the aetiology remains obscure.

Topics: Acute Disease; Adolescent; Adult; Aged; Anti-Infective Agents, Urinary; Bacteria; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Epididymitis; Humans; Male; Middle Aged; Prospective Studies; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder Neck Obstruction; Urinary Tract Infections; Urine

In a prospective trial, 67 women (outpatients and inpatients) with acute symptomatic infection of the lower urinary tract were randomly selected to receive either a single dose of oral co-trimoxazole or conventional five-day therapy with the same drug. Diagnostic and bacteriological problems were investigated. Both regimens showed similar effectiveness with 91% (five-day therapy) and 100% (single-dose therapy) clinical and bacteriological cure. There were no co-trimoxazole-resistant species in vitro and no therapy side effects. As in other studies, we found that in more than one-third of the cases enterococcus was the responsible bacteria for the infection. This is an important finding because of its resistance to cephalosporins.

Topics: Anti-Infective Agents, Urinary; Bacteriological Techniques; Bacteriuria; Clinical Trials as Topic; Drug Administration Schedule; Drug Combinations; Female; Humans; Prospective Studies; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The efficacy of single-dose therapy with trimethoprim-sulfamethoxazole (TMP-SMZ) and the cost-effectiveness of routine urinalyses and cultures were studied in a prospective randomized trial of 200 women who presented with symptoms of acute lower urinary tract infection. Without the physician's knowledge of the results of urinalysis or culture, the patients were randomly assigned to receive either a single dose or a 10-day multiple-dose course of TMP-SMZ and were followed up for 6 months. Of the 136 patients with positive urine cultures, 68 received single-dose therapy with TMP-SMZ--10 of whom had relapses--and 68 received multiple-dose therapy with TMP-SMZ--only 2 of whom had relapses (P less than 0.02). Fifteen patients in each treatment group experienced reinfection. Side effects of rash and vaginitis were more common in patients who received multiple-dose therapy, but they were mild and well tolerated. Of the 51 patients with urethral syndrome, 48 became asymptomatic after therapy. None of the following tests predicted treatment outcome: pretreatment urinalysis, urine culture or susceptibility testing, antibody-coated bacteria testing, or routine follow-up urinalyses or urine cultures. Empiric therapy with TMP-SMZ in selected women with symptoms of acute uncomplicated urinary tract infection seems practical, safe, and cost-efficient. Considerable savings can be achieved by reserving urinalyses and urine cultures for patients with persistent or recurrent symptoms. Higher cure rates can be expected in patients who receive a standard 10-day course of therapy with TMP-SMZ compared with those who receive single-dose therapy with TMP-SMZ.

Topics: Acute Disease; Adolescent; Adult; Clinical Trials as Topic; Cost-Benefit Analysis; Cystitis; Drug Combinations; Female; Humans; Middle Aged; Prospective Studies; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urine

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Clavulanic Acids; Drug Combinations; Humans; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Forty patients with urinary tract infections were randomly assigned to receive a ten-day course of oral therapy with either norfloxacin 400 mg twice daily or cotrimoxazole (trimethoprim-sulfamethoxazole) 160/800 mg twice daily. There were 34 cases (19 in the norfloxacin and 15 in the cotrimoxazole group) of evaluable infections due to Escherichia coli (85% of cases), Klebsiella pneumoniae, Enterobacter spp., Proteus vulgaris and Alcaligenes faecalis. All organisms were sensitive to the assigned study drug. Twenty-two strains of Escherichia coli and five other isolates had a norfloxacin MIC50 of 0.03 mg/l and MIC90 of 1.0 mg/l. All patients were cured of the initial infection. Three diabetic patients in the norfloxacin group and another healthy patient in the cotrimoxazole group experienced asymptomatic recurrences due to organisms of the same species which, in the absence of causes of bacterial persistence, were considered to be reinfections. Mild reversible adverse effects of no clinical significance were observed in nine patients in each treatment group. Norfloxacin seems to be as effective and safe as cotrimoxazole in the conventional treatment of uncomplicated urinary tract infection.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Bacteria; Clinical Trials as Topic; Drug Combinations; Female; Humans; Male; Middle Aged; Nalidixic Acid; Norfloxacin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In a randomised prospective study 61 patients with lower urinary tract infection received either 200 mg norfloxacin (33 patients) or 480 mg cotrimoxazole (28 patients) twice daily for ten days. Pathogens included Escherichia coli in 48 patients, Proteus mirabilis in ten patients, and Enterobacter cloacae, Klebsiella pneumoniae, Citrobacter freundii and Staphylococcus saprophyticus in one patient each. The MICs of norfloxacin and cotrimoxazole were less than or equal to 0.03 mg/l and less than or equal to 1 mg/l respectively. On the tenth day of treatment 94% of the patients receiving norfloxacin and 89% of the patients receiving cotrimoxazole were clinically cured, and the pathogens were eradicated in 94% and 96% of the patients respectively. At six week follow-up one patient given cotrimoxazole and two given norfloxacin had a reinfection. No side-effects or toxicity were observed with the exception of a diffuse rash in one patient receiving cotrimoxazole in whom treatment was discontinued. It is concluded that norfloxacin is safe and as effective as cotrimoxazole in the treatment of lower UTI and should have an important role to play whenever multiresistant organisms are implicated.

Topics: Adult; Aged; Anti-Infective Agents; Anti-Infective Agents, Urinary; Clinical Trials as Topic; Drug Combinations; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nalidixic Acid; Norfloxacin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

This study was undertaken to compare the effectiveness of trimethoprim alone (300 mg daily) with both cotrimoxazole (0.96 g 12-hourly) and sulphamethizole (1 g eight-hourly) for the treatment of uncomplicated urinary tract infections in general practice. Treatment was continued for five days in all patients. Twenty patients were included in each group. The cure rates (sterile urine one week after finishing treatment) for trimethoprim, co-trimoxazole and sulphamethizole were 90, 95 and 90% respectively. Side effects were minimal. It is recommended that trimethoprim alone replace co-trimoxazole for the treatment of uncomplicated urinary tract infections.

Topics: Adolescent; Adult; Aged; Clinical Trials as Topic; Drug Combinations; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Sulfamethizole; Sulfamethoxazole; Sulfathiazoles; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adult; Aged; Amoxicillin; Clinical Trials as Topic; Drug Combinations; Female; Humans; Male; Middle Aged; Nitrofurantoin; Penicillin G; Random Allocation; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Body Weight; Child; Child, Preschool; Drug Combinations; Female; Growth; Humans; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Two regimes of rifaprim (RPM), a 3.75 to 1 combination of rifampicin (RIF) and trimethoprim (TMP), were compared with co-trimoxazole (CO-T) for the treatment of urinary tract infection in 60 patients. Dosages were: A, 450 mg RIF + 120 mg TMP twice daily; B, 600 mg RIF + 160 mg TMP at bedtime and C, 800 mg sulphamethoxazole (SMZ) + 160 mg TMP twice daily. Clinical results were similar but CO-T treatment was accompanied by a greater number of late bacteriological failures. In none of 40 patients receiving RPM did resistance to any of the components develop, while in three of 20 patients receiving CO-T resistance to TMP or SMZ emerged during treatment. There were no side effects in the patients receiving RPM, but three patients developed transient laboratory abnormalities. One patient receiving CO-T had a rash and one further transient laboratory abnormalities. Satisfactory concentrations of RIF and TMP were measured in urine up to 24 h after a dose of 600 mg RIF + 160 mg TMP. RIF may be a better companion to TMP than the sulphonamides for the treatment of urinary tract infection.

Topics: Adult; Drug Combinations; Female; Humans; Male; Middle Aged; Rifampin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adult; Anti-Infective Agents; Child; Drug Combinations; Female; Follow-Up Studies; Humans; Male; Methenamine; Middle Aged; Nitrofurantoin; Recurrence; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Previous work has suggested that co-trimoxazole may be superior to trimethoprim in the treatment of complicated urinary tract infection. A prospective study has been done to assess the relative value of the drugs in this situation using trimethoprim at higher than normal dosage. Fifty three patients (33 women and 20 men) were randomly allocated to either a fourteen-day course of co-trimoxazole tabs, 2 twice a day (27 patients) or trimethoprim 250 mg twice a day (26 patients). After patient withdrawals from the study, 17 (77%) of the co-trimoxazole group achieved a sterile urine three weeks after starting treatment compared with 15 (65%) in the trimethoprim group (X2 = 0.80). When those patients with sterile urine at three weeks who could be reassessed four weeks later were analyzed, 8 (89%) of the co-trimoxazole patients maintained a sterile urine against 7 (58%) in the trimethoprim group (X2 = 1.09). Although statistical significance was not attained, the results suggest that even at increased dosage, trimethoprim would not appear to be as efficient as co-trimoxazole in complicated urinary tract infection.

Topics: Adult; Aged; Drug Combinations; Female; Humans; Male; Middle Aged; Prospective Studies; Random Allocation; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A new antimicrobial drug combination of trimethoprim and methenamine hippurate (TMP + MH) at 2 different dosages (100 + 500 mg and 200 + 1000 mg b.i.d.) was compared by a random double-blind technique with plain TMP (200 mg b.i.d.) and TMP-sulfamethoxazole combination (160 mg + 800 mg b.i.d.). Each of the 4 test groups of 40-47 patients with acute UTI was treated for 2 weeks. The successful response in the test groups varied from 91 to 98% and no statistical difference could be found between the groups. The side-effects were least common in the group treated with the lower dose of TMP-MH combination.

Topics: Acute Disease; Adolescent; Adult; Aged; Anti-Infective Agents, Urinary; Double-Blind Method; Drug Combinations; Female; Hippurates; Humans; Male; Methenamine; Middle Aged; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Acute Disease; Adolescent; Adult; Aged; Anti-Infective Agents, Urinary; Child; Drug Combinations; Female; Humans; Male; Middle Aged; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Augmentin was compared with co-trimoxazole for the treatment of uncomplicated urinary tract infections in general practice. All 28 patients randomly allocated to treatment with co-trimoxazole were cured. Of the 24 patients treated with augmentin 20(83%) were cured. The cure rate with co-trimoxazole was significantly greater (p = 0.039) than with augmentin. One patient treated with co-trimoxazole developed a skin rash. Two patients treated with augmentin developed severe diarrhoea and abdominal pain and a further two light-headedness. Two of the patients who failed augmentin treatment were reinfected with an augmentin-resistant organism. Twelve of the 52 pathogens were resistant to amoxycillin. One of these 12 was also resistant to augmentin and two only moderately sensitive. An additional three patients were excluded from the study because their infecting pathogen was resistant to augmentin. Augmentin would appear to have a place in the treatment of amoxycillin-resistant bacterial infections.

Topics: Adolescent; Adult; Aged; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Infective Agents, Urinary; Clavulanic Acids; Drug Combinations; Female; Humans; Male; Middle Aged; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Forty-four pregnant women with covert (asymptomatic) bacteriuria proven by suprapubic bladder aspiration were randomly allocated to treatment with either a single 1.92g dose or a standard 5-day course of co-trimoxazole. Twenty-one of 24 women were cured with a single dose. Seven of these 21 women were reinfected later in the pregnancy. All 20 women treated with a 5-day course of co-trimoxazole were cured, and 2 became reinfected later in the pregnancy. There were no side-effects of treatment, and no detrimental effects on the outcome of pregnancy. Single dose therapy should be considered as the treatment of choice for covert bacteriuria in pregnancy.

Topics: Adult; Anti-Infective Agents, Urinary; Drug Administration Schedule; Drug Combinations; Female; Humans; Pregnancy; Pregnancy Complications, Infectious; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adolescent; Adult; Aged; Amoxicillin; Bicarbonates; Double-Blind Method; Drug Combinations; Drug Evaluation; Female; Humans; Middle Aged; Penicillin Resistance; Random Allocation; Sodium Bicarbonate; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adult; Anti-Infective Agents, Urinary; Clinical Trials as Topic; Drug Combinations; Female; Humans; Nalidixic Acid; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

28 children with initial episodes of urinary tract infection were treated with cotrimoxazole or cotrifamole (dose ratio 3 : 2) for 14 days in a prospective randomized double blind trial. The two groups did not differ as regards clinical signs. The efficacy and cure rates of each regimen were similar. Laboratory studies (hemoglobin, WBC, liver, and renal function) showed no differences between both groups before and after therapy; an alteration of the laboratory values could not be observed during therapy. The number of children with X-ray abnormalities of kidneys and urinary tract was similar in both groups. During an observation time of up to 12 months after the first urinary tract infection no differences in the number of reinfections and relapses were observed. As a result of this study, we recommend cotrifamole in a lower dose (ratio 2 : 3) than cotrimoxazole for the treatment of urinary tract infection.

Topics: Adolescent; Anti-Infective Agents, Urinary; Child; Child, Preschool; Double-Blind Method; Drug Combinations; Female; Humans; Male; Radiography; Random Allocation; Recurrence; Sulfamethoxazole; Sulfamoxole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Child; Child, Preschool; Drug Administration Schedule; Drug Combinations; Female; Humans; Infant; Male; Sulfadiazine; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A new combination of trimethoprim with a sulphonamide, named Kelfiprim, differs from cotrimoxazole in that: a) the sulpha drug is sulphamethopyrazine instead of sulphamethoxazole; b) the trimethoprim to sulpha ratio is 5:4 instead of 1:5; c) the presence of a long-acting sulphonamide allows the administration of a daily dose of one capsule, following an initial loading dose of two capsules; d) a reduced amount of trimethoprim is given, as compared to cotrimoxazole, without any decrease of efficacy. Kelfiprim [KP] was compared to cotrimoxazole [Co] in a multicentre double blind trial. Sixty four patients suffering from acute and chronic infections of the upper and lower urinary tract entered the study. Urine sterilisation and clinical improvement without relapses showed no differences from the two treatment groups. Tolerance was excellent except in two patients, one treated with KP and the other treated with Co, who showed a transient exanthema.

Topics: Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Female; Humans; Male; Sulfalene; Sulfamethoxazole; Sulfanilamides; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Clinical Trials as Topic; Double-Blind Method; Drug Administration Schedule; Drug Combinations; Humans; Male; Patient Compliance; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A randomised single-blind clinical trial compared cinoxacin (500 mg every 12 hours) to co-trimoxazole (160 mg trimethoprim, 800 mg sulphamethoxazole every 12 hours) in the treatment of 63 patients with urinary tract infections. The symptomatic response was 73% for both drugs. Bacterial eradication was achieved in 81% and 100% of patients receiving cinoxacin and co-trimoxazole respectively. Three patients receiving co-trimoxazole stopped treatment because of adverse reactions. We conclude that cinoxacin is an effective and safe antibacterial agent in the treatment of urinary tract infections.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Urinary; Bacteriuria; Cinoxacin; Clinical Trials as Topic; Cystitis; Drug Combinations; Drug Hypersensitivity; Escherichia coli Infections; Female; Humans; Male; Middle Aged; Nausea; Pyelonephritis; Pyridazines; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The efficacy and tolerance of a fixed-dose combination of 200 mg pivmecillinam and 250 mg pivampicllin was compared with that of co-trimoxazole (800 mg sulphamethoxazole plus 160 mg trimethoprim) in 42 hospital in-patients with complicated urinary tract infections. Patients received a 10-day course of tablets of either agent twice daily. The infecting organisms, which were Enterobacteriaceae (79%) and enterococci (21%), were eradicated in 17(89%) of the 19 patients given co-trimoxazole and in all 23 subjects who received pivmecillinam/pivampicillin. Sixteen (89%) of the 18 symptomatic patients responded clinically to co-trimoxazole. Pivmecillinam/pivampicillin was effective in 19 (95%) of 20 patients with symptomatic infections. There was a fairly good correlation between the bacteriological and clinical responses. No serious side-effects were recorded and all patients completed the prescribed course of treatment.

Topics: Adult; Aged; Amdinocillin Pivoxil; Ampicillin; Clinical Trials as Topic; Drug Combinations; Female; Humans; Male; Middle Aged; Penicillanic Acid; Pivampicillin; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adult; Amoxicillin; Clinical Trials as Topic; Drug Administration Schedule; Drug Combinations; Female; Humans; Male; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Clinical Trials as Topic; Drug Administration Schedule; Drug Combinations; Humans; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Acute Disease; Double-Blind Method; Drug Combinations; Female; Humans; Microbial Sensitivity Tests; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

One hundred and thirty-five college-age women with acute urinary tract infections caused by gram-negative Enterobacteriaceae were treated by random allocation with either nalidixic acid (NA), 1 g every 6 h for 7 days, or trimethoprim/sulfamethoxazole (TMP/SMZ), 160/800 mg every 12 h for 10 days. The clinical and bacteriological cure rates were 98.0% in each group on the last day of therapy. At 1 and 4 week posttherapy, both the clinical and bacteriological cure rates for NA declined to 90.0 and 74.0% respectively; for TMP/SMZ, they declined to 93.0 and 72.0% respectively. By 4 weeks posttherapy, 96.0% of the TMP/SMZ group and 93.0% of the NA group had remained free of the initial urinary pathogens. Neither drug was associated with emergence of resistant bacterial mutants in urine. The antibody-coated bacteria tested (ACBT) localized 31.5% of the infections of the kidney and 67.7% to the bladder. Upper tract symptoms did not correlate with the presence of a positive ACBT. The response to therapy was similar for the two regimens regardless of ACBT results. After treatment, the emergence of resistant Enterobacteriaceae in fecal flora was 1.1% in the NA group and 2.3% in the TMP/SMZ group. The incidences of drug reactions were 7.0% with NA and 6.3% and TMP/SMZ.

Topics: Adult; Drug Combinations; Feces; Female; Humans; Nalidixic Acid; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Patient compliance and drug efficacy and side-effects were compared in two groups of patients with symptoms of acute lower urinary tract infections. One group was treated with trimethoprim, one tablet (300 mg) once a day, and the other with co-trimoxazole, two tablets (160 mg trimethoprim, 800 mg sulphamethoxazole) twice a day; both treatments were prescribed for seven days. Patient compliance was significantly greater with trimethoprim: corrected percentage compliance rates were 97.5 per cent for trimethoprim and 79.1 per cent for co-trimoxazole (p<0.05). Trimethoprim and co-trimoxazole were of equivalent effectiveness in the control of symptoms. Side-effects were more frequent with co-trimoxazole, but the difference was not significant.

Topics: Acute Disease; Adolescent; Adult; Aged; Anti-Infective Agents, Urinary; Bacterial Infections; Drug Combinations; Female; Humans; Middle Aged; Patient Compliance; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Amoxicillin; Anti-Bacterial Agents; Drug Administration Schedule; Drug Combinations; Female; Humans; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Two hundred patients undergoing prostatic surgery at 2 hospitals were randomly allocated into 4 equal groups. The groups were a control, cephalexin, co-trimoxazole and carfecillin treated groups. The incidence of urinary tract infections and other complications of prostatic surgery were studied in each group after a short-term prophylactic regime of 3 doses of the antibiotic. The incidence of urinary infection was significantly improved from 28% in the control group to 8% and 16% in the co-trimoxazole and cephalexin groups respectively. Carfecillin was not effective in reducing urinary infection. However, all 3 antibiotics reduced the incidence of other infective sequelae.

Topics: Anti-Bacterial Agents; Carfecillin; Cephalexin; Clinical Trials as Topic; Drug Combinations; Humans; Male; Postoperative Complications; Premedication; Prostatectomy; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A combination of sulphadiazine and trimethoprim (co-trimazine) has been developed specifically for the management of urinary tract infections. The pharmacokinetics of co-trimazine make it possible to use lower doses of both the sulphonamide and trimethoprim than in co-trimoxazole, while maintaining clinical efficacy. One hundred and twenty women with a urinary tract infection were randomly allocated to a five-day course of treatment with either co-trimazine (sulphadiazine 410 mg and trimethoprim 90 mg 12-hourly), co-trimoxazole (sulphamethoxazole 800 mg and trimethoprim 160 mg 12-hourly) or sulphamethizole (1 g 8-hourly). The respective cure rates were 95, 98 and 90 percent. No serious side effects of therapy were encountered. Co-trimazine proved to be an effective antibacterial combination for the treatment of uncomplicated urinary tract infections.

Topics: Adult; Clinical Trials as Topic; Drug Combinations; Drug Therapy, Combination; Female; Humans; Sulfadiazine; Sulfamethizole; Sulfamethoxazole; Sulfathiazoles; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adolescent; Adult; Aged; Bacteriuria; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Escherichia coli; Female; Follow-Up Studies; Humans; Male; Middle Aged; Random Allocation; Sulfamethizole; Sulfamethoxazole; Sulfathiazoles; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Sixty-four women with an uncomplicated urinary tract infection were randomly allocated to receive treatment with either an 0.96 g, 1.92 g or 2.88 g single oral dose of co-trimoxazole or a conventional five-day course of co-trimoxazole. The success of each group was comparable although it is suggested that a single dose should be at least 1.92 g (four tablets Septrin or Bactrim). This study confirmed previous work that single dose therapy was effective and well tolerated, preferred by the patients and side effects were minimal. This approach to treatment should be strongly encouraged.

Topics: Adolescent; Adult; Bacterial Infections; Drug Combinations; Escherichia coli Infections; Female; Humans; Middle Aged; Staphylococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Forty-eight women with urinary tract infection due to Co-trimoxazole sensitive organisms were randomly allocated to receive either two tablets (0.96 grams) of Co-trimoxazole twice a day for one day, four tablets (1.92 grams) of Co-trimoxazole as a single dose, or, two tablets of Co-trimoxazole twice a day for seven days. The infection cure rate was comparable in each group being 82%, 87% and 81% respectively. The patients who received the single dose had a high incidence of minor side effects. Accordingly one-day treatment appears to be the treatment mode of choice. Failure to respond to single dose or single day treatment may indicate those patients requiring investigation of their urinary tract.

Topics: Drug Administration Schedule; Drug Combinations; Escherichia coli Infections; Female; Humans; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

This retrospective single-center study included children aged 2 months to 18 years who were prescribed an oral antibiotic for microbiologically confirmed urinary tract infection (UTI). The primary outcomes were re-encounter to the hospital, emergency department, or urgent care within 30 days and modification of the antibiotic regimen within 14 days. Development of

Topics: Anti-Bacterial Agents; Cefdinir; Cephalexin; Child; Humans; Outpatients; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To evaluate variability among hospitals in susceptibility of common uropathogens to antimicrobial agents frequently used in transurethral procedures in order to examine whether state-based guidelines might be more appropriate than national prophylactic guidelines.. Hospital-level antibiograms were requested from all hospitals throughout the state of Missouri. We studied Escherichia coli, Klebsiella, and Proteus sensitivities to evaluate common guideline recommended antimicrobials including trimethoprim sulfamethoxazole (TMP-SMX), third-generation cephalosporins, cefazolin, penicillin combinations, gentamicin, and fluoroquinolones. We evaluated variability and association between hospital characteristics and antimicrobial sensitivities.. Data was requested from 81 hospitals across the state and 38 provided the requested data (47% response rate). Susceptibility was highest for third-generation cephalosporins for E. coli (mean of 94%), Proteus (96%), and Klebsiella (96%). Gentamicin also had high susceptibility for the bacteria studied; 94% for E. coli and 96% for Klebsiella. Current first line recommended agents showed more modest coverage for E. coli (cefazolin 84%, TMP-SMX 78%), Proteus (cefazolin 82%, TMP-SMX 71%), and Klebsiella (cefazolin 90%, TMP-SMX 89%).. Post transurethral procedure infections are common. Rates can be limited with appropriate prophylaxis. Deciding on empirical coverage must take into account local resistance patterns. There is substantial variability among and within states in antimicrobial susceptibility for common uropathogens. When selecting antimicrobial prophylaxis, urologists should consider local- rather than state- or nation-level antibiograms, given the considerable variability. Future studies should consider the merits of very-broad spectrum prophylaxis and the potential role of molecular urinary pathogen (and pathogen-resistance) testing when selecting an optimal regimen.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Cefazolin; Drug Resistance, Bacterial; Escherichia coli; Gentamicins; Humans; Microbial Sensitivity Tests; Missouri; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Bacterial Agents; beta-Lactamases; Escherichia coli; Escherichia coli Infections; Female; Humans; Male; Microbial Sensitivity Tests; Prospective Studies; Staphylococcus saprophyticus; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

IntroductionEmpirical therapy for the treatment of urinary tract infections should be tailored to the current distribution and susceptibility of potential pathogens to ensure optimal treatment.AimWe aimed to provide an up-to-date overview of the epidemiology and susceptibility of Enterobacterales isolated from urine in Germany.MethodsWe retrospectively analysed antimicrobial susceptibility data from 201,152 urine specimens collected between January 2016 and June 2021 from in- and outpatients. Multiple logistic regression analysis was used to evaluate the association between year of investigation and antibiotic resistance, adjusted for age, sex and species subgroup. Subgroup analyses were performed for midstream urine samples obtained from (i) female outpatients aged 15 to 50 years, (ii) female outpatients older than 50 years and (iii) male outpatients.ResultsResistance rates of less than 20% were observed for nitroxoline (3.9%), fosfomycin (4.6%), nitrofurantoin (11.7%), cefuroxime (13.5%) and ciprofloxacin (14.2%). Resistance to trimethoprim/sulfamethoxazole (SXT) (20.1%), amoxicillin-clavulanic acid (20.5%), trimethoprim (24.2%), pivmecillinam (29.9%) and ampicillin (53.7%) was considerably higher. In the subgroup of outpatient women aged 15-50 years, resistance rates were generally lower. Resistance rates of all antibiotics decreased from 2016 to 2021. Multiple logistic regression revealed the lowest adjusted odds ratio (ORadj) of 0.838 (95% confidence interval (CI): 0.819-0.858; p < 0.001) for pivmecillinam and the highest ORadj of 0.989 (95% CI: 0.972-1.007; p = 0.226) for nitrofurantoin.ConclusionsResistance has generally decreased over the past years, independent of sex, age and causative pathogen. Our data provide an important basis for empirical antibiotic recommendations in various settings and patient collectives.

Topics: Amdinocillin Pivoxil; Anti-Bacterial Agents; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Germany; Humans; Male; Microbial Sensitivity Tests; Nitrofurantoin; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Urinary tract infections (UTIs) in children are very common. They are often associated with a high risk of sepsis and death. In recent years, antibiotic-resistant uropathogens ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacteriaceae) are increasingly encountered in UTIs. These bacteria, usually multidrug-resistance (MDR), extensive drug-resistance (XDR), pandrug-resistance (PDR), Extended-spectrum cephalosporin-resistance (ESC), Usual Drug Resistance (UDR), Difficult-to-Treat Resistance (DTR) and Carbapenem-resistance Enterobacteriales (CRE), represent a global threat for the management of paediatric UTIs. The aim of this study was to determine the epidemiology of community origin and antibiotic sensitivity of major ESKAPE uropathogens in paediatric UTIs in South-East Gabon.. The study involved 508 children aged 0-17 years. Identification of bacterial isolates was carried out using Vitek-2 compact automated system and the antibiogram with the disk diffusion and microdilution methods according to the European Committee on Antimicrobial Susceptibility Testing recommendations. Logistic regression analysis was used to assess the impact of patients' socio-clinical characteristics on uropathogens phenotype in both univariate and multivariate analysis.. The prevalence of UTIs was 59%. E. coli (35%) and K. pneumoniae (34%) were the main ESKAPE involved in UTIs followed by Enterococcus spp. (8%) and S. aureus (6%). Among major ESKAPE, DTR-E. coli (p = 0.01), CRE-E. coli (p = 0.02) and XDR-E. coli (p = 0.03), Trimethoprim-sulfamethoxazole-resistant bacteria (p = 0.03) were associated with abdomino-pelvic pain. While MDR-E. coli (p < 0.001), UDR-E. coli (p = 0.02), ESC-E. coli (p < 0.001), MDR- Enterococcus (p = 0.04), UDR- Enterococcus (p = 0.02), bacteria resistant to Ampicillin (p < 0.01), Cefotaxime (p = 0.04), Ciprofloxacin (p < 0.001), Benzylpenicillin (p = 0.03) and Amikacin (p = 0.04) were more frequent among male children. MDR-Enterococcus (p < 0.01), bacteria resistant to Amoxicillin-clavulanic acid (p = 0.03), Cefalotin (p = 0.01), Ampicillin (p = 0.02) and Gentamicin (p = 0.03) were associated with treatment failure. In addition, Trimethoprim-sulfamethoxazole-resistant bacteria (p = 0.03) was associated with recurrent UTIs while those resistant to Ciprofloxacin was associated with pollakiuria (p = 0.01) and urinary burning (p = 0.04). Furthermore, UDR-K. pneumoniae (p = 0.02) was more frequent in neonates and infants.. This study determined the epidemiology of ESKAPE uropathogens in paediatric UTIs. It found a high prevalence of paediatric UTIs associated with children's socio-clinical characteristics and diverse bacterial antibiotic resistance phenotypes.

Topics: Ampicillin; Anti-Bacterial Agents; Ciprofloxacin; Enterococcus; Escherichia coli; Gabon; Humans; Klebsiella pneumoniae; Male; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination; 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

Higher resistance rates of > 20% have been noted in Enterobacteriaceae urinary isolates towards ciprofloxacin and co-trimoxazole (C + C) in Singapore, compared with amoxicillin-clavulanate and nitrofurantoin (AC + N). This study examined if treatment failure varied between different antibiotics, given different resistant rates, for uncomplicated urinary tract infections (UTIs) managed in primary care. We also aimed to identify gaps for improvement in diagnosis, investigations, and management.. A retrospective cohort study was conducted from 2019 to 2021 on female patients aged 18-50 with uncomplicated UTIs at 6 primary care clinics in Singapore. ORENUC classification was used to exclude complicated UTIs. Patients with uncomplicated UTIs empirically treated with amoxicillin-clavulanate, nitrofurantoin, ciprofloxacin or co-trimoxazole were followed-up for 28 days. Treatment failure was defined as re-attendance for symptoms and antibiotic re-prescription, or hospitalisation for UTI complications. After 2:1 propensity score matching in each group, modified Poisson regression and Cox proportional hazard regression accounting for matched data were used to determine risk and time to treatment failure.. 3194 of 4253 (75.1%) UTIs seen were uncomplicated, of which only 26% were diagnosed clinically. Urine cultures were conducted for 1094 (34.3%) uncomplicated UTIs, of which only 410 (37.5%) had bacterial growth. The most common organism found to cause uncomplicated UTIs was Escherichia coli (64.6%), with 92.6% and 99.4% of isolates sensitive to amoxicillin-clavulanate and nitrofurantoin respectively. Treatment failure occurred in 146 patients (4.57%). Among 1894 patients treated with AC + N matched to 947 patients treated with C + C, patients treated with C + C were 50% more likely to fail treatment (RR 1.49, 95% CI 1.10-2.01), with significantly higher risk of experiencing shorter time to failure (HR 1.61, 95% CI 1.12-2.33), compared to patients treated with AC + N.. Treatment failure rate was lower for antibiotics with lower reported resistance rates (AC + N). We recommend treating uncomplicated UTIs in Singapore with amoxicillin-clavulanate or nitrofurantoin, based on current local antibiograms. Diagnosis, investigations and management of UTIs remained sub-optimal. Future studies should be based on updating antibiograms, highlighting its importance in guideline development.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Ciprofloxacin; Drug Resistance, Bacterial; Escherichia coli; Female; Humans; Nitrofurantoin; Primary Health Care; Retrospective Studies; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Trimethoprim-sulfamethoxazole (TMP-SMX) and phenazopyridine are individually associated with methemoglobinemia through a series of altered reduction-oxidation reactions. We report a case of methemoglobinemia associated with concurrent use of TMP/SMX and phenazopyridine in a 70-year-old woman with recurrent urinary tract infections. She presented to the emergency department for worsening back pain in the setting of recurrent urinary tract infections, concerning for pyelonephritis. During her workup, she became acutely hypoxic. The emergency department provider suspected the presence of abnormal hemoglobin. An arterial blood gas showing elevated levels of methemoglobinemia confirmed the suspicion. The combined use of TMP/SMX and phenazopyridine was thought to be the likely etiology of hypoxia. This case highlights the importance of medication management in the geriatric population, as well as the judicious use of antibiotics for urinary tract infections-a common chief complaint in the primary care setting.

Topics: Aged; Eating; Female; Humans; Methemoglobinemia; Phenazopyridine; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Urinary tract infection (UTI) caused by Escherichia coli is a significant health issue in children. Today especially E.coli O25b/ST131, defined as a pandemic clone, is a serious public health problem due to its high virulence and antimicrobial resistance rates. In this study, a total of 200 (100 first and 100 recurrent UTI-causing) E.coli isolates from urine samples sent to the Ankara University School of Medicine Cebeci Training and Research Hospital Central Laboratory between January and September 2021 with the preliminary diagnosis of UTI in pediatric patients aged three to 18 years were analyzed for antimicrobial resistance rates, phylogenetic group distributions, virulence factor frequencies and whether they belong to the O25b/ST131 clone. It is aimed in this study that, the obtained data will shed light on new studies for diagnosis, treatment and prophylaxis options that can be developed for more effective UTI management by contributing to the surveillance studies in our country. Antimicrobial susceptibility of E.coli isolates identified by conventional methods was evaluated by Kirby-Bauer disc diffusion method and extended spectrum beta-lactamase (ESBL) production was evaluated by double disc synergy test. Polymerase chain reaction (PCR) was used for the investigation of phylogenetic grouping, the O25b/ST131 clone, virulence genes and the molecular level classification of the isolates detected as uropathogenic E.coli (UPEC). Pulsed-field gel electrophoresis (PFGE) was performed with the isolates collected at different times from the same patient. The highest antimicrobial resistance rates observed were against ampicillin (n= 100, 50%), cefazolin (n= 99, 49.5%), trimethoprim-sulfamethoxazole (n= 55, 27.5%), amoxicillin-clavulanic acid (n= 43, 21.5%) and cefotaxime (n= 43, 21.5%). In recurrent UTI agents, resistance rates were higher for cefotaxime (n= 29, 29%), trimethoprim-sulfamethoxazole (n= 35, 35%) and cefepime (n= 25, 25%) and in O25b/ST131 isolates (n= 67) the rates were higher for amikacin (n= 3, 4.5%), gentamicin (n= 10, 14.9%) and ciprofloxacin (n= 17, 25.4%) when compared to the first UTI agents and non-O25b/ ST131 isolates (p< 0.05). It was found that 29% (n = 58) of the isolates were multidrug resistant (MDR) and 19% (n = 38) produced ESBL.The rate of recurrent UTI agents was found to be higher among ESBL producing isolates and/or MDR isolates (n= 36, 62% and n= 27, 71%, respectively, p< 0.05). It was found that 45.5% (n= 91) of the iso

Topics: Anti-Bacterial Agents; Anti-Infective Agents; beta-Lactamases; Cefotaxime; Child; Clone Cells; Escherichia coli; Escherichia coli Infections; Humans; Phylogeny; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Virulence Factors

Urinary tract infection in pregnancy is a common microbial infection. Antimicrobial resistance among uropathogens is becoming a major health problem worldwide. The antimicrobial agents used to manage urinary tract infections during pregnancy should be carefully chosen. Therefore, this study aimed to determine the bacterial profile, antibiotic susceptibility pattern, and factors associated with urinary tract infection among pregnant women at Hosanna town public health facilities. A facility-based cross-sectional study was conducted from March to August 2022 on a total of 312 pregnant women who attended antenatal care at Hosanna Town public health facilities. Sociodemographic, clinical data, and related information were collected by using a pre-tested questionnaire. In addition, mid-stream urine specimens were collected from study participants. Bacterial pathogens were identified by standard bacteriological techniques. Antibiotic susceptibility testing was performed by using the Kirby Bauer disk diffusion method. The data were analyzed by using SPSS version 25. Chi-square and odds ratios were calculated and a P-value≤0.05 at a 95% confidence interval was considered statistically significant. The results were presented with words and tables. Of a total of pregnant women, 59/312(18.9%) (95% CI: 14.7-23.7) were found to have significant bacteriuria. The predominant isolates were Escherichia coli (E. coli) 22(34.4%), followed by coagulase-negative staphylococci (CoNS) 10(15.6%), Staphylococci aureus (S. aureus) 7(10.9%), and Klebsiella pneumoniae (K. pneumoniae) 6(9.4%). Overall, 78.1% of these isolates were multidrug-resistant (MDR). Gram-negative bacteria were susceptible to meropenem (97.6%), gentamicin (85.7%), nitrofurantoin (82.1%), ciprofloxacin (73.8%), amoxicillin-clavulanic acid (73.8%) and ceftriaxone (71.8%), but highly resistant to ampicillin (95.5%), trimethoprim-sulfamethoxazole (74.4%), doxycycline (71.8%), cefuroxime (69.2%), and cephalexin (69.2%). The gram-positive bacteria were susceptible to gentamicin (86.4%), erythromycin (81.8%), and nitrofurantoin (77.3%): whereas they showed a high level of resistance to penicillin (72.7%), doxycycline (54.5%), trimethoprim-sulfamethoxazole (52.9%), and cefoxitin (52.9%). No formal education for the participant (AOR: 2.86, 95% CI: 1.03-7.98, p=0.044), family monthly income <1500 birr (AOR: 3.19, 95% CI: 1.48-6.89, p=0.003), and previous history of UTI (AOR: 4.52, 95% CI: 2.04-10.03, p=0.001) were signi

Topics: Ampicillin; Anti-Bacterial Agents; Bacteria; Bacteriuria; Cefuroxime; Cephalexin; Cross-Sectional Studies; Doxycycline; Drug Resistance, Bacterial; Escherichia coli; Ethiopia; Female; Gentamicins; Humans; Microbial Sensitivity Tests; Nitrofurantoin; Pregnancy; Pregnant Women; Staphylococcal Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Targeted antibiotic prophylaxis (TAP) is required for patients with positive urine culture before urological surgery. Our aim was to determine the efficacy of TAP. This was a prospective single-center study performed in a urology department. All patients who underwent a programmed surgery were included. Urine culture was obtained before surgery requiring a prophylaxis: in the case of sterile urines, antibiotics were used in accordance with national recommendations; for positive urine culture, a TAP was used in accordance with susceptibility testing. The drugs were administered for 2 days before surgery until withdrawal of bladder catheter. The occurrence of healthcare-associated infections was registered until day 30 after surgery. Two hundred three patients were included for 8 non-consecutive weeks in 2020, among whom fifteen were lost of sight before day 30. Among the remaining 188 patients, most frequent surgeries were 75 prostatic diseases (40%), 50 endo-ureteral surgeries for JJ stent insertion (27%), and 23 bladder cancers (12%). One hundred forty-eight (79%) patients required a urine culture before procedure; 142/148 (96%) urine cultures were performed, leading to 74 TAP. The main isolated bacteria were 48 Enterobacteriaceae and 8 Enterococcus spp. TAP was cotrimoxazole (n = 30), aminoglycosides (n = 11), amoxicillin (n = 9), fluoroquinolones (n = 7), and others (n = 17). The rate of healthcare-associated infections was 14.8% (11/74), including six microbiologically documented antibiotic failures. The rate of healthcare-associated infection after urological surgery using TAP was high, implying to discuss the choice and the dosage of the antibiotic molecules.

Topics: Aged; Aged, 80 and over; Amoxicillin; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacteria; Bacteriuria; Female; Humans; Male; Middle Aged; Prospective Studies; Stents; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Catheters; Urinary Tract Infections; Urology

In some countries, third-generation cephalosporins (3GCs) serve as first-line therapy in children with urinary tract infections (UTIs). However, their use may contribute to the emergence of antibiotic resistance, notably among Gram-negative bacteria (GNB). Integrons are bacterial genetic elements involved in antibiotic resistance in GNB. Their absence is associated with >97% susceptibility to trimethoprim/sulfamethoxazole in adults infected with GNB. The objective of this study was to examine the value of integron detection directly from urine samples as a predictive marker of resistance to trimethoprim/sulfamethoxazole in children with GNB-related UTIs.. Children admitted to the Limoges University Hospital's paediatric emergency department between February 2018 and March 2019 with a suspicion of UTI were eligible for the study. Only confirmed cases presenting a positive urine culture with unique GNB were retained for further study analyses. Integrons were detected directly from urines using real-time PCR.. The data of 72 patients were analysed and integrons were detected in 15 urine samples. The negative predictive value of integron detection for resistance to trimethoprim/sulfamethoxazole was 100% as all of the GNB (all were Enterobacterales) isolated from patients with no integrons detected in their urine samples were susceptible to trimethoprim/sulfamethoxazole.. The detection of integrons in cases of paediatric patients with suspected UTI could help limit 3GC empirical use and empower an empirical first-line strategy better tailored to the needs of each patient.

Topics: Adult; Child; Drug Resistance, Microbial; Humans; Integrons; Microbial Sensitivity Tests; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Fluoroquinolones and trimethoprim/sulfamethoxazole (TMP-SMX) are first-line agents for acute pyelonephritis. Oral β-lactams are second-line agents owing to reported lower efficacy rates, primarily seen with aminopenicillins rather than cephalosporins. The increase in resistance rates and adverse effects associated with first-line agents provides justification to reconsider oral cephalosporins for pyelonephritis. Therefore, the objective of this study was to determine whether there is a difference in urinary tract infection (UTI) recurrence rates between oral cephalosporins and first-line agents in the treatment of acute pyelonephritis. This was a retrospective, single-centre, observational cohort study from 1 December 2018 to 31 May 2020. The study population was adult TRICARE beneficiaries with a diagnosis of acute pyelonephritis who were treated with oral antibiotics. The two cohorts compared were first-line antibiotics (ciprofloxacin, levofloxacin and TMP-SMX) and oral cephalosporins. The primary outcome was UTI recurrence rate at 30 days, which was defined as a repeat clinic visit, emergency department visit or hospital admission for a UTI (cystitis or pyelonephritis). The secondary outcome was to determine independent risk factors for UTI recurrence. A total of 268 cephalosporin and 211 first-line cases were included. The primary composite outcome of UTI recurrence within 30 days occurred in 44 (16%) cephalosporin and 36 (17%) first-line cases (P = 0.851). Independent risk factors for UTI recurrence were chronic kidney disease and Klebsiella spp. isolation. In conclusion, there was no significant difference in UTI recurrence rates between oral cephalosporins and first-line agents in the treatment of acute pyelonephritis in the outpatient setting.

Topics: Adult; Anti-Bacterial Agents; Cephalosporins; Humans; Outpatients; Pyelonephritis; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Antimicrobial resistance (AMR) can complicate effective management of urinary tract infections. We conducted a retrospective study of AMR in Enterobacterales urine isolates from ambulatory and hospitalized adult patients from 2018-2020 (BD Insights Research Database) to evaluate regional differences in isolates with an extended-spectrum beta-lactamase-producing phenotype and those not susceptible to beta-lactams, fluoroquinolone (FQ), nitrofurantoin (NFT), trimethoprim/sulfamethoxazole (TMP/SMX), or multiple antibiotic classes (≥ 2 or ≥ 3). Our analyses included 349,741 Enterobacterales urine isolates from 321 inpatient facilities and 980,354 isolates from 338 ambulatory care facilities. In multivariable analyses, the highest rate of resistance was to beta-lactams (60.8% and 55.8% for inpatient and ambulatory settings, respectively), followed by FQ (27.5%), NFT (27.0%), and TMP/SMX (25.4%) for inpatients and by TMP/SMX (22.4%), FQ (21.6%), and NFT (21.6%) for ambulatory patients. Isolates with an extended-spectrum beta-lactamase-producing phenotype (13.2% and 8.6% for inpatient and ambulatory settings, respectively) and multidrug resistance (inpatient and ambulatory rates of 23.4% and 17.7% for ≥ 2 drugs; 9.9% and 6.4% for ≥ 3 drugs) were also prevalent. Statistically significant differences by geographic region (P ≤ 0.005) were observed for AMR classes in both inpatient and ambulatory settings, but the rates remained above the thresholds recommended for empiric urinary tract infection therapy across most regions.

Topics: Anti-Bacterial Agents; beta-Lactamases; beta-Lactams; Drug Resistance, Bacterial; Enterobacteriaceae; Fluoroquinolones; Humans; Microbial Sensitivity Tests; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

Urinary tract infection and antimicrobial resistance remains the major problem, with significant health and socioeconomic burden, particularly in developing countries. This infection is commonly caused by Gram-negative bacteria, principally by Escherichia coli. So, this study aimed to determine bacterial isolates and antimicrobial resistance trend among patients with urinary tract infection at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. A retrospective study was conducted from January 1st to February 28th. A ten years (2010-2019) record of urine culture results, the biochemical test and antimicrobial susceptibility test results of isolates were collected from the medical microbiology laboratory register using a checklist. Data quality was checked, entered, and analyzed using SPSS version 23. We have presented results through descriptive tables and graphs. The overall prevalence of urinary tract infection among 4441 patients was 24.1%. Escherichia coli (37.7%), Klebsiella pneumoniae (11.4%), and Staphylococcus aureus (9.1%) were the predominant uropathogens. The infection rate was nearly similar across both sexes but highest in the age group above 60 years. Above 75% of Gram-negative isolates were resistant to ampicillin (92.5%), amoxicillin-clavulanate (80.1%), tetracycline (79.3%), cefuroxime (79.2%), and Trimethoprim-sulfamethoxazole (78.3%). Over 2/3 of Gram-positive isolates also showed increased resistance to tetracycline (84.8%) and penicillin (71.6%). Moreover, more than 44% of the isolates were multidrug-resistant (MDR). We have seen an inconsistent trend of antimicrobial resistance, with an overall resistance rate of above 50%. In conclusion, the overall prevalence of urinary tract infection was high and elderly patients were most affected. More than 70% of both Gram positive and gram-negative isolates were resistant to penicillin, ampicillin, amoxicillin-clavulanate, tetracycline, cefuroxime, Trimethoprim-sulfamethoxazole. Above than 44% of the isolates were multidrug-resistant (MDR). The increasing rate of antimicrobial resistance calls for routine diagnosis and antimicrobial susceptibility testing. A prospective multicenter study indicating the status of resistance should be encouraged.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Bacteria; Cefuroxime; Drug Resistance, Bacterial; Drug Resistance, Multiple, Bacterial; Escherichia coli; Ethiopia; Female; Hospitals; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Prospective Studies; Retrospective Studies; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Antibiotic-resistant E. coli infections represent a major cause of morbidity and mortality and pose a challenge to antibiotic stewardship. We analyzed a large outpatient data set of E. coli urinary isolates to determine whether resistance patterns vary between types of outpatient practices. Using deidentified data from a clinical reference laboratory over 5 years and logistic regression, we examined the association of antibiotic resistance with outpatient practice type, controlling for testing year, patient sex, and patient age. The odds of antibiotic resistance were significantly higher in urology/nephrology practices for ampicillin (odds ratio [OR] 1.36; 95% CI, 1.10 to 1.69), ciprofloxacin (OR 2.29; 95% CI, 1.77 to 2.94), trimethoprim-sulfamethoxazole (OR 1.52; 95% CI, 1.18 to 1.94), and gentamicin (OR 1.72; 95% CI, 1.16 to 2.46). Odds of resistance were also higher for ciprofloxacin in oncology practices (OR 1.54; 95% CI, 1.08 to 2.15) and "all other specialties" (OR 1.33; 95% CI, 1.13 to 1.56). In contrast, specimens from obstetrics and gynecology practices had lower odds of having resistance to ampicillin (OR 0.90; 95% CI, 0.82 to 0.99) and trimethoprim-sulfa (OR 0.83; 95% CI, 0.73 to 0.93) but higher odds of having resistance to nitrofurantoin (OR 1.33; 95% CI, 1.03 to 1.70). Other findings included lower odds of having resistance to trimethoprim-sulfa in pediatric practices (OR 0.78; 95% CI, 0.64 to 0.94) and lower odds of having resistance to gentamicin in isolates from internal medicine practices (OR 0.66; 95% CI, 0.51 to 0.84) (all

Topics: Ampicillin; Anti-Bacterial Agents; Child; Ciprofloxacin; Drug Resistance, Bacterial; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Gentamicins; Humans; Microbial Sensitivity Tests; Outpatients; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Urinary tract infections (UTIs) and bacterial resistance to antibiotics is global health problem and a threat to public health in many countries.. The study aimed to determine the prevalence of MDR Escherichia coli and Klebsiella pneumoniae in UTI patients.. The midstream urine samples of 120 patients were collected and cultured as described by the protocols at the respective sample collection sites on MacConkey Blood agar. Samples were tested by using the fully automated VITEK 2 Compact system for Gram-negative identification and detection of antimicrobial susceptibility of microorganisms.. The most prevalent pathogen was E. coli, which was found in 82 (68.3%) urine samples, followed by K. pneumonia, found in 38 (31.7%) urine samples. As far as antibiotic resistance is concerned, E. coli isolates were found to be highly resistant for ceftriaxone (89.0% of the isolates), ampicillin (86.6%), levofloxacin (82.9%), cefotaxime (79.3%), aztreonam (74.4%), ceftazidime (68.3%) and gentamicin, piperacillin, and trimethoprim-sulfamethoxazole, 54.9 and 53.7%, respectively. The E. coli isolates were found to be relatively less resistant to imipenem (2.4%), cefepime (34.1%), and ciprofloxacin (35.4%). For K. pneumonia isolates, high resistance rates were observed for piperacillin (81.6%), levofloxacin (78.9%), ampicillin (76.3%), cefotaxime (73.7%), trimethoprim-sulfamethoxazole (71.1%), ceftazidime (65.8%), gentamicin (63.2%), cefepime (50.0%), and aztreonam (44.7%). However, moderate resistance rates were detected for these were found to be less resistant for imipenem (13.2%), ceftriaxone (31.6%), and ciprofloxacin (36.8%).. E. coli and K. pneumoniae from the clinical isolates displayed high resistance to many antibiotics in UTI patients.

Topics: Ampicillin; Anti-Bacterial Agents; Aztreonam; Cefepime; Ceftazidime; Ceftriaxone; Ciprofloxacin; Drug Resistance, Multiple; Escherichia coli; Escherichia coli Infections; Gentamicins; Humans; Imipenem; Klebsiella Infections; Klebsiella pneumoniae; Levofloxacin; Microbial Sensitivity Tests; Piperacillin; Prevalence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Urinary tract infections (UTIs) seen in the emergency department are commonly treated as an outpatient with oral antibiotics. Given that antibiotics are available for over-the-counter purchase in Mexico, there is speculation that potential misuse and overuse of antibiotics in United States-Mexico border areas could lead to antibiotic resistance patterns that would render some empiric treatments for UTIs less effective. The purpose of this study was to examine the effectiveness of Infectious Disease Society of America (IDSA) guideline-recommended antibiotics for treatment of outpatient UTI diagnosed in the emergency department. Data were collected from a county hospital on the U.S.-Mexico border with a metropolitan area of over 2 million people. Secondary analysis included frequency of urine culture isolated, resistance rates of urine pathogens, and prescriber habits.. This study was a retrospective chart review of adult patients diagnosed and treated for UTI from August 1, 2019, to February 29, 2020. Culture results of included patients were analyzed against in vitro-tested antibiotics. Bacterial isolate frequency, resistance rates, and prescribing habits were collected.. A total of 985 patient charts were reviewed, of which 520 patients met inclusion criteria for analysis of prescribing habits. Of these, 329 positive bacterial culture growths were included in the analysis of antibiotic resistance rates. Oral antibiotics with comparatively lower resistance rates were amoxicillin/clavulanate, cefdinir, cefuroxime, and nitrofurantoin. Oral antibiotics with notably high resistance rates included trimethoprim-sulfamethoxazole (TMP-SMX), tetracycline, ciprofloxacin, levofloxacin, and cephalexin. Nitrofurantoin was prescribed most frequently for outpatient treatment of UTI/cystitis (41.6%) while cephalexin was the most commonly prescribed antibiotic for outpatient treatment of pyelonephritis (50%).. Our findings suggest that, while part of standard IDSA guidelines, fluoroquinolones and TMP-SMX are not ideal empiric antibiotics for treatment of outpatient UTI in the U.S.-Mexico border region studied due to high resistance rates. Although not listed as first line agents per current IDSA recommendations, 2nd and 3rd generation cephalosporins, and amoxicillin/clavulanate would be acceptable options given resistance patterns demonstrated in accordance with IDSA allowance for tailoring selection to local resistance. Nitrofurantoin appears to be consistent with recommendations and demonstrates a favorable resistance profile for treatment of outpatient UTI within this region.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefdinir; Cefuroxime; Cephalexin; Ciprofloxacin; Emergency Service, Hospital; Fluoroquinolones; Humans; Levofloxacin; Mexico; Nitrofurantoin; Retrospective Studies; Tetracyclines; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

Infections due to carbapenem-resistant. A total of 76 confirmed UPEC isolates were obtained from patients mentioned to teaching hospitals in Babol, Iran. The results of antibiotic susceptibility testing revealed a high rate of antibiotic resistance against nalidixic acid (81.6%) and trimethoprim-sulfamethoxazole (80.3%). Among UPEC isolates, 63.2% and 13.2% of UPEC isolates were positive for MBL production. The frequencies of the studied genes are in order of. The high prevalence of MDR and carbapenemase-producing isolates among the UPEC strain in this investigation is concerning. Moreover, the

Topics: Anti-Bacterial Agents; Anti-Infective Agents; beta-Lactamases; Biofilms; Carbapenems; Catheters; Cross-Sectional Studies; Edetic Acid; Genetic Variation; Humans; Iran; Nalidixic Acid; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To evaluate the association between initiation of fluoroquinolones and hospital admission or emergency department visit for suicidality.. Population based cohort study.. IBM MarketScan database, USA.. 2 756 268 adults (≥18 years) who initiated an oral fluoroquinolone (ciprofloxacin, levofloxacin, moxifloxacin, gemifloxacin, ofloxacin, gatifloxacin, norfloxacin, lomefloxacin, besifloxacin) or comparator antibiotic (January 2003 to September 2015) and had at least six months of continuous health plan enrollment and a diagnosis of pneumonia or urinary tract infection (UTI) three days or less before the drug initiation date. Comparator antibiotics were azithromycin in the pneumonia cohort and trimethoprim-sulfamethoxazole in the UTI cohort. Participants were matched 1:1 within each cohort on a propensity score, calculated from a multivariable logistic regression model that included 57 baseline covariates.. Primary outcome was hospital admission or emergency department visit for suicidal ideation or self-harm within 60 days after treatment initiation. Cox proportional hazard models were used to estimate hazard ratios and 95% confidence intervals.. The pneumonia cohort included 551 042 individuals, and the UTI cohort included 2 205 526 individuals. During the 60 day follow-up, 181 events were observed in the pneumonia cohort and 966 in the UTI cohort. The adjusted hazard ratios for fluoroquinolones were 1.01 (95% confidence interval 0.76 to 1.36) versus azithromycin in the pneumonia cohort and 1.03 (0.91 to 1.17) versus trimethoprim-sulfamethoxazole in the UTI cohort. Results were consistent across sensitivity analyses and subgroups of sex, age, or history of mental illnesses.. Initiation of fluoroquinolones was not associated with a substantially increased risk of admission to hospital or emergency department visits for suicidality compared with azithromycin or trimethoprim-sulfamethoxazole.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Ciprofloxacin; Cohort Studies; Emergency Service, Hospital; Fluoroquinolones; Gatifloxacin; Gemifloxacin; Hospitals; Humans; Levofloxacin; Moxifloxacin; Norfloxacin; Retrospective Studies; Suicidal Ideation; Suicide; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Urinary tract infections (UTI) are one of the most common infections encountered in the emergency department (ED) with an estimated 2-3 million annual visits. Commonly prescribed antibiotics for UTIs have shown growing rates of resistance. Previous studies lack direction on improving UTI treatment based on the labs available to the bedside clinician.. We sought to determine if antibiotic resistance in UTIs was related to demographics, urinalysis, and history of renal failure or kidney stones. We conducted an analysis of 892 women ≥18 years of age discharged from the ED with a UTI diagnosis. We assessed predictors of nitrofurantoin resistance, cefazolin resistance, ciprofloxacin resistance, and trimethoprim-sulfamethoxazole resistance using unadjusted and multivariable logistic regression models.. Antibiotic resistance was 13.6% for nitrofurantoin, 11.9% for cefazolin, 12.8% for ciprofloxacin, and 17.1% for trimethoprim-sulfamethoxazole. In multivariable analysis, significant independent associations with an increased likelihood of resistance to nitrofurantoin were observed for less urine blood (OR [per 1 category increase of score] 0.81; P = 0.02); greater mucous (OR [per 1 category increase of score] 1.22; P = 0.02); less specific gravity urine (OR [per 1 category increase] 0.87; P = 0.04), and presence of any history of kidney stones (OR 3.24; P = 0.01). There were no significant predictors for cefazolin resistance (all P ≥0.06); age was the only significant predictor of ciprofloxacin resistance (OR per 10 year increase] 1.10, P = 0.05), and lower specific gravity urine was significantly associated with an increased risk of resistance to trimethoprim- sulfamethoxazole (OR [per 1 category increase] 0.88, P = 0.04).. Women with any history of kidney stones may have bacteriuria resistant to nitrofurantoin, suggesting that providers might consider alternative antibiotic therapies in this scenario.

Topics: Anti-Bacterial Agents; Cefazolin; Ciprofloxacin; Drug Resistance, Microbial; Female; Humans; Kidney Calculi; Nitrofurantoin; Trimethoprim, Sulfamethoxazole Drug Combination; Urinalysis; Urinary Tract Infections

The purpose of this study was to determine the effect of sublethal concentrations of nitrofurantoin, ciprofloxacin, and trimethoprim on biofilm formation in 57 uropathogenic

Topics: Anti-Bacterial Agents; Biofilms; Ciprofloxacin; Humans; Nitrofurantoin; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Uropathogenic Escherichia coli

Context: Rising antibiotic resistance has transcended hospital boundaries and impacted individuals with community acquired urinary tract infections (UTI). Scant data on antibiotic resistance in outpatient settings exists and most studies in the United States (U.S.) have identified predictors of resistance in acute-care settings. Objective: Determine the antibiogram among Escherichia coli isolates and factors associated with ciprofloxacin and trimethoprim-sulfamethoxazole (TMP-SMX) resistant gram-negative urinary isolates. Study Design: Retrospective cohort study. Setting: Two primary care, safety-net clinics in Houston, TX between 11/2018 and 3/2020. Population studied: Patients aged 18 and older presenting with provider suspected uncomplicated or complicated UTI. Outcome measures: Resistance and predictors of resistance to UTI-relevant antibiotics. Results: Among 1265 cultures collected, 372 (28.4%) were positive. We detected E. coli (50.3%) and Group B Streptococcus (18.6%) most frequently. Our patient population consisted mostly of Hispanic (75.7%) females (92.5%) born outside the U.S. (67.3%) with a mean age of 47. Among patients with E. coli isolated (n=189), antibiotic resistance was highest to ampicillin (63%), TMP-SMX (44%), ciprofloxacin (31%), and cefazolin (30%); no or low resistance against amikacin (0%), fosfomycin (0%), and nitrofurantoin (2.7%) was detected. Approximately 12% of E. coli isolates were extended-spectrum beta-lactamase positive. Having a prior UTI caused by a TMP-SMX resistant gram-negative organism and being born outside the U.S increased the odds of TMP-SMX resistance by 3.71 (95% confidence interval: 1.6-9.2) and 3.08 (95% CI: 1.6-6.3), respectively. Having a complicated UTI (odds ratio (OR): 3.58; 95% CI: 1.1-12.1), prior fluoroquinolone use (OR: 6.81; 95% CI: 1.7-34.1) and a prior UTI with ciprofloxacin resistance (OR: 7.84; 95% CI: 3.2-20.7) increased the odds of having a ciprofloxacin resistance. Conclusion: The Infectious Disease Society of America cautions against prescribing an antibiotic if regional resistance exceeds 20%. We constructed an antibiogram and found resistance surpassed this threshold for TMP-SMX and ciprofloxacin and identified factors associated with resistance to these agents. Assessing these characteristics during clinical decision making may improve antibiotic-organism susceptibility concordance in primary care.

Topics: Anti-Bacterial Agents; Ciprofloxacin; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Outpatients; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

Urinary tract infection is the second-most common after respiratory infections. This is a single-center retrospective study conducted in Bahrain Specialist Hospital, Bahrain. Urine culture data from November 2011 until December 2020 was obtained from the hospital database. Out of 28082, 4849 (17.3%) cultures were positive. One hundred and thirty-four (2.8%) showed the growth of multiple organisms. The male-to-female ratio was 3.7. Most of the patients [1872 (39.7%)] were 20-40 years. Men and women were 53.84 ± 25.85 and 43.41 ± 23.89 years, respectively; P <0.001. 4118/4715 (87.3%) were Gram-negative. Five hundred and sixty-four (11.9 %) and 33 (0.7%) were Gram-positive cocci and fungi, respectively. Escherichia coli (E. coli) was the most common and Klebsiella species were second-most common, accounting for 2916 (61.8%) and 586 (12.4%), respectively. 30.2% of all E. coli and 130 (22.2%) of all Klebsiella species were extended-spectrum beta-lactamase (ESBL) producers. ESBL Klebsiella pneumoniae, Pseudomonas aeruginosa, and Enterococcus faecalis were present more in inpatients (P <0.001). P. aeruginosa was found more in women (P <0.001). E. coli was resistant to cotrimoxazole, ciprofloxacin, and levofloxacin in 28%, 17.3%, and 18.1%, respectively. ESBL E. coli and ESBL K. pneumoniae were resistant to amoxicillin-clavulanate, cotrimoxazole, ciprofloxacin, and levofloxacin in 73.8%, 62.3%, 62.4%, 58.4% and 68.2%, 62.6%, 55.7%, and 41.8% respectively. There is a high incidence of ESBL E. coli and ESBL K. pneumoniae. There is alarmingly increased resistance of P. aeruginosa to carbapenems. Amoxicillin-clavulanate, cefixime, and cefuroxime are suitable oral antibiotics for empirical treatment. For sick patients, piperacillin-tazobactam, aminoglycosides, and carbapenems should be considered. Antibiotic stewardship is the need of an hour.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bahrain; beta-Lactamases; Carbapenems; Ciprofloxacin; Escherichia coli; Female; Humans; Klebsiella pneumoniae; Levofloxacin; Male; Microbial Sensitivity Tests; Retrospective Studies; Tertiary Care Centers; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We need studies assessing therapeutic options for oral relay in febrile urinary tract infection (FUTI) due to ESBL-producing Enterobacteriaceae (ESBL-E) in children. Amoxicillin-clavulanate/cefixime (AC-cefixime) combination seems to be a suitable option. We sought to describe the risk of recurrence at 1 month after the end of treatment for FUTI due to ESBL-E according to the oral relay therapy used.. We retrospectively identified children <18 years who were included in a previous prospective observational multicentric study on managing FUTI due to ESBL-E between 2014 and 2017 in France. We collected whether children who received cotrimoxazole, ciprofloxacin or the AC-cefixime combination as the oral relay therapy reported a recurrence within the first month after the end of treatment. Then, we analyzed the susceptibility drug-testing of the strains involved.. We included 199 children who received an oral relay therapy with cotrimoxazole (n = 72, 36.2%), ciprofloxacin (n = 38, 19.1%) or the AC-cefixime combination (n = 89, 44.7%). Nine (4.5%) patients had a recurrence within the first month after the end of treatment, with no difference between the 3 groups of oral relay (p = 0.8): 4 (5.6%) cotrimoxazole, 2 (5.3%) ciprofloxacin and 3 (3.4%) AC-cefixime combination. Phenotype characterization of 249 strains responsible for FUTI due to ESBL-E showed that 97.6% were susceptible to the AC-cefixime combination.. The AC-cefixime combination represents an interesting therapeutic option for oral relay treatment of FUTI due to ESBL-E as the recurrence rate at 1 month after the end of treatment was the same when compared to cotrimoxazole and ciprofloxacin.

Topics: Administration, Oral; Adolescent; Amoxicillin-Potassium Clavulanate Combination; beta-Lactamases; Cefixime; Child; Child, Preschool; Ciprofloxacin; Enterobacteriaceae; Female; Fever; France; Humans; Infant; Infant, Newborn; Male; Microbial Sensitivity Tests; Phenotype; Recurrence; Retrospective Studies; Risk; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Bacteria are the commonest etiological factor among the microbes that cause UTIs. The most prevalent bacteria identified in the lab are Escherichia coli, Klebsiella pneumonia and Pseudomonas aeruginosa. Antibiotics are the empiric therapy for such infections but the reoccurrence rate is becoming high owing to the development of resistance due to their irrational and indiscriminate use across the globe. This study was designed on UTI cases of OPD, Medical, Nephrology, Surgical, Main OT, Urology and ICU wards of Allied hospital Faisalabad. 11 antibiotics were used which showed that E. coli is sensitive to Amikacin, Gentamicin, Imipenem, Piperacillin tazobactam, and Polymyxin B. Klebsiella pneumonia showed sensitivity for Amikacin, Gentamicin, Nitrofurantoin, Imipenem, Polymyxin B, Piperacillin tazobactam and Trimethoprim-sulfamethoxazole. While Pseudomonas aurignosa showed resistance to Amikacin, Ciprofloxacin, Gentamicin, Piperacillin tazobactam, Imipenem, and Polymyxin B. E. coli exhibited the highest sensitivity for Piperacillin tazobactam, Klebsiella pneumonia for Imipenem and Pseudomonas aurignosa for Ciprofloxacin. Further, the isolated DNA samples of these microorganisms were confirmed by gel electrophoresis and subjected to molecular characterization by performing trace file and phylogenetic tree analysis.

Topics: Amikacin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Gentamicins; Humans; Imipenem; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Nitrofurantoin; Oxacillin; Pakistan; Pipemidic Acid; Piperacillin, Tazobactam Drug Combination; Polymyxin B; Pseudomonas aeruginosa; Pseudomonas Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Drekonja DM, Trautner B, Amundson C, et al.

Topics: Anti-Bacterial Agents; Ciprofloxacin; Double-Blind Method; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Uncomplicated urinary tract infections are one of the most common bacterial infections in the United States. Clinical practice guidelines from the Infectious Diseases Society of America recommend nitrofurantoin, trimethoprim-sulfamethoxazole, and Fosfomycin as first-line antibiotic treatments and discourage the use of fluoroquinolone antibiotic agents. US Food and Drug Administration released several black box warnings about fluoroquinolones over the past decade owing to antibiotic resistance and a high burden of adverse events. Historically, uncomplicated urinary tract infections have high rates of guideline-discordant treatment with past studies noting substantial use of fluoroquinolones, directly contradicting clinical practice guidelines.. This study aimed to assess the current concordance of physician prescribing practices with Infectious Diseases Society of America guidelines for the treatment of uncomplicated urinary tract infections in women and identify patient and physician predictors of guideline concordance.. A retrospective observational secondary analysis was conducted using a series of cross-sectional data extracted from the IQVIA (Plymouth Meeting, Pennsylvania) National Disease and Therapeutic Index from 2015 to 2019. An estimated 44.9 million women with uncomplicated urinary tract infections at the age of 18 to 75 years were treated as outpatients. This population was selected to lack relevant comorbidities or urological abnormalities so that it matched the Infectious Diseases Society of America guidelines. The proportion of prescriptions for each antibiotic drug class were reported with 95% confidence intervals and compared with the Infectious Diseases Society of America guidelines. Patient and physician characteristics were included in a multivariate logistic regression model to identify independent predictors of antibiotic selection and thereby guideline concordance.. Of the visits that resulted in antibiotic treatment, the overall concordance rate was 58.4% (26.2 million visits of 44.9 million visits) and increased from 48.2% (3.9 million visits of 8.1 million visits) in 2015 to 64.6% (6.3 million visits of 9.8 million visits) in 2019. The most commonly prescribed antibiotic agents were fluoroquinolones (36.4%, 16.3 million visits of 44.9 million visits), nitrofurantoin (31.8%, 14.3 million visits of 44.9 million visits), and trimethoprim-sulfamethoxazole (26.3%, 11.8 million visits of 44.9 million visits). From 2015 to 2019, fluoroquinolone use decreased whereas nitrofurantoin and beta-lactam use increased. Based on the logistic regression, patients aged 18 to 29 years (odds ratio, 1.60; 95% confidence interval, 1.36-1.88; P<.001) and 30 to 44 years (odds ratio, 1.21; 95% confidence interval, 1.03-1.42; P=.020) had a statistically significantly higher likelihood of receiving guideline-concordant treatment than patients aged 45 to 75 years (reference group). Obstetricians-gynecologists (odds ratio, 3.56; 95% confidence interval, 2.91-4.37; P<.001) and urologists (odds ratio, 3.51; 95% confidence interval, 2.45-5.13; P<.001) had a statistically significantly higher likelihood of concordant treatment than all other specialties combined (reference group).. Guideline discordance continues in the treatment of uncomplicated urinary tract infections with the overuse of fluoroquinolones and the underuse of first-line antibiotic agents. Although improving, continued misuse of antibiotic agents may contribute to the growing rates of antibiotic resistance. Actions such as educating physicians about antibiotic resistance and clinical practice guidelines and providing feedback on prescription habits are needed to increase guideline concordance and therefore reduce the use of fluoroquinolones, especially for physicians in family and internal medicine.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Cross-Sectional Studies; Drug Prescriptions; Female; Fluoroquinolones; Guideline Adherence; Humans; Inappropriate Prescribing; Middle Aged; Nitrofurantoin; Practice Guidelines as Topic; Practice Patterns, Physicians'; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections; Young Adult

For several years, we applied an internal guideline for community-acquired urinary tract infections (cUTI), targeting the reduction of fluoroquinolone use (FQ) and thereby favouring cotrimoxazole (CTM) prescription. Our aim was to report adverse effects (AE) and outcome for patients presenting with cUTI and treated with these compounds.. This cohort study was based on the dashboard of our department, bringing together 28 parameters for all patients, including diagnosis, microbiological data, antibiotic therapy, AE, length of hospital stay (LHS) and outcome. We included all patients with cUTI due to Enterobacteriaeae treated with CTM or FQ, and compared these 2 groups on in-hospital AE, LHS, and unfavourable outcome defined as intensive care requirement or death.. From June 2008 to June 2019, 640 cUTI due to Enterobacteriaeae were observed, among which 295 (46%) treated with CTM and 345 (54%) with a FQ. There were 25 AE (3.9%): 17 (5.7%) in the CTM group, and 8 (2.3%) in the FQ group (P=0.025). Adverse effects were associated with increased LHS compared to patients without AE: 11±6 vs. 7±4 days respectively, P<0.001, 11.4±6.2 days in the CTM group vs. 9.2±5.8 in the FQ group (relative LHS increase of 73.5% and 29.5%, respectively). Unfavorable outcome occurred for 1 patient (0.3%) in the CTM group, and 5 (1.4%) in the FQ group, P=0.297.. Favouring cotrimoxazole for cUTI due to Enterobacteriaceae was associated compared to FQ with more AE and prolonged LHS. A cost-effectiveness analysis to validate such therapeutic strategy is warranted.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Cohort Studies; Community-Acquired Infections; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Fluoroquinolones; Humans; Intensive Care Units; Length of Stay; Male; Middle Aged; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To derive weighted-incidence syndromic combination antibiograms (WISCAs) in the skilled nursing facility (SNF). To compare burden of resistance between SNFs in a region and those with and without protocols designed to reduce inappropriate antibiotic use.. Retrospective analysis of microbial data from a regional laboratory.. We analyzed 2484 isolates collected at a regional laboratory from a large mixed urban and suburban area from January 1, 2015, to December 31, 2015.. A total of 28 regional SNFs (rSNFs) and 7 in-network SNFs (iSNFs).. WISCAs were derived combining Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, and reports restricted to fluoroquinolones, cefazolin, amoxicillin clavulanate, and trimethoprim/sulfamethoxazole.. Pooling the target isolates into WISCAs resulted in an average of 28 of 37 achieving a number greater than 30 with an average of 50 isolates (range = 11-113; >97% urinary). Significant differences were found in antibiotic susceptibility between grouped rSNF data and iSNF data of 75% vs 65% (2.76-11.77; P = .002). The susceptibilities were higher in iSNFs with active antibiotic reduction protocols compared with iSNFs without protocols and rSNFs (effect size = .79 vs .67 and .65, respectively) (I. These results suggest that WISCAs can be developed in most SNFs, and their results can serve as indicators of successful antibiotic stewardship programs. J Am Geriatr Soc 68:55-61, 2019.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Antimicrobial Stewardship; Escherichia coli; Female; Humans; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Retrospective Studies; Skilled Nursing Facilities; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

This study aimed to predict trimethoprim/sulfamethoxazole (SXT) resistance in patients with community-onset urinary tract infection (UTI) due to Enterobacteriaceae based on patient-specific risk factors.. This was a retrospective case-control study in Prisma Health facilities in central South Carolina, USA, including three community hospitals, affiliated emergency departments and ambulatory clinics, including adult patients with community-onset UTI due to Enterobacteriaceae (1 April 2015 to 29 February 2016). Multivariate logistic regression was used to examine risk factors for SXT resistance.. Among 351 unique patients with community-onset UTI, 71 (20.2%) had SXT-resistant Enterobacteriaceae urinary isolates. Overall, median age was 64 years and 252 (71.8%) were female. A multivariate model identified prior urinary infection/colonisation with SXT-resistant Enterobacteriaceae (OR=8.58, 95% CI 3.92-18.81; P<0.001) and SXT use within past 12 months (OR=2.58, 95% CI 1.13-5.89; P=0.02) as predictors of SXT resistance among urinary isolates. Most patients with UTI (285; 81.2%) had no risk factors for SXT resistance. SXT resistance rates increased from 13% in the absence of risk factors to 31% in patients with prior SXT use, 66% in those with prior urinary infection/colonisation with SXT-resistant Enterobacteriaceae and 73% in the presence of both risk factors.. SXT resistance in Enterobacteriaceae urinary isolates may be predicted based on prior urine culture results and SXT use within the previous year. Utilisation of a patient-specific antibiogram may allow empirical SXT use in patients with community-onset UTI in the absence of risk factors for resistance.

Topics: Adult; Anti-Bacterial Agents; Case-Control Studies; Female; Humans; Male; Middle Aged; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To determine if a multicomponent intervention was associated with increased use of first-line antibiotics (cephalexin or sulfamethoxazole and trimethoprim) among children with uncomplicated urinary tract infections (UTIs) in outpatient settings.. The study was conducted at Kaiser Permanente Colorado, a large health care organization with ∼127 000 members <18 years of age. After conducting a gap analysis, an intervention was developed to target key drivers of antibiotic prescribing for pediatric UTIs. Intervention activities included development of new local clinical guidelines, a live case-based educational session, pre- and postsession e-mailed knowledge assessments, and a new UTI-specific order set within the electronic health record. Most activities were implemented on April 26, 2017. The study design was an interrupted time series comparing antibiotic prescribing for UTIs before versus after the implementation date. Infants <60 days old and children with complex urologic or neurologic conditions were excluded.. During January 2014 to September 2018, 2142 incident outpatient UTIs were identified (1636 preintervention and 506 postintervention). Pyelonephritis was diagnosed for 7.6% of cases. Adjusted for clustering of UTIs within clinicians, the proportion of UTIs treated with first-line antibiotics increased from 43.4% preintervention to 62.4% postintervention (. A multicomponent intervention with educational and process-improvement elements was associated with a sustained change in antibiotic prescribing for uncomplicated pediatric UTIs.

Topics: Adolescent; Age Factors; Ambulatory Care; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Cephalexin; Child; Child, Preschool; Cystitis; Female; Humans; Infant; Interrupted Time Series Analysis; Male; Process Assessment, Health Care; Pyelonephritis; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Amdinocillin Pivoxil; Anti-Bacterial Agents; Cephalexin; Drug Substitution; Fluoroquinolones; Humans; Male; Middle Aged; Nitrofurantoin; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Wide-spectrum antibiotics have been favored to treat acute uncomplicated cystitis (AUC) for a long time, leading to the emergence of multi-drug resistant bacteria. We hypothesize that narrow-spectrum antibiotics might mitigate the issue and aim to investigate the clinical efficacy of cefaclor in patients with AUC.. We retrospectively reviewed the clinical data of female outpatients with AUC treated with cefaclor and evaluated the safety and clinical efficacy. Clinical cure was defined as the elimination of clinical symptom under 4 white blood cells (WBCs) per high power field on microscopy.. Overall, 223 women with AUC were enrolled. Escherichia coli was the dominant pathogen (n = 160; 68.6%), followed by Klebsiella species and E. coli-extended spectrum β-lactamase (ESBL) (n = 19; 8.1% and n = 18; 7.7%). Overall success rate was 94.0% (n = 219) and susceptibility rate of cefazolin was 84.1%, which was close to that of levofloxacin (82.9%). Ampicillin showed the lowest rate of 63.7% with a significantly greater resistance rate of 35.3% among all antibiotics (P < 0.001). In the subgroup analysis, the success rate in patients with resistance to levofloxacin or cefazolin was 100% (n = 24) or 93.3% (n = 14). The rate in patients with resistance to both antibiotics was 60.0% (n = 9), and the pathogens in the other 40.0% (n = 6) of patients with treatment failure were E. coli-ESBL.. Cefaclor showed excellent efficacy in AUC patients, even in those with in vitro resistance to cefazolin or levofloxacin. Cefaclor may be considered as a first-line option in patients with AUC and a second-line option for those with levofloxacin treatment failure.

Topics: Adult; Aged; Aged, 80 and over; Amikacin; Ampicillin; Anti-Bacterial Agents; beta-Lactam Resistance; Cefaclor; Cefazolin; Cystitis; Drug Resistance, Multiple, Bacterial; Escherichia coli Infections; Female; Fosfomycin; Humans; Klebsiella Infections; Levofloxacin; Microbial Sensitivity Tests; Middle Aged; Proteus Infections; Retrospective Studies; Staphylococcal Infections; Treatment Failure; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Young Adult

Fluoroquinolones are used for conditions including sinusitis, bronchitis, and urinary tract infections. It has been suggested that exposure to fluoroquinolones for these conditions is associated with disability resulting from adverse events in 2 or more organ systems. The objectives were to: describe: 1) fluoroquinolone, azithromycin, and sulfamethoxazole / trimethoprim utilization for these infections; 2) the rate of disability associated with exposure to each of these antibiotic classes and adverse events in 2 or more system organ classes, and 3) compare outcome rates for each of the antibiotic classes.. This study was conducted using administrative data to mitigate the limitations of spontaneous reports. The sampling frame was a U.S. population with both medical and disability insurance, including patients with the above uncomplicated infections who were prescribed the antibiotics of interest. The primary outcome was an incident short-term disability claim associated with adverse events in 2 different organ systems within 120 days of exposure. A matched analysis was used to compare the outcome for patients receiving each of the drug classes.. After propensity score matching, there were 119,653 individuals in each of the exposure groups. There were 264 fluoroquinolone associated disability events and 243 azithromycin/ sulfamethoxazole associated disability events (relative risk =1.09 (95% CI: 0.92-1.30; calibrated p = 0.84)). The results were not significantly different from the null hypothesis of no difference between groups.. Comparative assessments are difficult to conduct in spontaneous reports. This examination of disability associated with adverse events in different system organ classes showed no difference between fluoroquinolones and azithromycin or sulfamethoxazole in administrative data.

Topics: Adolescent; Adult; Adverse Drug Reaction Reporting Systems; Aged; Anti-Bacterial Agents; Azithromycin; Bronchitis; Drug Utilization; Female; Fluoroquinolones; Humans; Male; Middle Aged; Sinusitis; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Young Adult

Despite dramatic reductions in the rates of bacteremia and meningitis since the 1980s, febrile illness in children younger than 36 months continues to be a concern with potentially serious consequences. Factors that suggest serious infection include age younger than one month, poor arousability, petechial rash, delayed capillary refill, increased respiratory effort, and overall physician assessment. Urinary tract infections are the most common serious bacterial infection in children younger than three years, so evaluation for such infections should be performed in those with unexplained fever. Abnormal white blood cell counts have poor sensitivity for invasive bacterial infections; procalcitonin and C-reactive protein levels, when available, are more informative. Chest radiography is rarely recommended for children older than 28 days in the absence of localizing signs. Lumbar puncture is not recommended for children older than three months without localizing signs; it may also be considered for those from one to three months of age with abnormal laboratory test results. Protocols such as Step-by-Step, Laboratory Score, or the Rochester algorithms may be helpful in identifying low-risk patients. Rapid influenza testing and tests for coronavirus disease 2019 (COVID-19) may be of value when those diseases are circulating. When empiric treatment is appropriate, suggested antibiotics include ceftriaxone or cefotaxime for infants one to three months of age and ampicillin with gentamicin or with cefotaxime for neonates. For children three months to three years of age, azithromycin or amoxicillin is recommended if pneumonia is suspected; for urinary infections, suggested antibiotics are cefixime, amoxicillin/clavulanate, or trimethoprim/sulfamethoxazole. Choice of antibiotics should reflect local patterns of microbial resistance.

Topics: Algorithms; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Betacoronavirus; Blood Culture; C-Reactive Protein; Child, Preschool; Clinical Decision-Making; Clinical Laboratory Techniques; Coronavirus Infections; COVID-19; COVID-19 Testing; Culture Techniques; Fever; Humans; Infant; Infant, Newborn; Influenza, Human; Leukocyte Count; Pandemics; Pneumonia, Bacterial; Pneumonia, Viral; Procalcitonin; Radiography, Thoracic; SARS-CoV-2; Spinal Puncture; Trimethoprim, Sulfamethoxazole Drug Combination; Urinalysis; Urinary Tract Infections

Topics: Drug Combinations; Humans; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We evaluated the effect of long-term low dose antibiotic prophylaxis on children's gut microbiota.. We conducted 16S ribosomal RNA gene sequencing using stool samples from 35 patients younger than 3 years old (median age 5.2 months; male-to-female ratio 17:18) who underwent antibiotic treatment during the acute phase of febrile urinary tract infection. Samples were collected at 5 time points, ie before, during and at 1 to 2, 3 to 4, and 5 to 6 months after febrile urinary tract infection onset and antibiotic treatment. Continuous antibiotic prophylaxis using trimethoprim-sulfamethoxazole was initiated in 23 patients with grade III or higher vesicoureteral reflux and was not administered in 12 patients without reflux.. Within 2 weeks after initiation of treatment for febrile urinary tract infection almost all enteric bacteria belonged to the order Lactobacillales, and gut microbiota diversity decreased compared to the pretreatment level (average Shannon index 2.9 before treatment, 1.4 during treatment). The diversity recovered within 1 to 2 months after febrile urinary tract infection onset in both groups. Diversity was maintained during the study period in both groups (p=0.43). A smaller proportion of gut microbiota component belonged to the order Enterobacteriales (p=0.002) in the antibiotic prophylaxis group.. Our results revealed that patients receiving continuous antibiotic prophylaxis had normal gut microbiota diversity, indicating that the effect of trimethoprim-sulfamethoxazole on gut microbiota was insignificant. Furthermore, prophylaxis with trimethoprim-sulfamethoxazole might selectively suppress the growth of bacteria belonging to the order Enterobacteriales, such as Escherichia coli and Klebsiella species, which are the main causative bacteria of febrile urinary tract infections.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacteria; Child, Preschool; DNA, Bacterial; Dose-Response Relationship, Drug; Drug Administration Schedule; Dysbiosis; Feces; Female; Gastrointestinal Microbiome; Humans; Infant; Kidney Failure, Chronic; Male; RNA, Ribosomal, 16S; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

Urinary tract infection (UTI) is one of the most common infectious complications among renal transplant patients. Trimethoprim-sulfamethoxazole (TMP-SMX) is routinely used as first-line prophylaxis against Pneumocystis pneumonia (PCP) and other opportunistic infections including UTI. Aerosolized pentamidine is an alternate agent used for PCP prophylaxis; however, it does not provide coverage against uropathogens. This is a retrospective study of 81 renal transplant recipients who received TMP-SMX or aerosolized pentamidine for PCP prophylaxis at our center over 1 year. Survival analysis demonstrated increased cumulative incidence of UTI among patients receiving pentamidine for PCP prophylaxis compared to those receiving TMP-SMX (log-rank test P < .001). Univariate and multivariate Cox proportional hazard regression model showed pentamidine prophylaxis (HR 3.740; 95% CI 1.745-8.016; P = .001) and female sex (HR 4.025; 95% CI 1.770-9.154; P = .001) to independently increase UTI risk. Age, induction agent, graft type, diabetes, and delayed graft function (DGF) were not associated with increased risk. This study concludes that the use of pentamidine for PCP prophylaxis compared to TMP-SMX is associated with increased risk of UTI. Secondary UTI prophylaxis may be considered for patients who are unable to tolerate TMP-SMX and who have other risk factors for UTI; however, the efficacy of this has not been studied.

Topics: Female; Humans; Kidney Transplantation; Pentamidine; Pneumonia, Pneumocystis; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The risk of urinary tract infection (UTI) development after flexible cystoscopy (FC) is not well described. It remains difficult to assess the role of pre-FC antimicrobial prophylaxis to reduce UTI risk.. In fall 2017, the urology service at the Providence Veterans Affairs Medical Center implemented routine oral antimicrobial prophylaxis in its outpatient FC clinic. Outpatients were randomly selected for a retrospective chart review to compare patients who received pre-FC antimicrobials (cefuroxime 500 mg tablet or sulfamethoxazole/trimethoprim [800 mg/160 mg] tablet) and those who underwent FC prior to fall 2017 and did not receive prophylaxis. The primary outcome was presence of symptomatic UTI within 30 days post FC. Secondary outcomes included symptomatic UTI that met colony-forming unit (CFU)/mL guideline requirements, and UTI treatment received. Potential risk factors for UTI were also assessed.. A total of 296 patients were included in the final analysis: 139 who did not receive and 157 who received a prophylactic antimicrobial before FC. Rates of symptomatic UTI, symptomatic UTI meeting CFU/mL guideline requirements, and postprocedure treatment for UTI were similar with and without antimicrobial prophylaxis (2.5% vs 2.2% [P > 0.99], 1.9% vs 1.4% [P > 0.99], and 2.5% vs 4.3% [P = 0.53], respectively). The mean number of days from FC to the start of UTI treatment was 7.9 (range, 1-18 days). Age over 65 years was the only risk factor present in all patients with a post-FC UTI, irrespective of antimicrobial prophylaxis.. The rate of post-FC symptomatic UTI was lower than rates previously described in the literature. The role of antimicrobial prophylaxis prior to FC warrants further exploration.

Topics: Age Factors; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cefuroxime; Colony Count, Microbial; Cystoscopy; Female; Humans; Male; Middle Aged; Postoperative Complications; Practice Guidelines as Topic; Preoperative Care; Retrospective Studies; Risk Assessment; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Drug Eruptions; Female; Humans; Medical Illustration; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Young Adult

Oral β-lactam antibiotics are traditionally not recommended to treat Enterobacterales bacteremia because of concerns over subtherapeutic serum concentrations, but there is a lack of outcomes data, specifically after initial treatment with parenteral antibiotics. Given the limited data and increasing limitations of fluoroquinolones or trimethoprim-sulfamethoxazole (TMP-SMX), oral β-lactam antibiotics may be a valuable additional treatment option.. To compare definitive therapy with oral β-lactam antibiotics vs fluoroquinolones or TMP-SMX for Enterobacterales bacteremia from a suspected urine source.. A retrospective cohort study was conducted from January 1, 2007, to September 30, 2015, at 114 Veterans Affairs hospitals among 4089 adults with Escherichia coli, Klebsiella spp, or Proteus spp bacteremia and matching urine culture results. Additional inclusion criteria were receipt of active parenteral antibiotic(s) followed by conversion to an oral antibiotic. Exclusion criteria were previous Enterobacterales bacteremia, urologic abscess, or chronic prostatitis. Data were analyzed from April 15, 2019, to July 26, 2020.. Conversion of therapy to an oral β-lactam antibiotic vs fluoroquinolones or TMP-SMX after 1 to 5 days of parenteral antibiotics.. The main outcome was a composite of either 30-day all-cause mortality or 30-day recurrent bacteremia. Propensity-based overlap weights were used to adjust for differences between groups. Log binomial regression models were used to estimate adjusted relative risks (aRRs) and adjusted risk differences (aRDs).. Of the 4089 eligible patients (3731 men [91.2%]; median age, 71 years [interquartile range, 63-81 years]), 955 received an oral β-lactam antibiotic, and 3134 received fluoroquinolones or TMP-SMX. The primary outcome occurred for 42 patients (4.4%) who received β-lactam antibiotics and 94 patients (3.0%) who received fluoroquinolones or TMP-SMX (aRD, 0.99% [95% CI, -0.42% to 2.40%]; aRR, 1.31 [95% CI, 0.87-1.95]). Mortality rates were 3.0% (n = 29) for patients receiving β-lactam antibiotics vs 2.6% (n = 82) for those receiving fluoroquinolones or TMP-SMX (aRD, 0.06% [95% CI, -1.13% to 1.26%]; aRR, 1.02 [95% CI, 0.67-1.56]). Recurrent bacteremia rates were 1.5% (n = 14) among those receiving β-lactam antibiotics vs 0.4% (n = 12) among those receiving fluoroquinolones or TMP-SMX (aRD, 1.03% [95% CI, 0.24%-1.82%]; aRR, 3.43 [95% CI, 0.42-27.90]).. In this cohort study of adults with E coli, Klebsiella spp, or Proteus spp bacteremia from a suspected urine source, the relative risk of recurrent bacteremia was not significantly higher with β-lactam antibiotics compared with fluoroquinolones or TMP-SMX, and the absolute risk and risk difference were small (ie, <3%). No significant difference in mortality was observed. Oral β-lactam antibiotics may be a reasonable step-down treatment option, primarily when alternative options are limited by resistance or adverse effects. Further study is needed because statistical power was limited owing to a low number of recurrent bacteremia events.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; beta-Lactams; Cohort Studies; Drug Resistance, Multiple, Bacterial; Enterobacteriaceae Infections; Female; Humans; Male; Middle Aged; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In this study, we aimed at identifying community and hospital-induced uropathogens isolated in urinary tract infection (UTI) determining the regional antibiotic resistance and the antibiotic preferences in empirical treatment in Sanliurfa/Turkey.. The urinary culture results of the 842 paediatric patients, who were aged between 0 and 18 years, admitted to Department of Pediatrics, Harran University Medi-cal Faculty Hospital, Sanliurfa, Turkey with UTI complaints, diagnosed with UTI and in whose urine cultures production was detected, were retrospectively evaluated. Age, gender, clinical findings and culture results of the patients were examined in terms of reproducing pathogens, the frequency of their being community and hospital induced, Extended Spectrum Beta Lactamase production of reproduced pathogens, sensitivity and resistance to antibiotics.. A total of 842 patients, 472 (56.1%) girl were included in the study. According to the results of urine culture, Escherichia coli was detected in (58.9%) of the patients, Klebsiella (17.9%) and Proteus (15.8%). While high resistance to ampicillin (87.3%), cefuroxime (71.6%) and trimethoprim-sulfamethoxazole (60.8%) was found for all microorganisms, the lowest resistance to nitrofurantoin (21.4%), piperacillin/tazobactam (19.1), imipenem (8.6%), meropenem (8.8%), amikacin (6.2%) and cefoperazone/sulbactam (CSL) (4.7%) were determined in descending order. Resistance rates were higher in inpatients with UTI than in outpatients.. We think that the most appropriate antibiotic to be chosen for the outpatients for empirical treatment in all age groups in our region, is as oral nitrofurantoin and parenteral amikacin. Also the appropriate parenteral antibiotics that should be selected for the empirical treatment of inpatients UTI in all age groups are the CSL, amikacin and carbapenems.

Topics: Adolescent; Amikacin; Ampicillin; Anti-Bacterial Agents; Carbapenems; Child; Child, Preschool; Drug Resistance, Bacterial; Escherichia coli; Female; Humans; Infant; Infant, Newborn; Inpatients; Klebsiella; Male; Microbial Sensitivity Tests; Outpatients; Proteus; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey; Urinary Tract Infections

Diabetic patients are more susceptible to urinary tract infection compared to nondiabetic patients,. Total of 1,099 clean-catch mid stream urine (CCMSU) was processed by standard microbiological technique; 182 were from the diabetic group and 917 nondiabetic. Following identification, all isolates were subjected to antibiotic susceptibility testing using modified Kirby-Bauer disc diffusion method. In-vitro biofilm forming capacity of the isolates were detected by Microtitre plate method. The data were analyzed using SPSS software 16.. Urinary tract infection was found to be significantly higher in diabetic patients (42.9%) compared to nondiabetic patients (17.4%) with. Elderly populations with diabetes are at a higher risk of UTI. Higher biofilm production and resistance to in-use antimicrobial agents in this study render its inefficacy for empirical treatment and point out the importance of biofilm screening to ensure the effective management of infection.

Topics: Adolescent; Adult; Aged; Amikacin; Amoxicillin; Anti-Bacterial Agents; Biofilms; Cross-Sectional Studies; Diabetes Complications; Diabetes Mellitus; Disk Diffusion Antimicrobial Tests; Drug Resistance, Multiple, Bacterial; Escherichia coli Infections; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Uropathogenic Escherichia coli; Young Adult

BACKGROUND Trimethoprim-sulfamethoxazole (TMP-SMX) is recommended as prophylaxis against Pneumocystis pneumonia (PCP) in renal transplant recipients. The optimal duration of prophylaxis is unknown. Longer duration of prophylaxis may increase the risk of adverse effects. The aim of this retrospective observational cohort study was to assess the impact of increasing duration of TMP-SMX prophylaxis from 3 to 6 months after transplant on drug-resistant urinary tract infection (UTI), hyperkalemia, peripheral blood cytopenias, and incidence of PCP. MATERIAL AND METHODS Patients transplanted over a 4.5-year period before and after a change in protocol from 3- to 6-months TMP-SMX prophylaxis in our unit were grouped according to planned duration of prophylaxis, and results were analyzed on an intention-to-treat basis. Baseline characteristics, laboratory values, and all urine microbiology results in the 6 months after transplant were analyzed. RESULTS The overall UTI incidence rate was higher in the 3-month (3-m) treatment group than the 6-month (6-m) treatment group (0.52 vs. 0.33 UTI per 100 patient days; rate ratio 1.56 [95% CI 1.27-1.95]). However, this was not attributable to TMP-SMX: the incidences were significantly different in months 0-3 but not months 4-6. Twenty-eight multi-resistant UTIs occurred in the 3-m group, but there were none in the 6-m group (p=0.004). There were no significant differences in renal function, serum potassium, or cytopenias during the first 6 months. There were 15 cases of PCP in the 3-m group, 3 cases in the 6-m group, and no cases during prophylaxis. CONCLUSIONS Extending the duration of TMP-SMX prophylaxis was not associated with change in frequency of UTIs or multi-drug-resistant UTIs, nor was it associated with increased adverse events. TMP-SMX is an effective PCP prophylaxis, and these data support recommendations to extend the duration of prophylaxis after transplant.

Topics: Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cohort Studies; Drug Administration Schedule; Female; Hematologic Diseases; Humans; Hyperkalemia; Kidney Transplantation; Male; Middle Aged; Pneumonia, Pneumocystis; Retrospective Studies; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Diarrhoea and urinary tract infection (UTI) are common clinical problems. Meanwhile, Escherichia coli (E. coli), is the commonest bacterial pathogen reported in both of them. This study aimed to evaluate the pathogenic E. coli (PEC) in stool of acute diarrhoea and urine of UTI regarding their virulence genes and their influence on the susceptibility to routinely prescribed antibiotics.. Twenty two stool and another 22 urine samples of patients with acute diarrhoea and UTI respectively were collected from patients admitted at Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University, Egypt. E. coli isolation, identification of their phyla; chuA, yjaA, and TspE4.C2, and further identification of 10 virulent genes; fimH, papC, papG//, papG///, papEF, afa, sfa, CNF1, iroN & hlyA was performed. Antibiotic susceptibility was studied against quinolones, gentamicin (GM), and trimethoprim-sulphamethoxazole (TMP-SMX).. The studied virulence genes were comparably detected in both pathogenic samples. In diarrheogenic E. coli (DEC); phylum A was significantly related to both ciprofloxacin (CIP) and TMP-SMX resistance, and both of the virulence genes fimH and iroN were significantly related to all the studied antibiotics resistance, while afa was significantly related to nalidixic acid (NA) resistance. In uropathogenic E. coli (UEC); phylum D was significantly related to CIP and levofloxacin resistance, and both of the virulence genes fimH and iroN were significantly related to most of the studied antibiotics resistance.. The isolated PEC was evidently and broadly resistant to the studied antibiotics, with limited influence of their phyla and virulence genes (fimH and iroN).

Topics: Acute Disease; Anti-Bacterial Agents; Diarrhea; Egypt; Escherichia coli; Escherichia coli Proteins; Feces; Gentamicins; Humans; Quinolones; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Virulence

Topics: Acinetobacter baumannii; Anti-Bacterial Agents; Bacterial Proteins; Carrier Proteins; Drug Resistance, Multiple, Bacterial; Genome, Bacterial; Humans; Plasmids; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urine

Nitrofurantoin is recommended as a first-line antibiotic for the treatment of urinary tract infections (UTIs). However, it is contraindicated in patients with a creatinine clearance (Clcr) less than 60 mL/min. In 2015, the American Geriatrics Society updated the Beers criteria to recommend nitrofurantoin for short-term use in patients with a Clcr greater than or equal to 30 mL/min. It is unknown if nitrofurantoin can be safely and effectively used in a frail patient population with a high incidence of UTIs and frequent use of antibiotics. It is important to have treatment options other than fluoroquinolones and sulfamethoxazole/trimethoprim for patients with recurrent UTIs and frequent antibiotic use to sustain optimal antimicrobial stewardship practices. This study evaluated the safety and efficacy of nitrofurantoin for UTIs in medically complex patients with renal impairment living in a community setting, and it highlights the potential role for pharmacists to encourage antimicrobial stewardship.

Topics: Aged; Anti-Bacterial Agents; Fluoroquinolones; Frail Elderly; Humans; Independent Living; Nitrofurantoin; Renal Insufficiency; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

Identify changes in the prevalence and antimicrobial resistance patterns of potentially pathogenic bacteria in urine cultures during a 2-year antimicrobial stewardship intervention program in nursing homes (NHs).. Before-and-after intervention study.. The study included 27 NHs in North Carolina.. We audited all urine cultures ordered before and during an antimicrobial stewardship intervention. Analyses compared culture rates, culture positive rates, and pathogen antimicrobial resistance patterns.. Of 6,718 total urine cultures collected, 68% were positive for potentially pathogenic bacteria. During the intervention, significant reductions in the urine culture and positive culture rates were observed (P = .014). Most of the identified potentially uropathogenic isolates were Escherichia coli (38%), Proteus spp (13%), and Klebsiella pneumoniae (12%). A significant decrease was observed during the intervention period in nitrofurantoin resistance among E. coli (P ≤ .001) and ciprofloxacin resistance among Proteus spp (P ≤ .001); however carbapenem resistance increased for Proteus spp (P ≤ .001). Multidrug resistance also increased for Proteus spp compared to the baseline. The high baseline resistance of E. coli to the commonly prescribed antimicrobials ciprofloxacin and trimethoprim-sulfamethoxazole (TMP/SMX) did not change during the intervention.. The antimicrobial stewardship intervention program significantly reduced urine culture and culture-positive rates. Overall, very high proportions of antimicrobial resistance were observed among common pathogens; however, antimicrobial resistance trended downward but reductions were too small and scattered to conclude that the intervention significantly changed antimicrobial resistance. Longer intervention periods may be needed to effect change in resistance patterns.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Antimicrobial Stewardship; Ciprofloxacin; Drug Resistance, Bacterial; Escherichia coli; Female; Homes for the Aged; Humans; Klebsiella pneumoniae; Male; North Carolina; Nursing Homes; Proteus; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Urinary tract infection is an infection affecting infants and children. The aim of this study was to determine the etiology of urinary tract infection along with their antimicrobial resistance.. This cross-sectional study was conducted from June 2015 to January 2016 at Siddhi Memorial Hospital, Bhaktapur, Nepal. Urine samples were first cultured on cystine lactose electrolyte deficient agar and blood agar by semi-quantitative technique, and then incubated aerobically for 18-24 h at 37 °C. The identified bacterial isolates were tested for antimicrobial susceptibility by Kirby Bauer disc diffusion technique.. Of 1599 urine samples, 12.3% samples showed significant bacterial growth. E. coli (58.7%) was the most common pathogen, followed by Klebsiella pneumoniae (22.5%). Most of the isolates were resistant to ampicillin and co-trimoxazole, while least were resistant to amikacin and nitrofurantoin. Higher multi-drug resistance (61.9%) was observed among isolates.. E. coli and Klebsiella spp. were predominant cause of pediatric urinary tract infection in children. Higher susceptibility observed against aminoglycosides and nitrofurans make these drugs suitable in emergency.

Topics: Adolescent; Ampicillin; Anti-Bacterial Agents; Child; Child, Preschool; Cross-Sectional Studies; Drug Resistance, Bacterial; Escherichia coli; Female; Hospitals, Pediatric; Humans; Infant; Infant, Newborn; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Nepal; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Few studies have reported on breakthrough urinary tract infection (UTI) associated with the susceptibility of index UTI to prophylactic antibiotics in children with primary vesicoureteral reflux (VUR) receiving continuous antibiotic prophylaxis (CAP). We assessed the impact of the susceptibility of index UTI to prophylactic antibiotics in breakthrough UTIs in children with primary VUR receiving CAP.. We retrospectively reviewed the medical records of 81 children with primary VUR who were diagnosed after febrile or symptomatic UTI and subsequently received trimethoprim-sulfamethoxazole (TMP-SMX) as CAP between January 2010 and December 2013. We allocated children to a susceptible group or a resistant group based on the susceptibility of index UTI to TMP-SMX. We evaluated patient demographics and clinical outcomes after CAP according to the susceptibility of index UTI to TMP-SMX. Multivariate analysis was used to identify the predictive factors for breakthrough UTI.. Of the 81 children, 42 were classified into the susceptible group and 39 into the resistant group. The proportion of breakthrough UTI was 31.0% (13/42) in the susceptible group and 53.8% (21/39) in the resistant group (. Susceptibility of index UTI to prophylactic antibiotics is a risk factor of breakthrough UTI and is associated with poor clinical outcomes in children with primary VUR receiving CAP.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Bacteria; Drug Combinations; Female; Humans; Infant; Male; Retrospective Studies; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

The high incidence of urinary tract infection (UTI) among women and children, in combination with a lack of antibiotic efficacy with regard to pathogen eradication and recurrence prevention, as well as the negative side effects associated with antibiotics, has led researchers to explore the role of non-steroidal anti-inflammatory drugs as a primary management strategy. The aim of this study was to determine whether ibuprofen (IBU) or one of its major metabolites, 2-carboxyibuprofen (CIBU), could affect the growth and adhesion of the two most common uropathogens, Escherichia coli and Enterococcus faecalis. The bacterial growth and adhesion to the urothelial cells of E. coli UTI89 and E. faecalis 1131 in the presence of physiologically relevant concentrations of IBU and CIBU were assessed. The effect of IBU on bacterial adhesion to urothelial cells was also assessed following exposure to trimethoprim/sulfamethoxazole (TMP/SMX) and nitrofurantoin. Bacterial growth was not affected by IBU. Further, only at high levels of IBU not regularly found in the bladder was there a significant increase in E. faecalis 1131 attachment at growth inhibitory concentrations of TMP/SMX. There was no effect on the attachment of E. faecalis or E. coli to urothelial cells in the presence of nitrofurantoin. These studies indicate that the beneficial effects of IBU for UTI management are likely mediated through its anti-inflammatory properties rather than direct interactions with uropathogens in the bladder.

Topics: Anti-Infective Agents, Urinary; Anti-Inflammatory Agents, Non-Steroidal; Bacteria; Bacterial Adhesion; Cell Line; Enterococcus faecalis; Escherichia coli; Humans; Ibuprofen; Microbial Sensitivity Tests; Microbial Viability; Nitrofurantoin; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urothelium

The present study aims to evaluate the predominance of uropathogens responsible for urinary tract infection (UTI) and determine their resistance patterns, to assess if the recommended empirical treatment is appropriate for the studied population. Samples were collected in Aveiro (Portugal) from an ambulatory service between June 2011 and June 2014.. From the 4,270 positive urine samples for UTI, 3,561 (83%) were from women and only 709 (17%) were from men. The bacterium Escherichia coli was the most frequent uropathogen, followed by Klebsiella sp., Enterococcus sp., and Proteus mirabilis. E. coli was also the uropathogen presenting less resistance to antibiotics, including those recommended as first and second line UTI treatment. In general, bacteria isolated from men were more resistant to antimicrobials than bacteria isolated from women.. The results of this study emphasized the relevance to consider sex as a differentiating factor in the choice of UTI empirical treatment, mainly due to differences in antimicrobial resistance. From the first line drugs recommended by the European Association of Urology (EAU) to empirical treatment of uncomplicated UTI, nitrofurantoin is the most appropriate drug for both sexes. Ciprofloxacin, although appropriate for treatment in women, is not appropriate to treat UTIs in men. From the second line drugs, both trimethoprim-sulfamethoxazole (TMP-SMX) and amoxicillin-clavulanic acid (AMX-CA) are appropriate drugs for treatment of uncomplicated UTI in women, but not as effective for men.

Topics: Aged; Anti-Bacterial Agents; Ciprofloxacin; Drug Resistance, Bacterial; Enterococcus; Escherichia coli; Female; Humans; Klebsiella; Male; Microbial Sensitivity Tests; Middle Aged; Portugal; Proteus mirabilis; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The emergence of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) infections requires re-assessment of therapeutic choices. Here we report the efficacy of cefoxitin-based antibiotic therapy for ESBL-E prostatitis. A prospective study including patients with ESBL-E prostatitis resistant to trimethoprim/sulfamethoxazole and fluoroquinolones from January 2014 to March 2016 was conducted. Cefoxitin was administered by continuous infusion for 3 weeks in the case of acute bacterial prostatitis or 6 weeks in the case of chronic bacterial prostatitis (CBP), with intravenous fosfomycin for the first 5 days. Urological investigations were performed to diagnose underlying urinary tract pathology. Clinical and microbiological efficacy were evaluated 3 months (M3) and 6 months (M6) after the end of therapy. A total of 23 patients were included in the study. The median patient age was 74 years (range 48-88 years). Of the 23 infections, 14 (61%) were CBP and 12 (52%) were healthcare-associated infections. The bacteria involved were Escherichia coli in 11 cases, Klebsiella pneumoniae in 10 cases and Klebsiella oxytoca in 2 cases. Clinical cure was observed in 19/23 patients (83%) at M3 and in 17/22 patients (77%) at M6. Urocultures were sterile in 13/23 patients (57%) at M3 and in 9/19 patients (47%) and M6. Urinary colonisation was observed in 6/19 patients (32%) with clinical cure at M3 and 5/14 patients (36%) with clinical cure at M6. No resistance to cefoxitin was detected. Surgical treatment was required for 7/23 patients (30%). In conclusion, cefoxitin-based antibiotic therapy is suitable for difficult-to-treat ESBL-E infections such as prostatitis.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; beta-Lactamases; Cefoxitin; Cross Infection; Escherichia coli; Escherichia coli Infections; Fluoroquinolones; Fosfomycin; Humans; Klebsiella Infections; Klebsiella oxytoca; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Middle Aged; Pilot Projects; Prospective Studies; Prostatitis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The incidence of drug-resistant community-acquired urinary tract infections (CA-UTI) continues to increase worldwide. In 1999 to 2000, a single lineage of uropathogenic

Topics: Anti-Bacterial Agents; Bacterial Typing Techniques; California; Ciprofloxacin; Community-Acquired Infections; Drug Resistance, Multiple, Bacterial; Escherichia coli Infections; Female; Genotype; Humans; Male; Microbial Sensitivity Tests; Multilocus Sequence Typing; Prevalence; School Health Services; Trimethoprim, Sulfamethoxazole Drug Combination; Universities; Urinary Tract Infections; Uropathogenic Escherichia coli

To determine if trimethoprim use for urinary tract infection (UTI) is associated with an increased risk of acute kidney injury, hyperkalaemia, or sudden death in the general population.. Cohort study.. UK electronic primary care records from practices contributing to the Clinical Practice Research Datalink linked to the Hospital Episode Statistics database.. Adults aged 65 and over with a prescription for trimethoprim, amoxicillin, cefalexin, ciprofloxacin, or nitrofurantoin prescribed up to three days after a primary care diagnosis of UTI between April 1997 and September 2015.. The outcomes were acute kidney injury, hyperkalaemia, and death within 14 days of a UTI treated with antibiotics.. Among a cohort of 1 191 905 patients aged 65 and over, 178 238 individuals were identified with at least one UTI treated with antibiotics, comprising a total of 422 514 episodes of UTIs treated with antibiotics. The odds of acute kidney injury in the 14 days following antibiotic initiation were higher following trimethoprim (adjusted odds ratio 1.72, 95% confidence interval 1.31 to 2.24) and ciprofloxacin (1.48, 1.03 to 2.13) compared with amoxicillin. The odds of hyperkalaemia in the 14 days following antibiotic initiation were only higher following trimethoprim (2.27, 1.49 to 3.45) compared with amoxicillin. However, the odds of death within the 14 days following antibiotic initiation were not higher with trimethoprim than with amoxicillin: in the whole population the adjusted odds ratio was 0.90 (95% confidence interval 0.76 to 1.07) while among users of renin-angiotensin system blockers the odds of death within 14 days of antibiotic initiation was 1.12 (0.80 to 1.57). The results suggest that, for 1000 UTIs treated with antibiotics among people 65 and over, treatment with trimethoprim instead of amoxicillin would result in one to two additional cases of hyperkalaemia and two admissions with acute kidney injury, regardless of renin-angiotensin system blockade. However, for people taking renin-angiotensin system blockers and spironolactone treatment with trimethoprim instead of amoxicillin there were 18 additional cases of hyperkalaemia and 11 admissions with acute kidney injury.. Trimethoprim is associated with a greater risk of acute kidney injury and hyperkalaemia compared with other antibiotics used to treat UTIs, but not a greater risk of death. The relative risk increase is similar across population groups, but the higher baseline risk among those taking renin-angiotensin system blockers and potassium-sparing diuretics translates into higher absolute risks of acute kidney injury and hyperkalaemia in these groups.

Topics: Acute Kidney Injury; Age Factors; Aged; Anti-Infective Agents, Urinary; England; Female; Humans; Hyperkalemia; Male; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We present a case of pyeloduodenal fistula in an 89-year-old woman with history of nephrolithiasis and recurrent urinary tract infection (UTI) who presented to the emergency department with back pain. CT revealed a malrotated right kidney with a large renal stone and possible fistulous connection between the second portion of the duodenum and the right renal collecting system. Technetium-99m scintigraphy confirmed presence of the fistula. The patient declined intervention and was discharged from the hospital with oral antibiotic suppressive therapy. The patient remained clinically stable at time of follow-up 3 months later. Spontaneous pyeloduodenal fistula is an aetiology of recurrent upper or lower UTIs or persistent bacteriuria though uncommonly recognised. Diagnosis may be achieved using several modalities, including technetium-99m scintigraphy. Nephrectomy and primary fistula closure has traditionally been the treatment of choice for this condition; however, conservative management is an option for patients with intact renal function.

Topics: Aged, 80 and over; Anti-Infective Agents, Urinary; Conservative Treatment; Duodenal Diseases; Duodenum; Female; Humans; Intestinal Fistula; Kidney; Kidney Calculi; Radionuclide Imaging; Technetium; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Data are needed from outpatient settings to better inform antimicrobial stewardship. In this study, a random sample of outpatient antibiotic prescriptions by primary care providers (PCPs) at our health care system was reviewed and compared to consensus guidelines. Over 12 months, 3,880 acute antibiotic prescriptions were written by 76 PCPs caring for 40,734 patients (median panel, 600 patients; range, 33 to 1,547). PCPs ordered a median of 84 antibiotic prescriptions per 1,000 patients per year. Azithromycin (25.8%), amoxicillin-clavulanate (13.3%), doxycycline (12.4%), amoxicillin (11%), fluoroquinolones (11%), and trimethoprim-sulfamethoxazole (10.6%) were prescribed most commonly. Medical records corresponding to 300 prescriptions from 59 PCPs were analyzed in depth. The most common indications for these prescriptions were acute respiratory tract infection (28.3%), urinary tract infection (23%), skin and soft tissue infection (15.7%), and chronic obstructive pulmonary disease (COPD) exacerbation (6.3%). In 5.7% of cases, no reason for the prescription was listed. No antibiotic was indicated in 49.7% of cases. In 12.3% of cases, an antibiotic was indicated, but the prescribed agent was guideline discordant. In another 14% of cases, a guideline-concordant antibiotic was given for a guideline-discordant duration. Therefore, 76% of reviewed prescriptions were inappropriate. Ciprofloxacin and azithromycin were most likely to be prescribed inappropriately. A non-face-to-face encounter prompted 34% of prescriptions. The condition for which an antibiotic was prescribed was not listed in primary or secondary diagnosis codes in 54.5% of clinic visits. In conclusion, there is an enormous opportunity to reduce inappropriate outpatient antibiotic prescriptions.

Topics: Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antimicrobial Stewardship; Azithromycin; Delivery of Health Care; Doxycycline; Female; Fluoroquinolones; Humans; Inappropriate Prescribing; Male; Middle Aged; Physicians, Primary Care; Practice Guidelines as Topic; Pulmonary Disease, Chronic Obstructive; Respiratory Tract Infections; Retrospective Studies; Soft Tissue Infections; Trimethoprim, Sulfamethoxazole Drug Combination; United States; United States Department of Veterans Affairs; Urinary Tract Infections

Failure to timely diagnose and treat urinary tract infections is associated with grave long term consequences. The objectives of this study included assessing the proportion and predictors of Urinary Tract Infection (UTI) as a cause of pediatric outpatient department (OPD) visits and determining common uropathogens with antimicrobial susceptibility pattern.. A cross sectional study was conducted from May to September 2015 among children of less than 15 years old at a tertiary center in Hawassa, Ethiopia. Children who fulfilled predefined eligibility criteria were recruited to undergo urine culture and urine analysis.. A total of 863 children visited the OPD during the study period among which 269(31.2%) fulfilled the predefined eligibility criteria. Urine culture was positive for 74/269(27.5%) of the clinically suspected children. Male uncircumcision (adjusted odds ratio (aOR) 3.70; 95% CI 1.34-10.16) and under nutrition (aOR 5.41; 95%CI 2.64-11.07) were independent predictors of culture positivity. More than 5 WBC per high power field (aOR 4.7, 95% CI 1.8-12.7) on microscopy, urine PH > 5.0 (aOR 2.6, 95%CI 1.2-5.8), and positive leukocyte esterase (aOR 9.9, 95%CI 4.1-25.7) independently predicted positive growth on urine culture. Escherichia coli (34/74, 45.9%) and Klebsiella spp (18/74, 24.3%) were the most frequent isolates. High resistance was noted against amoxicillin (70.6%) and cotrimoxazole (97.1%) by E. coli.. UTI accounted for a tenth of total OPD visits. Commonly used first line antibiotics showed high level resistance to common etiologies of UTI. UTI should be suspected in febrile children, and antibiograms should be done to tailor prescription of antibiotics.

Topics: Adolescent; Ambulatory Care Facilities; Amoxicillin; Anti-Bacterial Agents; Bacteria; Child; Child, Preschool; Cross-Sectional Studies; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Ethiopia; Female; Fever; Humans; Incidence; Infant; Klebsiella; Male; Microbial Sensitivity Tests; Pediatrics; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Aged; Anti-Infective Agents, Urinary; Anxiety; Depression; Depressive Disorder, Major; Female; Humans; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Enterococcus faecalis is one of the most common causes of recurrent urinary tract infection (RUTI), yet enterococcal pathogenesis is poorly understood. Our aims were to identify the prevalence of enterococci in RUTI patients and characterize the enterococcal response to nitrofurantoin and trimethoprim-sulfamethoxazole.. We studied pediatric patients receiving antibiotic prophylaxis and those only under clinical observation for 12 months (n = 39). We then assessed the response of uropathogenic E. faecalis to nitrofurantoin and trimethoprim-sulfamethoxazole.. Enterococci were isolated from almost half of patients and exposure of Enterococcus to nitrofurantoin increased virulence properties; this did not correlate with increased expression of virulence factors.. Our results demonstrate that antibiotic prophylaxis may not be suitable for treatment of enterococcal RUTI (NCT02357758).

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Adhesion; Canada; Child; Child, Preschool; Cytokines; Enterococcus faecalis; Female; Gene Expression Regulation, Bacterial; Humans; Microbial Sensitivity Tests; Nitrofurantoin; Prevalence; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Virulence Factors

We present a special case of an 8-year-old girl diagnosed with severe drug reaction with eosinophilia and systemic symptoms due to trimethoprim-sulfamethoxazole for urinary tract infection prophylaxis for congenital vesicoureteral reflux. The patient is believed to have developed drug reaction with eosinophilia and systemic symptoms because of her underlying renal disease.

Topics: Anti-Bacterial Agents; Child; Drug Hypersensitivity Syndrome; Female; Glucocorticoids; Humans; Methylprednisolone; Renal Insufficiency, Chronic; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

Antimicrobial resistance data from surveillance networks are frequently do not accurately predict resistance patterns of urinary tract infections at the bedside.. To determine simple patient- and institution-related risk factors affecting antimicrobial resistance patterns of Escherichia coli urine isolates.. From January 2012 to May 2015 all consecutive urine samples with significant growth of E. coli (≥103 CFU/ml) obtained from a tertiary care hospital were analysed for antimicrobial susceptibility and related to basic clinical data such a patient age, ward, sample type (catheter vs non-catheter urine).. Antimicrobial susceptibility testing was available for 5246 E. coli urine isolates from 4870 patients. E. coli was most commonly resistant to amoxicillin (43.1%), cotrimoxazole (24.5%) and ciprofloxacin (17.4%). Resistance rates were low for meropenem (0.0%), fosfomycin (0.9%) and nitrofurantoin (1.5%). Significantly higher rates of resistance to ciprofloxacin (32.8 vs 15.8%) and cotrimoxazole (30.6 vs 23.9%) were found in urological patients compared with patients on other wards (p <0.01). In multivariable analysis, predictors for E. coli resistance against ciprofloxacin and cotrimoxazole were: treatment in the urological unit (odds ratio [OR] 2.04, 95% confidence interval [CI] 1.63-2.54; p <0.001 and OR 1.33, 95% CI 1.07-1.64; p = 0.010, respectively), male sex (OR 1.93, 95% CI 1.630-2.29; p <0.001 and OR 1.22, 95% CI 1.22-1.04; p = 0.015), and only to a lesser extent urine samples obtained from indwelling catheters (OR 1.30, 95% CI 1.05-1.61; p = 0.014 and OR 1.26, 95% CI 1.04-1.53; p = 0.020). Age ≥65 years was associated with higher resistance to ciprofloxacin (OR 1.42, 95% CI 1.21-1.67; p <0.001), but lower resistance to cotrimoxazole (OR 0.76, 95% CI 0.67-0.86; p <0.001).. Simple bedside patient data such as age, sex and treating hospital unit help to predict antimicrobial resistance and can improve the empirical treatment of urinary tract infections.

Topics: Age Factors; Amoxicillin; Anti-Bacterial Agents; Catheters, Indwelling; Ciprofloxacin; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Hospitals; Humans; Male; Middle Aged; Retrospective Studies; Sex Factors; Switzerland; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urology Department, Hospital

Despite the known clonal distribution of antibiotic resistance in many bacteria, empiric (pre-culture) antibiotic selection still relies heavily on species-level cumulative antibiograms, resulting in overuse of broad-spectrum agents and excessive antibiotic/pathogen mismatch. Urinary tract infections (UTIs), which account for a large share of antibiotic use, are caused predominantly by Escherichia coli, a highly clonal pathogen. In an observational clinical cohort study of urgent care patients with suspected UTI, we assessed the potential for E. coli clonal-level antibiograms to improve empiric antibiotic selection. A novel PCR-based clonotyping assay was applied to fresh urine samples to rapidly detect E. coli and the urine strain's clonotype. Based on a database of clonotype-specific antibiograms, the acceptability of various antibiotics for empiric therapy was inferred using a 20%, 10%, and 30% allowed resistance threshold. The test's performance characteristics and possible effects on prescribing were assessed. The rapid test identified E. coli clonotypes directly in patients' urine within 25-35 minutes, with high specificity and sensitivity compared to culture. Antibiotic selection based on a clonotype-specific antibiogram could reduce the relative likelihood of antibiotic/pathogen mismatch by ≥ 60%. Compared to observed prescribing patterns, clonal diagnostics-guided antibiotic selection could safely double the use of trimethoprim/sulfamethoxazole and minimize fluoroquinolone use. In summary, a rapid clonotyping test showed promise for improving empiric antibiotic prescribing for E. coli UTI, including reversing preferential use of fluoroquinolones over trimethoprim/sulfamethoxazole. The clonal diagnostics approach merges epidemiologic surveillance, antimicrobial stewardship, and molecular diagnostics to bring evidence-based medicine directly to the point of care.

Topics: Anti-Bacterial Agents; Bacterial Typing Techniques; Cohort Studies; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Evidence-Based Medicine; Gene Frequency; Genotype; Humans; Polymerase Chain Reaction; Polymorphism, Single Nucleotide; Sensitivity and Specificity; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Institutional antibiograms guide Emergency Department (ED) clinicians' empiric antibiotic selection. For this study, we created and compared antibiograms of ED patients stratified by disposition (admitted or discharged).. We conducted a cross-sectional study at two hospitals for 2014, comparing antibiograms limited to Escherichia coli urinary tract infections. Study-Specific Antibiograms, created for the study, excluded polymicrobial samples and multiple cultures from the same patient. Study-Specific Antibiograms were arranged by patient disposition: admitted (IP-Only) vs discharged from the ED (ED-Only). Antibiogram data were presented as average antibiotic sensitivities with 95% confidence intervals and demographic data as medians with interquartile ranges. Sensitivities between Study-Specific Antibiograms were compared by Fisher's Exact Test, alpha=0.05, 2 tails.. For Hospital A, 13 antibiotics were compared between Study-Specific ED-Only (n=313) vs IP-Only (n=244). We found that sensitivities to all four antibiotics appropriate for empiric outpatient therapy by Infectious Disease Society of America guidelines were significantly (p<0.0001) higher in the ED-Only compared to IP-Only groups: ciprofloxacin 80% (76-90%) vs 60% (53-69%), levofloxacin 81% (77-91%) vs 63% (57-72%), nitrofurantoin 75% (70-84%) vs 51% (44-58%), and trimethoprim/sulfamethoxazole 73% (68-82%) vs 58% (52-67%). For Hospital B, 14 antibiotics were compared between Study-Specific ED-Only (n=256) and IP-Only (n=168). Two out of the five appropriate empiric outpatient antibiotics had significantly (p<0.0001) higher sensitivities for ED-Only compared to IP-Only: ciprofloxacin 87% (83-91%) vs 71% (64-78%) and levofloxacin 86% (82-91%) vs 71% (65-78%).. We found higher antibiotic sensitivities in ED-Only than the IP-Only Study-Specific Antibiograms. Our Study-Specific Antibiograms offer an alternative guide for antibiotic selection in the ED.

Topics: Adult; Aged; Anti-Bacterial Agents; Ciprofloxacin; Cross-Sectional Studies; Drug Resistance, Bacterial; Emergency Service, Hospital; Escherichia coli; Escherichia coli Infections; Female; Humans; Levofloxacin; Male; Microbial Sensitivity Tests; Middle Aged; Nitrofurantoin; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

Urinary tract infection is the second most common type of infection and the problem is further compounded by the emergence of drug resistance in bacterial uropathogens. The aim of this study was to determine the spectrum of bacterial uropathogens and their drug resistant pattern.. A single institutional cross-sectional study was carried out at Arsho Advanced Medical laboratory from September 2015 to May 2016. A total of 712 urine samples were collected, inoculated onto primary isolation culture media, incubated at 37 °C for 18-24 h, and significant bacteriuria was determined. Identification and the antimicrobial susceptibility testing of bacteria were determined by using the automated VITEK 2 compact system.. Out of 712 urine samples processed, 256 (36%) yielded significant bacteriuria of which 208 (81.25%) were obtained from female and 48 (18.75%) from male patients. Age group of 25-44 were more affected with the infection. Of 256 bacterial isolates recovered, Escherichia coli, was the dominant bacterium. Ampicillin and trimethoprim/sulfamethoxazole were the least effective drugs while piperacillin/tazobactam was the most effective drug against Gram-negative bacteria. Erythromycin was the least effective drug while vancomycin was the most active drug against Gram-positive bacteria.. Observation of many bacterial species causing UTI in this study warrants, a continuous epidemiological survey of UTI in health institutions across the country. High level of drug resistance to the commonly prescribed drugs necessitates a search for other options.

Topics: Adolescent; Adult; Aged; Ampicillin; Anti-Bacterial Agents; Bacteriuria; Child; Child, Preschool; Cross-Sectional Studies; Drug Resistance, Bacterial; Erythromycin; Escherichia coli; Ethiopia; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Infant; Male; Microbial Sensitivity Tests; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vancomycin

The aim of the current study was to compare community-acquired acute pyelonephritis (CA-APN) with health care-associated acute pyelonephritis (HCA-APN), describe the outcomes, and identify variables that could predict antimicrobial susceptibility. We conducted an observational study that included all consecutive episodes of acute pyelonephritis (APN) in adults during 2014 at a Spanish university hospital. From each episode, demographic data, comorbidities, clinical presentation, microbiological data, antimicrobial therapy, and outcome were recorded. A multivariable logistic regression model was performed to define the variables associated with antimicrobial resistance. A total of 607 patients, 503 (82.9%) with CA-APN and 104 (17.1%) with HCA-APN, were included in the study. Patients with HCA-APN were older than patients with CA-APN (70.4 versus 50.6 years;

Topics: Acute Disease; Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefotaxime; Cefuroxime; Ciprofloxacin; Cohort Studies; Community-Acquired Infections; Cross Infection; Drug Resistance, Bacterial; Empirical Research; Escherichia coli; Escherichia coli Infections; Female; Hospitals, University; Humans; Logistic Models; Male; Microbial Sensitivity Tests; Middle Aged; Pyelonephritis; Risk Factors; Spain; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Cellulitis; Cephalexin; Drug Combinations; Humans; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We present an isolate of Klebsiella pneumoniae OXA-48 isolated in a 68-year-old\ man who underwent radical prostatectomy due to prostate cancer. The antibiotic susceptibility testing\ to a wide range of antibiotics was performed by disk diffusion method and determination of minimal\ inhibitory concentrations. The isolate was classified as multidrug-resistant. It showed intermediate\ susceptibility to imipenem and meropenem, resistance to ertapenem, and sensitivity only to colistin,\ amikacin, and trimethoprim-sulfamethoxazole. The isolate was positive for ESBLs, negative for\ AmpC. Polymerase chain reaction and sequencing revealed bla(OXA-48)', bla(CTX-M-15) and bla(SHV-11). The plasmid\ encoding OXA-48 ß-lactamase did not belong to any known PCR-based replicon typing. According\ to genotyping, the isolate belonged to ST37.

Topics: Aged; Anti-Bacterial Agents; beta-Lactamases; Drug Resistance, Multiple, Bacterial; Genotype; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Polymerase Chain Reaction; Postoperative Complications; Prostatectomy; Prostatic Neoplasms; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To report a case of hemolytic anemia in a patient who received trimethoprim/sulfamethoxazole (TMP-SMX) for a urinary tract infection (UTI).. A 47-year-old woman recently diagnosed with uncomplicated UTI received 3 doses of TMP-SMX. She developed yellowing of the skin and eyes, lethargy, mild abdominal pain, and dry mucous membranes. Laboratory testing demonstrated significant anemia with red blood cells (RBCs) of 1.99, hemoglobin (Hgb) of 6.3 g/dL, and hematocrit (Hct) of 18.1%. TMP-SMX was immediately discontinued. The patient was given methylprednisolone 60 mg intravenously (IV) followed by oral steroids and infused with 3 units of packed RBCs over the course of a 10-day inpatient admission. On discharge, the patient continued oral steroids. Outpatient follow-up indicated Hgb of 11.0 g/dL and Hct of 32.7%, 41 days after hospital discharge. Utilizing the Naranjo adverse drug reaction probability scale, there is a probable association between the patient's hemolytic anemia and TMP-SMX.. We report a case of hemolytic anemia resulting from the use of TMP-SMX. Although this is a rare adverse effect, clinicians should be aware of the signs and symptoms of hemolytic anemia, and so appropriate treatment can be administered should it occur.

Topics: Anemia, Hemolytic; Anti-Infective Agents, Urinary; Female; Humans; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Urinary tract infections (UTIs) are the commonest infectious complication in kidney transplant recipients (KTRs). No recommendations exist regarding treatment of asymptomatic bacteriuria. We aimed to identify potential risk factors and microbiological profile for UTIs, the role of treatment of asymptomatic bacteriuria, and effects on graft outcomes of bacteriuria within the first year post-transplantation.. We performed a retrospective analysis of UTIs in KTRs transplanted between January 2012 and December 2013 in 2 transplantation centers. Patients were routinely commenced on prophylactic sulfamethoxazole-trimethoprim. Clinical and microbiological data were analyzed for the first year following transplantation.. In all, 276 KTRs were evaluated; 67% were men, with a mean age of 51 years. At 12 months post-transplantation 158 (57%) KTRs had no bacteriuria, 75 (27%) had asymptomatic bacteriuria, 21 (8%) had symptomatic UTIs without further complication, and 22 (8%) with UTIs developed either pyelonephritis or urosepsis. Most frequent pathogens identified were Enterococcus faecalis and Escherichia coli, and 36% of organisms were multidrug resistant. Female sex was a risk factor for infection (P = .002), and presence of a double-J ureteral stent significantly increased the risk of asymptomatic bacteriuria and symptomatic UTIs (P = .003). Diabetes, age, and prior transplantation did not increase risk. Presence of infection was not associated with increased rejection, with similar renal function at 12 months. For episodes of bacteriuria (n = 420, asymptomatic n = 324), untreated asymptomatic bacteriuria (n = 185) followed by symptomatic UTI with the same organism was significantly higher (P = .002) compared with cases of treated asymptomatic bacteriuria (n = 139).. Bacteriuria post-kidney transplantation is common, affecting nearly half of KTRs in the first year after transplantation. Treatment of asymptomatic bacteriuria may be beneficial to prevent subsequent episodes of symptomatic UTIs.

Topics: Adult; Bacterial Infections; Bacteriuria; Enterococcus faecalis; Escherichia coli; Female; Humans; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Pyelonephritis; Retrospective Studies; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Cotrimoxazole is widely used, particularly as a prophylactic drug in HIV patients. We assessed resistance mechanisms among cotrimoxazole resistant-Gram negative bacterial isolates (n = 123) obtained from blood (n = 69) and urine (n = 54) from Tanzanian patients. sul genes were detected in 98% (121/123) of the isolates. Coexistence of sul1 and sul2 was common (49/123). The dfr genes were found in 63% (77/123) of all isolates. sul1, dfrA15, and dfrA5 genes predominated among Klebsiella pneumoniae, while sul2 and dfrA1 genes were frequent in Escherichia coli isolates. Two isolates, both K. pneumoniae, carried sul3. Integrons were detected in 81.3% (100/123) of all isolates. Class 1 integrons were found in 95% (42/44), 53% (23/43), and 80.6% (25/31) of K. pneumoniae, E. coli, and other Enterobacteriaceae isolates, respectively. Class 2 integrons were found in 14% of E. coli, but not in K. pneumoniae. All sul1 genes in K. pneumoniae were carried in class 1 integrons. Gene cassette arrays dfrA5 and dfrA15-aadA1 were most frequently associated with class 1 integrons, while class 2 integrons contained only dfrA1-sat2-aadA1 gene cassettes. This is the first report of sul3 gene in K. pneumoniae from human sources. The finding that mechanisms differ between E. coli and K. pneumoniae may broaden our understanding of cotrimoxazole resistance.

Topics: Anti-Bacterial Agents; Cross-Sectional Studies; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Genes, Bacterial; Humans; Integrons; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Prospective Studies; Tanzania; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Biofilm formation can cause refractory urinary tract infections (UTIs) in dogs; however, minimum biofilm eradication concentrations (MBECs) of veterinary drugs against canine uropathogens remain to be investigated. In this study, the MBECs of orbifloxacin (OBFX), trimethoprim-sulfamethoxazole (TMS) and amoxicillin/clavulanate (ACV) over different time periods for treatment of canine uropathogenic Escherichia coli (n = 10) were determined. The MBECs of OBFX for other bacterial uropathogens, including Staphylococcus pseudintermedius (n = 5), Pseudomonas aeruginosa (n = 5), Klebsiella pneumoniae (n = 5) and Proteus mirabilis (n = 5) were also determined. Minimum inhibitory concentrations (MICs) were identified for all strains by broth microdilution, and MBECs were determined at 24, 72, and 168 hr using the Calgary biofilm method. The 24 hr MBECs of OBFX, TMS and ACV for the E. coli strains were significantly higher than the MICs (P < 0.05), and the 72 and 168 hr MBECs were significantly lower than those at 24 hr (P < 0.05). In addition, the 24 hr OBFX MBECs for the four other uropathogens were significantly higher than the corresponding MICs (P < 0.05). The 72 and/or 168 hr OBFX MBECs for S. pseudintermedius, K. pneumoniae and P. mirabilis were significantly lower than the 24 hr concentrations (P < 0.05), whereas for P. aeruginosa, no significant difference was found between any of the MBECs (P > 0.05). These data indicate that the administration period and uropathogenic bacterial species are important factors affecting the efficacy of OBFX treatment of biofilm-related UTIs in dogs.

Topics: Amoxicillin-Potassium Clavulanate Combination; Animals; Anti-Bacterial Agents; Biofilms; Ciprofloxacin; Disease Eradication; Dog Diseases; Dogs; Gram-Negative Bacteria; Gram-Positive Bacteria; Microbial Sensitivity Tests; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Amoxicillin; Ampicillin; Anti-Bacterial Agents; beta-Lactamase Inhibitors; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Fluoroquinolones; Humans; Microbial Sensitivity Tests; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; United States; United States Department of Veterans Affairs; Urinary Tract; Urinary Tract Infections; Veterans

To identify risk factors for antibiotic resistance to Escherichia coli (E. coli) in children with urinary tract infections (UTIs) in emergency room and primary care clinics.. This is a cross-sectional study of children 0 to 18 years of age reported to have E coli-positive UTIs whose medical and laboratory records were systematically reviewed.. Compared with girls, boys were 2.29 times (confidence interval [CI] = 1.30-4.02) more likely to have E coli isolates resistant to ampicillin and 2 times more likely (CI = 1.13-3.62) to have isolates resistant to trimethoprim-sulfamethoxazole (TMP/SMX). Patients with genitourinary abnormalities were 1.57 times more likely to be resistant to ampicillin (CI = 1.03-2.41) and 1.86 times to TMP/SMX (CI = 1.18-2.94).. Higher rates of ampicillin and TMP/SMX resistant urinary E coli isolates were observed among boys and children with a history of genitourinary abnormality. Age and recent antibiotic prescription are also potential risk factors for resistance.

Topics: Adolescent; Ampicillin; Anti-Bacterial Agents; Child; Child, Preschool; Cross-Sectional Studies; Drug Resistance, Bacterial; Emergency Service, Hospital; Escherichia coli; Escherichia coli Infections; Female; Humans; Illinois; Infant; Infant, Newborn; Male; Microbial Sensitivity Tests; Primary Health Care; Retrospective Studies; Risk Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinalysis; Urinary Tract Infections

Bolivia is among the lowest-resourced South American countries, with very few data available on antibiotic resistance in bacterial pathogens. The phenotypic and molecular characterization of bacterial isolates responsible for urinary tract infections (UTIs) in the Bolivian Chaco are reported here.. All clinical isolates from UTIs collected in the Hospital Basico Villa Montes between June 2010 and January 2014 were analyzed (N=213). Characterization included susceptibility testing, extended-spectrum beta-lactamase (ESBL) detection, identification of relevant resistance determinants (e.g., CTX-M-type ESBLs, 16S rRNA methyltransferases, glutathione S-transferases), and genotyping of CTX-M producers.. Very high resistance rates were observed. Overall, the lowest susceptibility was observed for trimethoprim-sulphamethoxazole, tetracycline, nalidixic acid, amoxicillin-clavulanic acid, ciprofloxacin, and gentamicin. Of E. coli and K. pneumoniae, 11.6% were ESBL producers. Resistance to nitrofurantoin, amikacin, and fosfomycin remained low, and susceptibility to carbapenems was fully preserved. CTX-M-15 was the dominant CTX-M variant. Four E. coli ST131 (two being H30-Rx) were identified. Of note, isolates harbouring rmtB and fosA3 were detected.. Bolivia is not an exception to the very high resistance burden affecting many South American countries. Optimization of alternative approaches to monitor local antibiotic resistance trends in resource-limited settings is strongly encouraged to support the implementation of effective empiric treatment guidelines.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; beta-Lactamases; Bolivia; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Fosfomycin; Genotype; Humans; Klebsiella Infections; Klebsiella pneumoniae; Methyltransferases; RNA, Ribosomal, 16S; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Increasing resistance among Gram-negative uropathogens limits treatment options, and susceptibility data for multidrug-resistant isolates are limited. We assessed the activity of five oral agents against 91 multidrug-resistant Gram-negative urine isolates that were collected from emergency department/hospitalized patients. Fosfomycin and nitrofurantoin were most active (>75% susceptibility). Susceptibilities to sulfamethoxazole-trimethoprim, ciprofloxacin, and ampicillin were ≤40%; empirical use of these agents likely provides inadequate coverage in areas with a high prevalence of multidrug-resistant uropathogens.

Topics: Ampicillin; Anti-Bacterial Agents; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Fosfomycin; Microbial Sensitivity Tests; Nitrofurantoin; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) trial found that recurrent urinary tract infections (rUTI) with resistant organisms were more common in the trimethoprim-sulfamethoxazole prophylaxis (TSP) arm. We describe factors associated with trimethoprim-sulfamethoxazole (TMP-SMX) resistance of rUTIs in RIVUR.. Children aged 2 to 71 months with first or second UTI (index UTI) and grade I to IV vesicoureteral reflux (VUR) were randomized to TSP or placebo and followed for 2 years. Factors associated with TMP-SMX-resistant rUTI were evaluated.. Among 571 included children, 48% were <12 months old, 43% had grade II VUR, and 38% had grade III VUR. Recurrent UTI occurred in 34 of 278 children receiving TSP versus 67 of 293 children receiving placebo. Among those with rUTI, 76% (26/34) of subjects receiving TSP had TMP-SMX-resistant organisms versus 28% (19/67) of subjects receiving placebo (P < .001). The proportion of TMP-SMX-resistant rUTI decreased over time: in the TSP arm, 96% were resistant during the initial 6 months versus 38% resistant during the final 6 months; corresponding proportions for the placebo arm were 32% and 11%. Among children receiving TSP, 7 (13%) of 55 with TMP-SMX-resistant index UTI had rUTI, whereas 27 (12%) of 223 with TMP-SMX-susceptible index UTI had rUTI (adjusted hazard ratio 1.38, 95% confidence interval 0.54-3.56). Corresponding proportions in placebo arm were 17 (26%) of 65 and 50 (22%) of 228 (adjusted hazard ratio 1.33, 95% confidence interval 0.74-2.38).. Although TMP-SMX resistance is more common among children treated with TSP versus placebo, resistance decreased over time. Among children treated with TSP, there was no significant difference in UTI recurrence between those with TMP-SMX-resistant index UTI versus TMP-SMX-susceptible UTI.

Topics: Antibiotic Prophylaxis; Child, Preschool; Drug Resistance, Bacterial; Female; Humans; Infant; Male; Recurrence; Secondary Prevention; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

Inflammatory myofibroblastic tumors (IMT) are rare benign tumors, most commonly arising in the lungs and urinary bladder. Many etiologic factors are suspected in their development, but none have been formally demonstrated. Conventional treatment for bladder IMT is complete surgical resection by partial cystectomy or transurethral resection. We report the case of an 8-year-old girl with documented bladder IMT that resolved completely after antibiotic therapy.

Topics: Anti-Infective Agents, Urinary; Child; Female; Granuloma, Plasma Cell; Humans; Methicillin-Resistant Staphylococcus aureus; Staphylococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder Diseases; Urinary Tract Infections

Escherichia coli is the most common pathogen isolated from both nosocomial and community acquired urinary tract infections. Although there are many studies from different centers concerning the antibiotic susceptibility of E.coli isolates in Turkey, the studies are quite few about class 1 and class 2 integron cassettes in clinical E.coli isolates from urinary samples. The aim of the study was to investigate the antibiotic susceptibility and the carriage of integron gene cassettes in E.coli strains isolated from urinary samples. A total of 626 E.coli strains isolated from urine cultures in microbiology laboratories located at 10 provinces from different regions of Turkey (Denizli, Ankara, Kayseri, Niğde, Şanlıurfa, Kahramanmaras, Tokat, Malatya, Konya and Trabzon) between June 2011-June 2012 were included in the study. The identification and antibiotic susceptibility testing of the isolates were studied by conventional methods as well as Vitek® 2 Compact (bioMérieux, France) and BD Phoenix™ 100 (Becton Dickinson, USA) systems. The antibiotic susceptibilities of all the isolates were retested by Kirby-Bauer disk diffusion method according to CLSI recommendations in the main center of the study in order to achive the standardization. The presence of integrons was detected with polymerase chain reaction (PCR) method by using specific primers targeting class 1 (intI1) and class 2 (intI2) integrase gene regions. After integron amplification the samples were cloned and subjected to DNA sequencing. When the antibiotic susceptibility of the isolates were evaluated, the highest resistance was observed against most commonly used empirical antibiotics namely ampicillin and trimethoprim-sulfamethoxazole (SXT) with the mean rate of 58.6% (range: 43.8%-73.2%) and 41.2% (range: 35.4%-45.8%), respectively. The most effective antibiotics detected against the isolates were imipenem and amikacin with the lowest resistance rates of 0.2% (range: 0%-1.1%) and 0.6% (range: 0%-3.2%), respectively. The frequency of positive IntI1 gene and class 1 integron gene cassettes were found as 25.8% (162/626) and 16.6% (104/626), respectively, whereas the frequency of positive intI2 gene II and class 2 integron gene cassettes were 5.1% (32/626) and 3% (19/626), respectively. The lowest intI1 gene frequency was detected in the isolates from Kayseri (16.6%) and the highest in the isolates from Kahramanmaraş (35.4%) provinces. While there was no intI2 gene in the isolates from Denizli and Kays

Topics: Amikacin; Ampicillin; Anti-Bacterial Agents; Bacteriuria; Escherichia coli Infections; Humans; Imipenem; Integrons; Microbial Sensitivity Tests; Polymerase Chain Reaction; Sequence Analysis, DNA; Streptomycin; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey; Urinary Tract Infections; Uropathogenic Escherichia coli

Infection is a major determinant of clinical outcome among patients in the intensive care unit. However, these data are lacking in most developing countries; hence, we set out to describe the profile of nosocomial infection in one of the major tertiary hospitals in northern Nigeria.. Case records of patients who were admitted into the intensive care unit over a 4-year period were retrospectively reviewed. A preformed questionnaire was administered, and data on clinical and microbiological profile of patients with documented infection were obtained.. Eighty-our episodes of nosocomial infections were identified in 76 patients. Road traffic accident (29/76, 38.2%) was the leading cause of admission. The most common infections were skin and soft tissue infections (30/84, 35.7%) followed by urinary tract infection (23/84, 27.4%). The most frequent isolates were Staphylococcus aureus (35/84, 41.7%), Klebsiella pneumoniae (18/84, 21.4%), and Escherichia coli (13/84, 15.5%). High rate of resistance to cloxacillin (19/35, 54.3%) and cotrimoxazole (17/26, 65.4%) was noted among the S aureus isolates. All the Enterobacteriaceae isolates were susceptible to meropenem, whereas resistance rate to ceftriaxone was high (E coli, 55.6%; K pneumoniae, 71.4%; Proteus spp, 50%).. Infection control practice and measures to curtail the emergence of antimicrobial resistance need to be improved.

Topics: Adult; Anti-Bacterial Agents; Bacteremia; Catheter-Related Infections; Ceftriaxone; Cloxacillin; Cross Infection; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Intensive Care Units; Klebsiella Infections; Klebsiella pneumoniae; Male; Meropenem; Microbial Sensitivity Tests; Middle Aged; Nigeria; Pneumonia, Bacterial; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Tertiary Care Centers; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Young Adult

Urinary tract infections (UTIs) are among the most common bacterial infections in adult population. They are prevalent in all age groups both in women and men. Also, UTIs are the most frequent indication for empirical antibiotic treatment in emergency department. The aim of this study was to determine the antibiotic resistance rates in the treatment of uncomplicated UTIs. Adult patients admitted to emergency department with uncomplicated UTIs were included in this cross-sectional study. Mid-stream urine samples were obtained under sterile conditions and cultured quantitatively. After 24 hours, the samples showing 10(5) colony forming unit per milliliter (CFU/mL) were tested for antibiotic susceptibility. Resistance to fosfomycin-trometamol (FT), amoxicillin-clavulanic acid (AC), ciprofloxacin (CIP), trimethoprim-sulfamethoxazole (TMP-SMX) and cefpodoxime (CEF) was tested by Kirby-Bauer disc diffusion system. Escherichia (E.) coli accounted for the vast majority (93.4%) of the organisms isolated in the study. Among the E. coli positive patients, resistance to TMP-SMX was the most common antibiotic resistance. The E. coli species detected in our study group were least resistant to FT (2.4%). The resistance rates, especially to CEF, AC and CIP, were significantly higher in patients over 50 years of age. In conclusion, in the treatment of uncomplicated UTIs, TMP-SMX should be excluded from empirical treatment, while fosfomycin could be a viable option in all age groups.

Topics: Adolescent; Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefpodoxime; Ceftizoxime; Ciprofloxacin; Cross-Sectional Studies; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Fosfomycin; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Young Adult

Empirical treatment of uncomplicated urinary tract infections (UTIs) in women should be based on local susceptibility data. We aimed to generate regional and provincial cumulative antibiograms combining data from different laboratory information systems and determine the impact of basic patient characteristics on susceptibility results.. All positive urine samples for Escherichia coli obtained from women aged 18-65 years old in outpatient settings between 1 April 2010 and 31 March 2015 from four hospitals in Quebec, Canada, were included. The cumulative antibiogram for ciprofloxacin, nitrofurantoin and trimethoprim/sulfamethoxazole was calculated. A clinically significant difference in susceptibility profile was defined as factor(s) that lowered the susceptibility proportion below 80%.. A total of 36 293 positive urine cultures were analysed. In the last year of the study, the proportion of susceptibility for ciprofloxacin, nitrofurantoin and trimethoprim/sulfamethoxazole was 90.3%, 95.4% and 81.9%, respectively. The susceptibility proportion was <80% for trimethoprim/sulfamethoxazole in the Montreal region (73.4%; 95% CI 71.1%-75.9%), whereas it remained >80% for the other regions. A significant decrease in susceptibility with time was identified for ciprofloxacin (92.1%-90.3%, P < 0.001) and nitrofurantoin (97.1%-95.4%, P < 0.001). Increasing age, recent hospitalization and site of collection were associated with an increase in resistance for certain antibiotics.. Overall, all first-line antimicrobials remain acceptable choices for empirical treatment of uncomplicated UTIs in women in Quebec. The regional variability in susceptibility data within a single province emphasizes the importance of local susceptibility data to inform the development of empirical treatment guidelines for UTIs.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Ciprofloxacin; Escherichia coli; Escherichia coli Infections; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Nitrofurantoin; Outpatients; Quebec; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urine; Young Adult

Klebsiella pneumoniae New Delhi metallo-beta-lactamase-1 (NDM-1) strains have recently become a new threat in kidney transplant recipients due to the strains' resistance to almost all antibiotics, including carbapenems.. We present a case series of 3 patients with urinary tract infections (UTIs) caused by multiresistant K pneumoniae NDM-1 strains who were treated with the same protocol. Genotyping sequencing with pulsed-field gel electrophoresis was performed in all cases.. All patients were male and had undergone kidney transplantation 4, 7, and 8 months, respectively, before the admission. Combined antibiotic therapy consisting of imipenem/cilastatin in maximal doses, gentamicin and/or colistin for 21 to 27 days, followed by oral fosfomycin, was used in all cases. There were no further UTI episodes in 2 patients at the 12-month visit. Three months after initial treatment, the third patient presented with leukocyturia with no clinical symptoms and a urine culture positive for K pneumonia NDM-1 strain. Interestingly, the strain was susceptible to trimethoprim/sulfamethoxazole despite resistance in previous urine culture samples. The patient was successfully treated with trimethoprim/sulfamethoxazole 2 × 960 mg/d for 3 weeks followed by 480 mg/d and 3 doses of fosfomycin. Genotyping sequencing revealed identical DNA restriction fragments in bacterial strains from 2 patients. In the third case, although a difference in 2 restriction fragments was observed, the strain was considered related to the others.. In cases of UTI caused by K pneumoniae NDM-1 strains, prolong combined treatment followed by oral fosfomycin prophylaxis can be successful. Strain genotyping should be performed to optimize further treatment protocols in such cases.

Topics: Anti-Bacterial Agents; beta-Lactamases; Cilastatin; Cilastatin, Imipenem Drug Combination; Colistin; Drug Combinations; Drug Resistance, Microbial; Electrophoresis, Gel, Pulsed-Field; Fosfomycin; Genotype; Gentamicins; Humans; Imipenem; Kidney Transplantation; Klebsiella Infections; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Transplant Recipients; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Aged; Anti-Bacterial Agents; Drug Therapy, Combination; Escherichia coli Infections; Female; Fluoroquinolones; Humans; Pyelonephritis; Risk Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urolithiasis; Urology

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

OBJECTIVE To evaluate risk factors for and molecular characteristics of community-onset extended-spectrum cephalosporin-resistant (ESC-R) Enterobacteriaceae (EB) urinary tract infections (UTIs) in a US health system. DESIGN Case-control study. PARTICIPANTS All patients presenting to the emergency department or outpatient practices with EB UTIs from December 21, 2010, through April 22, 2013, were included. Case patients had ESC-R EB UTIs. Control patients had ESC-susceptible EB UTIs and were matched 1:1 on study year. METHODS Risk factors for ESC-R EB UTI were assessed using multivariable conditional logistic regression. A subset of case isolates was evaluated for extended-spectrum beta-lactamases. RESULTS A total of 302 patients with community-onset EB UTI were included, of which 151 were cases. On multivariable analysis, risk factors for ESC-R EB UTI included trimethoprim-sulfamethoxazole use in the prior 6 months (odds ratio, 2.40 [95% CI, 1.22-4.70]; P=.01), older age (1.03 [1.01-1.04]; P<.001), diabetes (2.91 [1.32-6.41]; P=.008), and presentation to the emergency department ( 2.42 [1.31-4.46]; P=.005). The prevalence of extended-spectrum beta-lactamases among 120 case isolates was 52% CTX-M, 29% TEM, 20% OXA, and 13% SHV. The prevalence of AmpC was 25%. Pulsed-field gel electrophoresis of the CTX-M Escherichia coli isolates showed no distinct clusters. CONCLUSIONS Use of trimethoprim-sulfamethoxazole, older age, diabetes, and presentation to the emergency department were associated with community-onset ESC-R EB UTI. There was a high prevalence of CTX-M among our community isolates. Further studies are needed to determine strategies to limit emergence of these organisms in the community. Infect Control Hosp Epidemiol 2016;1433-1439.

Topics: Academic Medical Centers; Adult; Aged; Anti-Bacterial Agents; Case-Control Studies; Cephalosporin Resistance; Cephalosporins; Community-Acquired Infections; Drug Resistance, Bacterial; Emergency Service, Hospital; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Gram-Negative Facultatively Anaerobic Rods; Humans; Logistic Models; Male; Middle Aged; Pennsylvania; Polymerase Chain Reaction; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To evaluate whether intestinal microbiota predicts the development of new-onset urinary tract infections (UTIs) in postmenopausal women with prior recurrent UTIs (rUTIs).. Fecal samples (n = 40) originated from women with rUTI who received 12 months' prophylaxis of either trimethoprim-sulfamethoxazole (TMP-SMX) or lactobacilli. Microbial composition was assessed by 16S rRNA pyrosequencing.. At baseline, fecal microbiota of women with zero and more than or equal to four UTIs during follow-up showed no significant differences. Only TMP-SMX prophylaxis resulted in reduced microbial diversity. Microbial structure of two samples from the same woman showed limited relatedness.. In postmenopausal women with rUTI, the intestinal microbiota was not predictive for new-onset UTIs. Only TMP-SMX, and not lactobacilli, prophylaxis had effects on the microbial composition. Data in ENA:PRJEB13868.

Topics: Antibiotic Prophylaxis; Biodiversity; DNA, Bacterial; Feces; Female; Gastrointestinal Microbiome; Humans; Lactobacillus; Microbiological Phenomena; Middle Aged; Phylogeny; Postmenopause; Probiotics; RNA, Ribosomal, 16S; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The spread of Extended-Spectrum beta (β)-Lactamases (ESBL)-producing Enterobacteriaceae has become a serious global problem. ESBL-producing Enterobacteriaceae vary based on differences in antibiotic use, nature of patients and hospital settings. This study was aimed at determining ESBL and antibiogram in Enterobacteriaceae isolates from clinical and drinking water sources in Bahir Dar City, Northwest Ethiopia.. Enterobacteriaceae species were isolated from clinical materials and tap water using standard culturing procedures from September 2013 to March 2015. ESBL-producing-Enterobacteriaceae were detected using double-disk method by E-test Cefotaxim/cefotaxim+ clavulanic acid and Ceftazidime/ceftazidime+ clavulanic acid (BioMerieux SA, France) on Mueller Hinton agar (Oxoid, UK).. Overall, 274 Enterobacteriaceae were isolated. Of these, 210 (44%) were from patients and 64 (17.1%) were from drinking water. The median age of the patients was 28 years. Urinary tract infection and blood stream infection accounted for 60% and 21.9% of Enterobacteriaceae isolates, respectively. Klebsiella pneumoniae was isolated from 9 (75%) of neonatal sepsis. The overall prevalence of ESBL-producing Enterobacteriaceae in clinical and drinking water samples were 57.6% and 9.4%, respectively. The predominant ESBL-producers were K. pneumoniae 34 (69.4%) and Escherichia coli 71 (58.2%). Statistically significant associations were noted between ESBL-producing and non- producing Enterobacteriaceae with regard to age of patients, infected body sites and patient settings (P = 0.001). ESBL-producing Enterobacteriaceae showed higher levels of resistance against chloramphenicol, ciprofloxacin and cotrimoxazole than non-ESBL producers (P = 0.001).. ESBL-producing Enterobacteriaceae coupled with high levels of other antimicrobials become a major concern for treatment of patients with invasive infections such as blood stream infections, neonatal sepsis and urinary tract infections. ESBL-producing Enterobacteriaceae were also detected in drinking water sources.

Topics: Adult; Age Factors; Anti-Bacterial Agents; Bacteremia; beta-Lactamases; Child, Preschool; Chloramphenicol; Ciprofloxacin; Cross-Sectional Studies; Drinking Water; Drug Resistance, Multiple, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Ethiopia; Female; Gene Expression; Humans; Infant; Infant, Newborn; Male; Microbial Sensitivity Tests; Neonatal Sepsis; Prevalence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Escherichia coli clonal group A (CGA) causes urinary tract and other extra-intestinal infections in humans. CGA is an important cause of trimethoprim/sulfamethoxazole (SXT) resistance in extra-intestinal pathogens. We examined the extent to which resistance in this area is related to CGA dissemination of E. coli from urinary tract infections (UTIs) in Mexico City. The virulence backgrounds of the isolates were also characterized. In this study, the frequency of resistance to SXT used for UTI treatment was high (56-65 %), and CGA isolates accounted for 9 of the 78 SXT-resistant isolates (11.5 %). Although all CGA isolates were found to be multidrug resistant (MDR), none of them were extended-spectrum β-lactamase-producing organisms. The prevalence of CGA among the 45 MDR isolates that we identified was 20 %, indicating that this clonal group moderately contributes to the antibiotic resistance of uropathogenic E. coli isolates in this region. Most of the nine CGA isolates carried transferable, large-size plasmids of approximately 80 to 100 kb, which were able to transfer antimicrobial resistance to E. coli J53 in mating assays. CGA isolates mainly belonged to phylogenetic groups F and D. We found no association between antimicrobial resistance and virulence-associated genes: the median virulence scores of CGA isolates were slightly higher (4.6) than those of non-CGA isolates, whether they were susceptible (3.7) or resistant (3.5) to SXT. Our results indicate that CGA is not a major contributor to the high level of resistance to SXT in this region but, instead, seems to be an important constituent of MDR isolates from UTIs.

Topics: Anti-Bacterial Agents; beta-Lactamases; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Escherichia coli Infections; Genotype; Humans; Mexico; Phylogeny; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Uropathogenic Escherichia coli; Virulence Factors

Rhabdomyolysis is a rare phenomenon that may be challenging to recognize in an emergency setting. Drugs are one of the common causes. Trimethoprim-sulfamethoxazole is a commonly used antibiotic effective in the treatment of upper and lower respiratory tract infections as well as renal, urinary, and gastrointestinal tract infections. It has variable side effects, ranging from mild symptoms of fatigue and insomnia to a potentially life-threatening Steven-Johnson syndrome and renal failure. Rhabdomyolysis is a rare complication of therapy with this drug and is commonly seen in immunocompromised patients or those with an allogenic stem cell transplant. In this article, we report a case of rhabdomyolysis in an immunocompetent patient who has undergone treatment with trimethoprim-sulfamethoxazole and a possible drug interaction with nonsteroidal anti-inflammatory drugs, with the latter acting as an aggravating factor of this complication.

Topics: Anti-Infective Agents, Urinary; Diagnosis, Differential; Emergency Service, Hospital; Humans; Kidney Function Tests; Male; Middle Aged; Rhabdomyolysis; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Academic Medical Centers; Administration, Oral; Anti-Infective Agents, Urinary; Clinical Decision-Making; Drug Resistance, Bacterial; Drug Resistance, Multiple, Bacterial; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Gram-Positive Bacteria; Gram-Positive Bacterial Infections; Humans; Japan; Microbial Sensitivity Tests; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We described the clinical predictive role of emerging Escherichia coli O25b/sequence type 131 (ST131) in treatment failure of urinary tract infection.. In this prospective observational cohort study, the outpatients with acute cystitis with isolation of E. coli in their urine cultures were assessed. All the patients were followed up for clinical cure after 10 days of treatment. Detection of the E. coli O25:H4/ST131 clone was performed by multiplex polymerase chain reaction (PCR) for phylogroup typing and using PCR with primers for O25b rfb and allele 3 of the pabB gene.. In a cohort of patients with diagnosis of acute urinary cystitis, 294 patients whose urine cultures were positive with a growth of >10(4) colony-forming units/mL of E. coli were included in the study. In empiric therapy, ciprofloxacin was the first choice of drug (27%), followed by phosphomycin (23%), trimethoprim-sulfamethoxazole (TMP-SMX) (9%), and cefuroxime (7%). The resistance rate was 39% against ciprofloxacin, 44% against TMP-SMX, and 25% against cefuroxime. Thirty-five of 294 (12%) isolates were typed under the O25/ST131 clone. The clinical cure rate was 85% after the treatment. In multivariate analysis, detection of the O25/ST131 clone (odds ratio [OR], 4; 95% confidence interval [CI], 1.51-10.93; P = .005) and diabetes mellitus (OR, 2.1; 95% CI, .99-4.79; P = .05) were found to be significant risk factors for the treatment failure. In another multivariate analysis performed among quinolone-resistant isolates, treatment failure was 3 times more common among the patients who were infected with ST131 E. coli (OR, 3; 95% CI, 1.27-7.4; P = .012).. In urinary tract infections, the E. coli ST131 clone seems to be a consistent predictor of treatment failure.

Topics: Aged; Anti-Bacterial Agents; Bacterial Typing Techniques; Cefuroxime; Ciprofloxacin; Cohort Studies; Cystitis; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Forecasting; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Multiplex Polymerase Chain Reaction; Multivariate Analysis; Phylogeny; Prospective Studies; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Female; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Anti-Infective Agents, Urinary; Female; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

Prospective studies from developing countries that have investigated risk factors for trimethoprim-sulfamethoxazole (TMP-SMX)-resistant Escherichia coli in women with uncomplicated urinary tract infection (UTI) remain scarce.. Women with acute uncomplicated UTI were enrolled prospectively. Urine was sent for antimicrobial susceptibility testing. Logistic regression analysis was used to identify risk factors for TMP-SMX resistance.. Of 405 participants, 229 (56.5%) had bacteriuria (mean age 31.9 ± 9.5 years). In the previous 12 months, 77 (33.6%) had experienced at least one UTI episode and 106 (46.3%) reported antimicrobial use. The most common uropathogens were E. coli (75.8%) and Staphylococcus saprophyticus (8.9%). For the 179 E. coli, resistance rates were highest for ampicillin (64.3%) and TMP-SMX (41.3%). Resistance to cephalosporins, nitrofurantoin, and fluoroquinolones was much lower compared with the hospital laboratory-based surveillance data. Risk factors for TMP-SMX resistance were UTI in the last 6 months (odds ratio 2.22; p = 0.04) and the number of UTI episodes in the past year (odds ratio 2.06; p = 0.004). The number of UTI episodes (adjusted odds ratio 2.21; p = 0.02) remained significant on multivariate analysis.. TMP-SMX resistance was high. Number of previous UTI episodes was associated with increased risk of resistance; prior antimicrobial use was not. Hospital antibiograms should be used with caution when treating uncomplicated UTI.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Developing Countries; Drug Resistance, Bacterial; Escherichia coli Infections; Female; Fluoroquinolones; Humans; Microbial Sensitivity Tests; Prevalence; Prospective Studies; Risk Factors; Staphylococcal Infections; Staphylococcus saprophyticus; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Uropathogenic Escherichia coli; Young Adult

Topics: Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Female; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

The antibiotic nitrofurantoin is commonly used to treat uncomplicated urinary tract infections. However, when this drug is used by patients with reduced kidney function, its urine concentration may be subtherapeutic.. We conducted a population-based study of older women (mean age 79 years) in Ontario, Canada, whose estimated glomerular filtration rate was relatively low (median 38 mL/min per 1.73 m(2)) and for whom 1 of 4 antibiotics had been prescribed for urinary tract infection: nitrofurantoin, ciprofloxacin, norfloxacin or trimethoprim-sulfamethoxazole. We assessed 2 measures of treatment failure in the subsequent 14 days: receipt of a second antibiotic indicated for urinary tract infection and hospital encounter (emergency department visit or hospital admission) with a urinary tract infection. We repeated the analysis for older women with relatively high estimated glomerular filtration rate (median 69 mL/min per 1.73 m(2)).. The baseline characteristics of the 4 antibiotic groups were similar. Relative to nitrofurantoin, the other antibiotics (including ciprofloxacin) were associated with a lower rate of treatment failure among women with relatively low estimated glomerular filtration rate (for ciprofloxacin v. nitrofurantoin: second antibiotic prescription, 130/1989 [6.5%] v. 516/3739 [13.8%], odds ratio [OR] 0.44, 95% confidence interval [CI] 0.36-0.53; hospital encounter, 21/1989 [1.1%] v. 95/3739 [2.5%], OR 0.41, 95% CI 0.25-0.66). However, a similar risk of treatment failure with nitrofurantoin was also observed among women with relatively high estimated glomerular filtration rate. The results were consistent in multiple additional analyses.. In this study, the presence of mild or moderate reductions in estimated glomerular filtration rate did not justify avoidance of nitrofurantoin.

Topics: Age Factors; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Ciprofloxacin; Female; Glomerular Filtration Rate; Humans; Nitrofurantoin; Norfloxacin; Renal Insufficiency; Retrospective Studies; Sex Factors; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Female; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

Multiple medications have been associated with pancreatitis, however, data in the pediatric population are scarce secondary to the nonspecific presentation and infrequent diagnosis. The aim of this report is to characterize drug-induced pancreatitis in an adolescent patient.. A 16-year-old African-American female presented with a surgical site infection 8 weeks after a motor vehicle accident with multiple traumas. Two weeks prior to the admission, the patient was hospitalized for a urinary tract infection (UTI) and was initiated on sulfamethoxazole/trimethoprim (TMP/SMX) daily for UTI prophylaxis. On day 13, the patient was diagnosed with acute pancreatitis with an amylase level of 187 units/L (normal = 30-110) and a lipase level of 987 units/L (normal = 23-208). TMP/SMX was discontinued, and pancreatic enzyme levels decreased but did not reach normal. The patient was asymptomatic at discharge.. TMP/SMX was identified as the likely etiology of pancreatitis by the medical team. Evaluation with the Naranjo algorithm indicated a "possible" adverse drug reaction.. Acute pancreatitis can have significant morbidity and mortality in the pediatric population but can go undiagnosed due to its lower incidence. Pediatric patients presenting with idiopathic abdominal pain should be evaluated for pancreatitis and drug therapy should be reviewed for potential causative agents.

Topics: Abdominal Pain; Accidents, Traffic; Acute Disease; Adolescent; Anti-Infective Agents, Urinary; Female; Humans; Multiple Trauma; Pancreatitis; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Corynebacteria have an important place among the commensal flora of the skin and mucous membranes. Except for Corynebacterium diphtheriae, they were once considered contaminants of mucosa. Recent publications in medical bacteriology have highlighted the importance of several species, such as C. aurimucosum. To the best of our knowledge, we report the first isolation of this strain from urine.. We report a case of a patient with a urinary tract infection with C. aurimucosum. We isolated this bacterium from a 52-year-old man of Wolof ethniticity (an ethnic group in Senegal, West Africa) at the regional hospital of Saint Louis, Senegal. Microscopic examination of his total urine sample showed coryneform Gram-positive bacilli associated with a high leukocyte reaction. After repeated isolation of the corynebacteria in three samples from the patient's urine, it was identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. The strain was susceptible to antibiotics, except for penicillin and co-trimoxazole. The potential infectious role of these commensal species in several infections should be taken into consideration.. This case highlights the significant proportion of species in the genus Corynebacterium other than dyphteriae in the infectious process. The use of mass spectrometry for identification highlights the originality of this work and the importance of these new diagnostic tools that are unavailable in most health facilities of countries with limited resources. We share the results of our method of identification of the isolated bacteria. This case should prompt attention to these rare bacteria, which can cause severe infections.

Topics: Anti-Bacterial Agents; Constriction, Pathologic; Corynebacterium; Humans; Male; Mass Spectrometry; Middle Aged; Penicillins; Trimethoprim, Sulfamethoxazole Drug Combination; Urethra; Urinary Tract Infections

The purpose of this study is to describe a case report of a patient experiencing hyponatremia from trimethoprim-sulfamethoxazole (TMP-SMX) upon initial use and subsequent rechallenge.. An 82-year-old woman presented to the emergency department with altered mental status thought to be due to complicated cystitis and was treated with TMP-SMX 160 mg/800 mg orally twice daily for 7 days. Her basic metabolic panel prior to initiation of TMP-SMX was within normal limits, with the exception of her serum sodium of 132 mmol/L (range 133-145 mmol/L). The day after completing her 7-day course of TMP-SMX therapy the patient was evaluated by her primary care provider and another basic metabolic panel revealed a reduction in the serum sodium to 121 mmol/L. The patient's serum sodium concentrations increased to baseline 7 days after completion of the TMP-SMX therapy, and remained normal until she was treated in the emergency department several months later for another presumed urinary tract infection. She was again started on TMP-SMX therapy empirically, and within several days her serum sodium concentrations decreased from 138 mmol/L to a low of 129 mmol/L. The TMP-SMX therapy was discontinued upon negative urine culture results and her serum sodium increased to 134 mmol/L upon discharge. Based upon the Naranjo probability scale score of 9, TMP-SMX was the probable cause of the patient's hyponatremia.. Our patient developed hyponatremia from TMP-SMX therapy upon initial use and rechallenge. Although hyponatremia appears to be rare with TMP-SMX therapy, providers should be aware of this potentially life-threatening adverse event.

Topics: Aged, 80 and over; Female; Humans; Hyponatremia; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Urinary tract infection (UTI) is a common complication after kidney transplantation, often associated to graft loss and increased healthcare costs. Kidney transplant patients (KTPs) are particularly susceptible to infection by Enterobacteriaceae-producing extended-spectrum β-lactamases (ESBLs). A retrospective case-control study was conducted to identify independent risk factors for ESBL-producing Escherichia coli and Klebsiella pneumoniae in non-hospitalized KTPs with UTI. Forty-nine patients suffering from UTI by ESBL-producing bacteria (ESBL-P) as case group and the same number of patients with UTI by ESBL negative (ESBL-N) as control-group were compared. Clinical data, renal function parameters during UTI episodes, UTI recurrence and relapsing rate, as well as risk factors for recurrence, molecular characterization of isolates and the respective antimicrobial susceptibility profile were evaluated. Diabetes mellitus (p <0.007), previous antibiotic prophylaxis (p=0.017) or therapy (p<0.001), previous UTI (p=0.01), relapsing infection (p=0.019) and patients with delayed graft function after transplant (p=0.001) represented risk factors for infection by ESBL positive Enterobacteriaceae in KTPs. Interestingly, the period of time between data of transplantation and data of UTI was shorter in case of ESBL-P case-group (28.8 months) compared with ESBL-N control-group (50.9 months). ESBL-producing bacteria exhibited higher resistance to fluoroquinolones (p=0.002), trimethoprim-sulfamethoxazole (p<0.001) and gentamicin (p<0.001). Molecular analysis showed that blaCTX-M was the most common ESBL encoding gene (65.3%), although in 55.1% of the cases more than one ESBL gene was found. In 29.4% of K. pneumoniae isolates, three bla-genes (blaCTX-M-blaTEM-blaSHV) were simultaneously detected. Low estimated glomerular filtration rate (p=0.009) was found to be risk factor for UTI recurrence. Over 60% of recurrent UTI episodes were caused by genetically similar strains. UTI by ESBL-producing Enterobacteriaceae in KTPs represent an important clinical challenge regarding not only hospitalized patients but also concerning outpatients.

Topics: Adult; Aged; Anti-Bacterial Agents; beta-Lactamases; Case-Control Studies; Escherichia coli; Escherichia coli Infections; Female; Humans; Kidney Transplantation; Klebsiella Infections; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Middle Aged; Molecular Epidemiology; Retrospective Studies; Risk Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Urine cultures are not always performed for female Emergency Department (ED) patients with uncomplicated urinary tract infection (UTI). Accordingly, hospital, and even ED-specific, antibiograms might be skewed toward elderly patients with many comorbidities and relatively high rates of antimicrobial resistance, and thus do not accurately reflect otherwise healthy women. Our ED antibiogram indicates Escherichia coli resistance rates for ciprofloxacin, levofloxacin, and trimethoprim-sulfamethoxazole (TMP-SMX) of 42%, 26%, and 33%, respectively.. This study aims to compare resistance rates of urinary E. coli from otherwise healthy women with uncomplicated UTI and pyelonephritis in the ED to rates in our ED antibiogram.. Females > 18 years old with acute onset of urinary frequency, urgency, or dysuria with pyuria identified on urinalysis (white blood cell count > 10/high-power field) were prospectively enrolled in the ED of an urban, academic medical center. Exclusion criteria indicating a complicated UTI were consistent with Infectious Diseases Society of America guidelines. Susceptibility patterns of E. coli to ciprofloxacin, levofloxacin, and TMP-SMX in the study group were compared to our ED antibiogram.. Forty-five patients grew E. coli. Pyelonephritis was suspected in nine (20%) subjects. Compared with the ED antibiogram, significantly lower rates of resistance to ciprofloxacin (2% vs. 42%, p < 0.001), levofloxacin (2% vs. 26%, p < 0.001), and TMP-SMX (16% vs. 33%, p = 0.016) were observed. Six patients grew non-E. coli uropathogens. All were susceptible to both levofloxacin and TMP-SMX.. ED antibiograms may overestimate resistance rates for uropathogens causing uncomplicated UTIs. In cases where nitrofurantoin cannot be used, fluoroquinolones and possibly TMP-SMX may remain viable options for treatment of uncomplicated UTI and pyelonephritis in women.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Ciprofloxacin; Drug Resistance, Bacterial; Emergency Service, Hospital; Escherichia coli; Escherichia coli Infections; Female; Humans; Levofloxacin; Microbial Sensitivity Tests; Middle Aged; Prospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Escherchia coli isolated, from urine samples were studied for their antibiotic susceptibility patterns, with special reference to the new antimicrobial compound fosfomycin and their correlation with various virulence factors.. The mid stream urine samples received in the department were processed and identification was done by using the standard culture and identification techniques. The antibiotic susceptibility testing was done by modified Kirby-Bauer disk diffusion and the disk diffusion method was used to confirm the ESBL, AmpC, MBL production by the UPEC. Various virulence factors like hemolysin, haemagglutinaton, gelatinase, siderophore production, biofilm formation, serum resistance and hydrophobicity were detected.. Fosfomycin was found to be most effective agent (100%) against uropathogenic E.coli followed by netilmicin (89.5%). The least effective agents were ampiciilin and cotrimoxazole. Twenty nine percent (29%) isolates were found to be multi drug resistant (MDR).. The testing of the newer therapeutic agents like fosfomycin will add on to therapeutics for UTI's.

Topics: Ampicillin; Anti-Bacterial Agents; Biofilms; Drug Resistance, Multiple, Bacterial; Escherichia coli Infections; Fosfomycin; Humans; Microbial Sensitivity Tests; Netilmicin; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urine; Uropathogenic Escherichia coli; Virulence Factors

Single institution and population-based studies highlight that infectious complications following transrectal ultrasound guided prostate needle biopsy (TRUS PNB) are increasing. Such infections are largely attributable to quinolone resistant microorganisms which colonize the rectal vault and are translocated into the bloodstream during the biopsy procedure. A povidone iodine rectal preparation (PIRP) at time of biopsy is a simple, reproducible method to reduce rectal microorganism colony counts and therefore resultant infections following TRUS PNB. All patients are administered three days of oral antibiotic therapy prior to biopsy. The PIRP technique involves initially positioning the patient in the standard manner for a TRUS PNB. Following digital rectal examination, 15 ml of a 10% solution of commercially available povidone iodine is mixed with 5 ml of 1% lidocaine jelly to create slurry. A 4 cmx4 cm sterile gauze is soaked in this slurry and then inserted into the rectal vault for 2 min after which it is removed. Thereafter, a disposable cotton gynecologic swab is used to paint both the perianal area and the rectal vault to a distance of 3 cm from the anus. The povidone iodine solution is then allowed to dry for 2-3 min prior to proceeding with standard transrectal ultrasonography and subsequent biopsy. This PIRP technique has been in practice at our institution since March of 2012 with an associated reduction of post-biopsy infections from 4.3% to 0.6% (p=0.02). The principal advantage of this prophylaxis regimen is its simplicity and reproducibility with use of an easily available, inexpensive agent to reduce infections. Furthermore, the technique avoids exposing patients to additional systemic antibiotics with potential further propagation of multi-drug resistant organisms. Usage of PIRP at TRUS PNB, however, is not applicable for patients with iodine or shellfish allergies.

Topics: Anti-Infective Agents, Local; Antibiotic Prophylaxis; Bacterial Infections; Biopsy, Needle; Ciprofloxacin; Humans; Male; Povidone-Iodine; Prostate; Prostatic Neoplasms; Reproducibility of Results; Sepsis; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography, Interventional; Urinary Tract Infections

Determination of treatment protocols for infections according to antimicrobial susceptibility test (AST) results is are important for controlling the problem of antibiotic resistance. Two standards are widely used in the world. One of them is Clinical Laboratory Standards Institute (CLSI) standards used in Turkey for many years and the other is the European Committee on Antimicrobial Susceptibility Testing (EUCAST) standards which is used in European Union member countries and came into use in 2015 in Turkey. Since the EUCAST standards had higher clinical sensitivity limits particularly for gram-negative bacilli compared to CLSI (2009) standards, there will be some changes in antibiotic resistance profiles of Turkey with the use of EUCAST. CLSI has changed zone diameters after 2009 versions and the differences between the two standards were brought to a minimum level. Knowledge of local epidemiological data is important to determine empirical therapy which will be used in urinary tract infections (UTI). The aim of this study was to determine the differences of antibiotic susceptibility zone diameters based on our local epidemiological data among uropathogenic Escherichia coli isolates according to EUCAST 2014 and CLSI 2014 standards. A total of 298 E.coli strains isolated from urine samples as the cause of uncomplicated acute UTI agents, were included in the study. Isolates were identified by conventional methods and with BBL Crystal E/NF ID System (Becton Dickinson, USA). AST was performed with Kirby Bauer disk diffusion method and results were evaluated and interpreted according to the CLSI 2014 and EUCAST 2014 standards. According to the results, susceptibility rates of isolates against amikacin (100%) and trimethoprim-sulfamethoxazole (63.09%) were identical in both standards. However, statistically significant differences were observed between CLSI and EUCAST standards in terms of susceptibilities against gentamicin (91.95% and 84.56%, respectively; p= 0.004), cefuroxime axetil (20.13% and 77.18%, respectively; p= 0.000) and levofloxacin (73.83% and 67.11%, respectively; p= 0.044). No statistically differences between two standards for ampicillin (32.89% and 36.24%, respectively; p= 0.219), ampicillin-sulbactam (65.77% and 69.13%, respectively; p= 0.216), ciprofloxacin (72.48% and 71.14%, respectively; p= 0.392) and imipenem (94.63% and 95.30%, respectively; p= 0.426) were determined. In this transitional period, continuity of cooperation between the

Topics: Amikacin; Ampicillin; Anti-Bacterial Agents; Bacteriuria; Cefuroxime; Ciprofloxacin; Disk Diffusion Antimicrobial Tests; Drug Resistance, Bacterial; Escherichia coli Infections; European Union; Gentamicins; Humans; Imipenem; Levofloxacin; Microbial Sensitivity Tests; Reference Standards; Sulbactam; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey; Urinary Tract Infections; Uropathogenic Escherichia coli

The aim of our study was to characterize the phylogenetic groups of Escherichia coli, antibiotic resistance, and containment of class 1 integrons in the first attack of pyelonephritis and in subsequent recurrences in young children. Altogether, 89 urine E. coli isolates from 41 children with urinary tract infection (UTI) were studied for prevalence and persistence of phylogenetic groups by pulsed-field gel electrophoresis (PFGE), antibacterial resistance by minimal inhibitory concentrations (MIC) and class 1 integrons by PCR. Phylogenetic group B2 was most common (57%), followed by D (20%), A (18%) and B1 (5%). Overall resistance to betalactams was 61%, trimethoprim-sulfamethoxazole 28%, and was not associated with phylogenetic groups. According to PFGE, the same clonal strain persisted in 77% of patients. The persistence was detected most often in phylogenetic group B2 (70%). Phylogenetic group B2 more often contained class 1 integrons than group A. Integron positive strains had higher MIC values of cefuroxime, cefotaxime, and gentamicin. In conclusion, phylogenetic group B2 was the most common cause of the first episode of pyelonephritis, as well as in case of the persistence of the same strain and contained frequently class 1 integrons in childhood recurrent UTI. An overall frequent betalactam resistance was equally distributed among phylogenetic groups.

Topics: Anti-Bacterial Agents; Bacterial Typing Techniques; Cefotaxime; Cefuroxime; Child; Child, Preschool; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Escherichia coli; Escherichia coli Infections; Female; Gentamicins; Humans; Integrons; Male; Microbial Sensitivity Tests; Phylogeny; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Despite stable overall antibiotic use between 2007 and 2011 in The Netherlands, use of nitrofurantoin and trimethoprim increased by 32%. The background of this increased antibiotic use against uropathogens is unknown.. To determine whether increased use of urinary tract infection antibiotics is caused by changes in patients' consultation or physicians' prescribing behaviour and to investigate attitudes and opinions of women with respect to cystitis management and antibiotics.. Consultation and prescribing for International Classification of Primary Care (ICPC) codes U01 (dysuria), U02 (frequency), U05 (other urination problems), U70 (pyelonephritis) and U71 (cystitis) were determined from 2007 to 2010, using routinely collected primary health care data. Separately, behaviour of women with respect to managing cystitis, consultation and opinions towards (delayed) antibiotic treatment were studied using questionnaires in 2012.. Consultation for U02 and U71 significantly increased from 93 to 114/1000 patient-years from 2007 to 2010; proportion of episodes in which an antibiotic was prescribed remained constant. Questionnaires revealed that urination problems and pain were dominant complaints of cystitis; pain medication, however, was not adequately used. One-third of women directly consult upon first symptoms, whereas the majority awaits an average of 4 days. Sixty-six per cent of women report to be willing to postpone antibiotic use.. Increased use of urinary tract infection antibiotics may be caused by increased consultation for cystitis in primary care. Future research should focus on the outcomes of adequate pain medication, enhanced diagnostic procedures and of delaying antibiotic use in cystitis management.

Topics: Adult; Anti-Infective Agents, Urinary; Attitude to Health; Cystitis; Drug Utilization; Dysuria; Female; Humans; Middle Aged; Netherlands; Nitrofurantoin; Patient Acceptance of Health Care; Practice Patterns, Physicians'; Primary Health Care; Surveys and Questionnaires; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Young Adult

We report a case of a 55-year-old immunocompromised female who presented to the emergency department with severe diarrhea and vomiting following travel to the Philippines. Stool bacteriology revealed a mixed infection involving an enteropathogenic Escherichia coli and two distinct strains of enteroaggregative Escherichia coli (EAEC). During hospitalization, urine and blood culture tested positive for one of the diarrheagenic EAEC strains, necessitating urinary catheterization, intensive care, and antimicrobial treatment with trimethoprim-sulfamethoxazole, followed by meropenem. Although known to occasionally cause urinary tract infections, EAEC have not been previously associated with sepsis. Our report highlights the potential of EAEC to cause severe extraintestinal infections.

Topics: Anti-Bacterial Agents; Bacteremia; Critical Care; Diarrhea; Enteropathogenic Escherichia coli; Escherichia coli; Escherichia coli Infections; Female; Humans; Middle Aged; Philippines; Sepsis; Travel; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Catheterization; Urinary Tract Infections

Topics: Anti-Bacterial Agents; Antioxidants; Ascorbic Acid; Bethanechol; Biopsy; Diagnosis, Differential; Female; Fluoroquinolones; Humans; Ill-Housed Persons; Kidney; Kidney Function Tests; Malacoplakia; Middle Aged; Muscarinic Agonists; Organ Size; Prognosis; Renal Dialysis; Renal Insufficiency; Substance-Related Disorders; Tomography, X-Ray Computed; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The use of potent immunosuppression increases the risk of infectious complications following kidney transplantation. Sulfamethoxazole-trimethoprim (SMX/TMP) is an inexpensive broad-spectrum antimicrobial agent used in our center as lifelong prophylaxis against Pneumocystis jirovecii, unless contraindicated. This study evaluated the clinical impact of SMX/TMP prophylaxis compared with no prophylaxis with SMX/TMP (NoPPx), but with alternative agents.. This was a retrospective cohort analysis of renal transplant recipients (RTR) transplanted from January 2002 through December 2010. Patients were divided into SMX/TMP group and NoPPX group, based on whether they received prophylaxis with SMX/TMP or not, and rates of sepsis were compared between groups. We also analyzed the pathogens and source implicated in these episodes, as well as the dose of SMX/TMP. Rates were compared using multivariate logistic regression.. With a mean follow-up of 4.8 (± 2.5) years, 63 cases of sepsis occurred in 1224 patients (5.1%), and 60% of these cases had a urinary source. The risk of sepsis was significantly reduced with prophylaxis vs. NoPPx (13.3% vs. 4.3% for SMX/TMP, P < 0.001), and this association was maintained through multivariate regression. Sepsis was associated with a numerically increased risk of graft loss and death that was not significantly affected by use of SMX/TMP.. Prophylaxis with SMX/TMP is an inexpensive way to reduce the incidence of sepsis in RTR.

Topics: Adult; Aged; Anti-Infective Agents; Antibiotic Prophylaxis; Female; Follow-Up Studies; Humans; Immunosuppression Therapy; Kidney Transplantation; Male; Middle Aged; Retrospective Studies; Sepsis; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Female; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Anti-Infective Agents, Urinary; Female; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

The purpose of this study is to provide resistance data for Escherichia coli isolates causing urinary tract infections in emergency department (ED) patients not requiring admission and explore if differences between this subpopulation and the hospital antibiogram exist. Differences between community-acquired urinary tract infection (CA-UTI) and health care-associated (HA-UTI) subgroups were also investigated.. Patients with a positive urine culture treated and discharged from the ED of a 200-bed community hospital were reviewed. Patients with urinary isolates of more than 100000 colony-forming unit/mL and documented intention to treat were included. Patients who required admission, were pregnant, less than the age of 18 years, or who had a positive culture but without any evidence of intention to treat were excluded. Only the initial visit was included for patients who returned to the ED within 7 days.. Overall, 308 visits were screened, and 217 were included. Of these, 78.3% were CA-UTI, and 21.7% were HA-UTI. Females comprised 88.5% of all patients. E coli was the most common pathogen overall and in both subgroups. E coli resistance to levofloxacin was 13.5% overall, 9.2% for CA-UTI, and 38.5% for HA-UTI compared with 27% on the hospital antibiogram. E coli resistance to sulfamethoxazole/trimethoprim was 26.9% overall, 25.2% for CA-UTI, and 34.6% for HA-UTI vs 26% on the antibiogram.. E coli susceptibility for ED patients not requiring admission may not be accurately represented by hospital antibiograms that contain culture data from various patient types, sites of infection, or patients with varying illness severity. Separation of the ED population into CA-UTI and HA-UTI subgroups may be helpful when selecting empiric antibiotic therapy.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Drug Resistance, Bacterial; Emergency Service, Hospital; Escherichia coli Infections; Female; Hospitals, Community; Humans; Levofloxacin; Male; Microbial Sensitivity Tests; Middle Aged; Retrospective Studies; Severity of Illness Index; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Young Adult

Toxic epidermal necrolysis (TEN) is a rare but serious dermatological emergency characterised by diffuse exfoliation of the skin and mucous membranes due to immune mediated destruction of the epidermis which can lead to sepsis and respiratory distress. Trimethoprim-sulfamethoxazole is a widely used antibiotic which can rarely lead to TEN. Early diagnosis and aggressive medical care is essential for the reduction of high morbidity and mortality associated with this disease. We present a case of successfully recovered TEN due to trimethoprim-sulfamethoxazole in a 62-year-old woman.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Dose-Response Relationship, Drug; Early Diagnosis; Female; Fluid Therapy; Follow-Up Studies; Humans; Middle Aged; Stevens-Johnson Syndrome; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Wound Healing

Topics: Aged; Amoxicillin; Anti-Infective Agents, Urinary; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Fosfomycin; Germany; Humans; Male; Microbial Sensitivity Tests; Nitroquinolines; Outpatients; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Female; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

An elderly female patient with an uncomplicated urinary tract infection from Salmonella newport is presented. Radiological and laboratory studies were performed because of her systemic and exposure risk factors as well as prior urinary tract abnormalities. While this patient was successfully treated as an outpatient with oral antibiotics, complications and recurrence are common and deserve close follow-up with repeat urine cultures at a minimum. Further laboratory and radiological testing should be guided by patient gender, risk factors and recurrence.

Topics: Aged; Anti-Infective Agents, Urinary; Female; Follow-Up Studies; Humans; Risk Factors; Salmonella; Salmonella Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Female; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Anti-Infective Agents, Urinary; Female; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Anti-Infective Agents, Urinary; Female; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Anti-Infective Agents, Urinary; Female; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Anti-Infective Agents, Urinary; Female; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Acetaminophen; Anti-Infective Agents, Urinary; Blood Chemical Analysis; Child; Drug Hypersensitivity Syndrome; Female; Follow-Up Studies; Hematologic Tests; Humans; Neutrophils; Prednisolone; Severity of Illness Index; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinalysis; Urinary Tract Infections

Urinary tract infections (UTIs) are one of the most common infections treated in ambulatory care settings, however the epidemiology differs by age and sex. The incidence of UTI is far greater in females than males, and infection in pediatric patients is more often due to anatomical abnormalities. The purpose of this research was to describe age- and sex-specific trends in antibiotic susceptibility to common urinary anti-infectives among urinary isolates of Escherichia coli from ambulatory primary care patients in a regional health maintenance organization.. Clinical microbiology data were collected for all urine cultures from patients with visits to primary care clinics in a regional health maintenance organization between 2005 and 2010. The first positive culture for E. coli tested for antibiotic susceptibilities per patient per year was included in the analysis dataset. The frequency of susceptibility to ampicillin, amoxicillin-clavulanate, ciprofloxacin, nitrofurantoin, and trimethoprim/sulfamethoxazole (TMP/SMX) was calculated for male and female patients. The Cochrane-Mantel-Haenzel test was used to test for differences in age-stratified susceptibility to each antibiotic between males and females.. A total of 43,493 E. coli isolates from 34,539 unique patients were identified for study inclusion. After stratifying by age, E. coli susceptibility to ampicillin, amoxicillin-clavulanate, ciprofloxacin, and nitrofurantoin differed significantly between males and females. However, the magnitude of the differences was less than 10% for all strata except amoxicillin-clavulanate susceptibility in E. coli isolated from males age 18-64 compared to females of the same age.. We did not observe clinically meaningful differences in antibiotic susceptibility to common urinary anti-infectives among E. coli isolated from males versus females. These data suggest that male sex alone should not be used as an indication for empiric use of second-line broad-spectrum antibiotic agents for the treatment of UTIs.

Topics: Adolescent; Adult; Age Factors; Aged; Ambulatory Care; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Ciprofloxacin; Cross-Sectional Studies; Drug Resistance, Bacterial; Escherichia coli; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Nitrofurantoin; Sex Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Young Adult

The microbiology and epidemiology of UTI pathogens are largely unknown in Botswana, a high prevalence HIV setting. Using laboratory data from the largest referral hospital and a private hospital, we describe the major pathogens causing UTI and their antimicrobial resistance patterns.. This retrospective study examined antimicrobial susceptibility data for urine samples collected at Princess Marina Hospital (PMH), Bokamoso Private Hospital (BPH), or one of their affiliated outpatient clinics. A urine sample was included in our dataset if it demonstrated pure growth of a single organism and accompanying antimicrobial susceptibility and subject demographic data were available.. A total of 744 samples were included. Greater than 10% resistance was observed for amoxicillin, co-trimoxazole, amoxicillin-clavulanate, and ciprofloxacin. Resistance of E. coli isolates to ampicillin and co-trimoxazole was greater than 60% in all settings. HIV status did not significantly impact the microbiology of UTIs, but did impact antimicrobial resistance to co-trimoxazole.. Data suggests that antimicrobial resistance has already emerged to most oral antibiotics, making empiric management of outpatient UTIs challenging. Ampicillin, co-trimoxazole, and ciprofloxacin should not be used as empiric treatment for UTI in this context. Nitrofurantoin could be used for simple cystitis; aminoglycosides for uncomplicated UTI in inpatients.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Botswana; Ciprofloxacin; Comorbidity; Drug Resistance, Multiple, Bacterial; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; HIV Infections; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Nitrofurantoin; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To investigate the risk factors for recurrent urinary tract infections (UTIs) in infants with vesicoureteral reflux (VUR) and whether bacterial pathogen affected breakthrough UTI or not.. We compared children with infantile VUR with recurrent UTI (33 males, 11 females, mean age 3.2 months) and without recurrent UTI (40 males, 7 females, mean age 4.8 months). The following were compared between the 2 groups: sex, timing of UTI episode, bacterial growth on urine culture, degree and bilaterality of the reflux, hydronephrosis, renal scar, and delayed ureteral excretion of refluxed contrast on voiding cystourethrogram (VCUG).. Univariate Cox survival-time regression showed that younger age at first UTI, a non-Escherichia coli strain, bilateral and VUR, high-grade VUR, and hydronephrosis on initial ultrasonography (USG) significantly increased the risks of recurrent UTI (P <.05 each). In multivariate analysis, timing of the UTI episode (P = .015), a non-E. coli strain (P = .003), high grade (P = .012), and bilateral VUR (P = .002) were independently associated with increased risk of recurrent UTI. Non-E. coli strains were identified in 60% and 33% of infants with and without recurrent UTI, respectively.. During the first year of life, the earlier the first UTI then the higher the chance is for recurrent UTIs. Higher grades of reflux, bilateral VUR, and the first infection by a non-E. coli strain all significantly increase the risk of recurrent UTIs.

Topics: Antibiotic Prophylaxis; Candida albicans; Candidiasis; Citrobacter freundii; Enterobacter cloacae; Enterobacteriaceae Infections; Escherichia coli; Female; Fever; Humans; Hydronephrosis; Infant; Klebsiella oxytoca; Klebsiella pneumoniae; Male; Multivariate Analysis; Proportional Hazards Models; Proteus mirabilis; Proteus vulgaris; Recurrence; Risk Factors; Staphylococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

Urinary tract infections (UTIs) are common after kidney transplantation, with limited data to guide antibiotic prophylaxis.. Retrospective single-center study comparing sulfamethoxazole-trimethoprim 800/160 mg (SMZ/TMP) daily for 30 days followed by Monday, Wednesday, Friday for an additional 5 months (Group 1) versus SMZ/TMP Monday, Wednesday, Friday for 6 months plus ciprofloxacin 250 mg twice daily for 30 days (Group 2) on UTI incidence after kidney transplantation.. There were 106 and 130 patients in Groups 1 and 2, respectively. Demographics and transplant characteristics were well matched, except for more patients in Group 2 on corticosteroid maintenance. At 1 year, more patients in Group 1 developed UTIs (23.6% vs. 10.8%; P=0.01) and the mean time to first UTI was shorter (96.6±79.5 vs. 168±89.7 days; P=0.01). UTIs caused by Enterococcus species were higher in Group 2 (28.6% vs. 4%; P=0.047) with enteric gram-negative bacilli accounting for the remaining infections. There was a similar incidence of enteric gram-negative antibiotic resistance to SMZ/TMP (75% vs. 80%; P=1.00) and ciprofloxacin (16.7% vs. 30%; P=0.39) in Groups 1 and 2. For Groups 1 and 2, the proportion of first UTIs requiring hospitalization was 48.9% vs. 40.6%, respectively (P=0.62). Female gender was a UTI risk factor (hazard ratio, 3.5; 95% confidence interval, 1.78-6.8; P=0.0003).. The addition of a 30-day course of ciprofloxacin lowered the incidence of UTI; randomized prospective studies are needed to confirm the safety and efficacy of this approach.

Topics: Adult; Aged; Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Bacterial Infections; Ciprofloxacin; Cohort Studies; Drug Administration Schedule; Drug Resistance, Bacterial; Drug Therapy, Combination; Female; Humans; Incidence; Kidney Transplantation; Male; Middle Aged; Retrospective Studies; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A case-case-control study was conducted to identify independent risk factors for recovery of Escherichia coli strains producing CTX-M-type extended-spectrum β-lactamases (CTX-M E. coli) within a large Southeastern Michigan medical center. Unique cases with isolation of ESBL-producing E. coli from February 2010 through July 2011 were analyzed by PCR for blaCTX-M, blaTEM, and blaSHV genes. Patients with CTX-M E. coli were compared to patients with E. coli strains not producing CTX-M-type ESBLs (non-CTX-M E. coli) and uninfected controls. Of 575 patients with ESBL-producing E. coli, 491 (85.4%) isolates contained a CTX-M ESBL gene. A total of 319 (84.6%) patients with CTX-M E. coli (282 [74.8%] CTX-M-15 type) were compared to 58 (15.4%) non-CTX-M E. coli patients and to uninfected controls. Independent risk factors for CTX-M E. coli isolation compared to non-CTX-M E. coli included male gender, impaired consciousness, H2 blocker use, immunosuppression, and exposure to penicillins and/or trimethoprim-sulfamethoxazole. Compared to uninfected controls, independent risk factors for isolation of CTX-M E. coli included presence of a urinary catheter, previous urinary tract infection, exposure to oxyimino-cephalosporins, dependent functional status, non-home residence, and multiple comorbid conditions. Within 48 h of admission, community-acquired CTX-M E. coli (n = 51 [16%]) and non-CTX-M E coli (n = 11 [19%]) strains were isolated from patients with no recent health care contacts. CTX-M E. coli strains were more resistant to multiple antibiotics than non-CTX-M E. coli strains. CTX-M-encoding genes, especially bla(CTX-M-15) type, represented the most common ESBL determinants from ESBL-producing E. coli, the majority of which were present upon admission. Septic patients with risk factors for isolation of CTX-M E. coli should be empirically treated with appropriate agents. Regional infection control efforts and judicious antibiotic use are needed to control the spread of these organisms.

Topics: Aged; Aged, 80 and over; Ambulatory Care; beta-Lactamases; Case-Control Studies; Ciprofloxacin; Community-Acquired Infections; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Female; Genes, Bacterial; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Retrospective Studies; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Catheters; Urinary Tract Infections

Urinary tract infections (UTI), the most common infectious complications after kidney transplantation, are associated with poor allograft survival. Identifying its predisposing factors is therefore remarkably important in order to optimize prevention strategies.. A retrospective study was performed in a cohort of patients who received kidney transplantation between June 2007 and June 2009. Factors associated with development of UTI were assessed.. The population consisted of 301 patients, with majority receiving allograft from living donors (85%). A total of 101 patients (34%) developed at least one episode of UTI, and 25% of the episodes occurred during the first year after transplantation. Risk factors associated with increased risk of UTI were female gender, recurrent UTI prior to transplant, and presence of urological abnormalities. Trimethoprim-sulfamethoxazole (TMP-SMZ) use was associated with a lower risk of UTI, including a lower risk of recurrent UTI.. In this cohort of predominantly living donor kidney transplant recipients, we report a high incidence of UTI, despite our practice of early ureteral and Foley catheter removal. Female gender and prior recurrent UTI or urological abnormalities were predisposing factors, while TMP-SMZ use had a protective role. These clinical relevant findings should guide clinicians in optimizing prevention strategies against UTI in kidney transplant recipients.

Topics: Aged; Anti-Infective Agents, Urinary; Cohort Studies; Female; Humans; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Risk Factors; Sex Factors; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Ciprofloxacin; Female; Humans; Kidney Transplantation; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Lengthier antimicrobial therapy is associated with increased costs, antimicrobial resistance, and adverse drug events. Therefore, establishing minimum effective antimicrobial treatment durations is an important public health goal. The optimal treatment duration and current treatment patterns for urinary tract infection (UTI) in men are unknown. We used Veterans Affairs administrative data to study male UTI treatment and outcomes.. Male UTI episodes in the Veterans Affairs system (fiscal year 2009) were identified by combining International Classification of Diseases, Ninth Revision codes with UTI-relevant antimicrobial prescriptions. Episodes were categorized as index, early recurrence (<30 days), or late recurrence (≥30 days) cases. Drug name, treatment duration, and outcomes (recurrence and Clostridium difficile infection during 12 months) were recorded for index cases. Demographic, clinical, and treatment characteristics were assessed for associations with outcomes in univariate and multivariate analyses.. Among 4 854 765 outpatient male veterans, 39 149 UTI episodes involving 33 336 unique patients were identified, including 33 336 index cases (85.2%), 1772 early recurrences (4.5%), and 4041 late recurrences (10.3%). Highest-use antimicrobial agents were ciprofloxacin (62.7%) and trimethoprim-sulfamethoxazole (26.8%); 35.0% of patients received shorter-duration treatment (≤7 days), and 65.0% of patients received longer-duration treatment (>7 days). Of the index cases, 4.1% were followed by early recurrence and 9.9% by late recurrence. Longer-duration treatment was not associated with a reduction in early or late recurrence but was associated with increased late recurrence compared with shorter-duration treatment (10.8% vs 8.4%, P < .001), including in multivariate analysis (odds ratio, 1.20; 95% CI, 1.10-1.30). In addition, C difficile infection risk was significantly higher with longer-duration vs shorter-duration treatment (0.5% vs 0.3%, P = .02) and exhibited a similar suggestive trend in multivariate analysis (odds ratio, 1.42; 95% CI, 0.97-2.07).. Longer-duration treatment (>7 days) for male UTI in the outpatient setting was associated with no reduction in early or late recurrence.

Topics: Aged; Anti-Infective Agents; Ciprofloxacin; Clostridium Infections; Comorbidity; Drug Administration Schedule; Drug Resistance, Microbial; Episode of Care; Humans; Male; Medication Therapy Management; Outcome Assessment, Health Care; Secondary Prevention; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; United States; United States Department of Veterans Affairs; Urinary Tract Infections; Veterans

Thrombotic thrombocytopenic purpura (TTP) is a hematological disease characterized by microangiopathic hemolytic anemia and thrombocytopenia. Although the link between ADAMTS13 deficiency and idiopathic TTP has been well-established, the role of trimethoprim-sulfamethoxazole (TMP-SMX) in the pathogenesis of TTP is not yet well elucidated. To the best of our knowledge, there have been only two previous reports linking this medication with the development of TTP. We present the case of a healthy woman, age 26 years, who developed TTP during TMP-SMX therapy for urinary tract infection. She was found to have ADAMTS13 deficiency with anti-ADAMTS13 antibodies. Her condition responded to discontinuation of the TMP-SMX, plasmapheresis, and rituximab therapy. We speculate that the acquired ADAMTS13 deficiency might have been triggered by the TMP-SMX therapy.

Topics: ADAM Proteins; ADAMTS13 Protein; Adult; Anti-Infective Agents, Urinary; Antibodies, Monoclonal, Murine-Derived; Female; Humans; Plasmapheresis; Purpura, Thrombotic Thrombocytopenic; Rituximab; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Withholding Treatment

A 4-month-old female kitten presented with chronic lower urinary tract signs and Escherichia coli cystitis, and was diagnosed with urinary bladder malakoplakia based upon histopathology. The kitten was treated with a prolonged antibiotic course and the malakoplakia resolved. Malakoplakia is a chronic granulomatous reaction characterized by the formation of Michaelis-Gutman bodies within von Hansemann macrophages. It is well described in humans, but has never been documented in a living veterinary patient. This case report describes the first successful treatment of malakoplakia in veterinary medicine.

Topics: Animals; Anti-Bacterial Agents; Cat Diseases; Cats; Escherichia coli; Escherichia coli Infections; Female; Malacoplakia; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder Diseases; Urinary Tract Infections

Increase in resistance pattern of urinary tract pathogens to conventional antimicrobial agents used for urinary tract infections (UTIs) is gaining the attention of many microbiologists worldwide in respect to treatment of UTIs. The aim of the present study was to obtain data on resistance patterns of pathogens responsible for UTIs to currently used antimicrobial agents in Sher-I-Kashmir Institute of Medical Sciences (tertiary healthcare hospital).. A total of 2842 samples were collected from both outpatient and inpatient departments. The majority of samples in this study were midstream urine specimens, others included catheterized urine samples. Standard parameters were followed for isolation and identification of clinical isolates and further antimicrobial susceptibility test was done by Kirby Bauer disk diffusion method.. Out of 2842 samples, 1980 (67%) were culture positive. Escherichia coli (E coli) was the most prevalent isolate (OP 63%, IP 45.5%) followed by Klebsiella pneumonia (K pneumonia) as the second commonest UTI-causing agent (OP 15.9%, IP 21.7%). High percentage of isolates showed resistance to sulfa drugs such as cotrimoxazole. First generation cephalosporins were ineffective, while aminoglycosides and third generation cephalosporins were effective against E coli, K pneumoniae, Pseudomonas aeruginosa (P aeruginosa), Enterococcus faecalis and Staphyococcus aureus (Staph aureus). Furthermore, this study noticed that glycopeptide drugs such as vancomycin are highly effective against E faecalis and Staph aureus UTIs.. This study reveals the increased trend in resistance pattern of uropathogens in the valley region. These data may aid health professionals in choosing the appropriate treatment for patients with UTI in the region and hopefully will prevent the misuse of antibiotics.

Topics: Aminoglycosides; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Cephalosporins; Drug Resistance, Bacterial; Female; Gram-Positive Bacterial Infections; Humans; India; Male; Microbial Sensitivity Tests; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vancomycin

Patients with renal failure who are taking trimethoprim have an increased risk of developing hyperkalemia, which can cause muscle weakness. In patients with postpolio syndrome, a normal creatinine level could be abnormally high, renal failure is possible because of lack of creatinine production, and the muscle weakness from resultant hyperkalemia could be more severe because of their underlying condition. This abnormally high creatinine level has been termed from this point relative renal failure. The objective of the study was to review a case in which relative renal failure and hyperkalemia caused muscle weakness that manifested as shortness of breath and confusion with electrocardiographic changes. A dehydrated patient with relative renal failure and postpolio syndrome had taken trimethoprim-sulfamethoxazole that caused symptomatic hyperkalemia. The patient presented with muscle weakness, shortness of breath, and confusion, with her postpolio syndrome compounding the situation and likely making the muscle weakness more severe. A patient on trimethoprim with renal failure is at an increased risk of developing hyperkalemia. Patients with postpolio syndrome could have severe muscle weakness from the hyperkalemia and could have renal failure even with a normal creatinine level. This case report will remind treating physicians to evaluate such patients for hyperkalemia if they present with muscle weakness, especially if the patient has renal failure and is on trimethoprim.

Topics: Aged, 80 and over; Creatinine; Electrocardiography; Female; Humans; Hyperkalemia; Postpoliomyelitis Syndrome; Renal Insufficiency; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The objectives of this study are to examine antibiotic resistance rates and to determine appropriate empiric oral antibiotic for patients with urinary tract infections (UTIs) evaluated and discharged from the ED.. A retrospective, single-institution chart review study from August 2008 to March 2009 was conducted. Adult patients seen in the ED with UTI were identified for study inclusion from review of microbiology records. Hospitalized or asymptomatic bacteriuria cases were excluded. Health care-associated (HA)-UTI was defined as UTI with indwelling urinary catheters, health care exposure, or urologic procedures within 3 months. Prevalence of causative bacteria, antibiotic resistance rates, and risk factors for quinolone resistance were determined.. There were 337 eligible patients with 83% women. The most common uropathogens among 357 bacterial isolates were Escherichia coli (71%) and Klebsiella spp. (9%). Overall levofloxacin resistance rate was 17%. Resistance rates for HA-UTIs were significantly greater than those for community-associated-UTI: levofloxacin, 38% vs 10%; trimethoprim-sulfamethoxazole, 26% vs 17%; amoxicillin, 53% vs 45%; and amoxicillin-clavulanate, 16% vs 6%. Nitrofurantoin resistance rates were similar (9%). Independent risk factors for levofloxacin resistance were long-term medical conditions (adjusted odds ratio [aOR], 4.23; P = .001), HA-UTI (aOR, 2.56; P = .006), and prior quinolone use within 1 week (aOR, 14.90; P = .02) and within 1 to 4 weeks (aOR, 4.62; P = .04).. We report high rates of quinolone resistance in ED patients with UTIs at our institution. For patients with risk factors for quinolone resistance, empiric therapy with cephalosporins or nitrofurantoin may be preferred. Urine culture and susceptibility testing should be performed to guide definitive therapy for HA-UTIs.

Topics: Adult; Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cross Infection; Drug Resistance, Bacterial; Emergency Service, Hospital; Female; Humans; Levofloxacin; Male; Microbial Sensitivity Tests; Middle Aged; Ofloxacin; Quinolones; Retrospective Studies; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Young Adult

Increased trimethoprim/sulfamethoxazole (TMP/SMX) resistance has led to changes in empiric treatment of female urinary tract infections (UTI) in the emergency department (ED), particularly increased use of fluoroquinolones (Acad Emerg Med.2009;16(6):500-507). Whether prescribing changes have affected susceptibility in uropathogens is unclear. Using narrow-spectrum agents and therapy tailored to local susceptibilities remain important goals.. The primary goal of this study is to characterize the susceptibility patterns of uropathogens among ambulatory female ED patients with UTI. Its secondary goal is to identify demographic or clinical factors predictive of resistance to narrow-spectrum agents.. This was a cross-sectional study of women with suspected UTI referred to a trial of computer kiosk-aided treatment of UTI in 3 Northern California EDs. Demographic and clinical data were gathered from the kiosk and chart, and features associated with resistance were identified by bivariate and multivariable regression analysis.. Two hundred eighty-three participants, aged 15 to 84 years, were diagnosed with UTI and cultured. One hundred thirty-five (48%) of cultures were positive, with full susceptibilities reported (81% Escherichia coli). Only 2 isolates (1.5%) were fluoroquinolone resistant. Resistance to TMP/SMX was 18%, to nitrofurantoin 5%, and to cefazolin 4%. Seventy-four percent were sensitive to all 3 narrow-spectrum agents. Resistance to narrow-spectrum agents did not vary significantly by diagnosis, age, recent UTI, or any clinical or demographic factors; but overall, there was a trend toward lower resistance rates in our population than in our hospitals' published antibiograms.. In our population of ambulatory female ED patients, resistance to TMP/SMX is just below the 20% threshold that the Infectious Disease Society of America recommends for continued empiric use (Clin Infect Dis.1999;29(4):745-758, Clin Infect Dis.2011;52(5):e103-120), whereas resistance to other narrow-spectrum agents, such as nitrofurantoin and cephalexin, may be lower than published antibiograms for our sites. Fluoroquinolone resistance remains very low.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; California; Cefazolin; Cross-Sectional Studies; Drug Resistance, Bacterial; Emergency Service, Hospital; Female; Fluoroquinolones; Humans; Middle Aged; Nitrofurantoin; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Young Adult

Topics: Anti-Infective Agents, Urinary; Biopsy; Child; Female; Humans; Iatrogenic Disease; Kidney; Lipidoses; Microscopy, Electron; Phospholipids; Proteinuria; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Escherichia coli; Escherichia coli Infections; Female; Humans; Premenopause; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vaccinium macrocarpon

Quinolones are increasingly favored over trimethoprim-sulfamethoxazole (TMP-SMX) for empirical treatment of uncomplicated urinary tract infection (UTI). This is associated with increasing resistance toward this broad-spectrum group of antibiotics. Our objective is to describe the prescribing patterns and identify determinants of the choice between TMP-SMX and quinolones for outpatient UTI treatment in Switzerland. An ongoing national Sentinel surveillance system was used to study 11,799 antibiotic prescriptions for UTI in adult outpatients and associated physician and patient factors between 2006 and 2008, to compare the prescription of quinolones versus that of TMP-SMX for treatment of UTI. Most UTI episodes were diagnosed as cystitis (90%). TMP-SMX was prescribed for one-fifth (22%) of UTIs. Independent predictors for prescribing quinolones were pyelonephritis and physicians with low thresholds for prescribing antibiotics for upper respiratory tract infections ("high prescribers"), whereas female patients were more likely to receive TMP-SMX. High-prescribing physicians also more often cared for patients who themselves favor antibiotic treatment (P < 0.001). Quinolones are commonly prescribed to outpatients with UTI. Nonclinical factors influence the choice of quinolones versus TMP-SMX, which may provide opportunities for interventions to improve prescribing patterns and control quinolone resistance.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Urinary; Community-Acquired Infections; Cystitis; Female; General Practitioners; Humans; Longitudinal Studies; Male; Middle Aged; Outpatients; Physician-Patient Relations; Population Surveillance; Prescription Drugs; Pyelonephritis; Quinolones; Switzerland; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

This study examines in vitro antimicrobial resistance data from Escherichia coli isolates obtained from urine samples of U.S. outpatients between 2000 and 2010 using The Surveillance Network (TSN). Antimicrobial susceptibility results (n = 12,253,679) showed the greatest increases in E. coli resistance from 2000 to 2010 for ciprofloxacin (3% to 17.1%) and trimethoprim-sulfamethoxazole (TMP-SMX) (17.9% to 24.2%), whereas nitrofurantoin (0.8% to 1.6%) and ceftriaxone (0.2% to 2.3%) showed minimal change. From 2000 to 2010, the antimicrobial resistance of urinary E. coli isolates to ciprofloxacin and TMP-SMX among outpatients increased substantially.

Topics: Ceftriaxone; Cephalosporin Resistance; Ciprofloxacin; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Humans; Microbial Sensitivity Tests; Nitrofurantoin; Outpatients; Population Surveillance; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

• To review a contemporary cohort of patients undergoing a transrectal ultrasound-guided prostate needle biopsy (TRUS PNBx) at a single centre to determine the incidence of major complications necessitating hospital admission or emergency department (ED) visits.. • The charts of 1000 consecutive patients undergoing TRUS PNBx were reviewed. • All patients received peri-procedural antibiotic prophylaxis with either ciprofloxacin or co-trimoxazole. • Hospital admission and ED visits within 30 days of the procedure were identified for indication, management and outcome. • Patient comorbidities and biopsy characteristics were reviewed for association with complications.. • Of the 1000 patients, 25 (2.5%) had post-biopsy complications requiring hospital admission or an ED visit. • Indications included twelve patients (1.2%) with urosepsis, eight (0.8%) with acute urinary retention requiring urethral catheterization, four (0.4%) with gross haematuria requiring bladder irrigation for <24 h, and one (0.1%) with a transient ischaemia attack 1 day after biopsy. • Patients with urosepsis had an average hospitalization of 5 days, and 75% carried quinolone-resistant Escherichia coli organisms. • All patients with urinary retention had catheters removed within 10 days. No patients with haematuria required a blood transfusion. • No demographic or biopsy variables were particularly associated with development of a post-procedure complication.. • In this large contemporary series of TRUS PNBx, we observed a 2.5% rate of major complications requiring hospital admission or an ED visit. • No clinical or biopsy variables were directly associated with development of complications. • These data may be valuable when counselling patients before biopsy.

Topics: Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Biopsy, Needle; Ciprofloxacin; Emergencies; Emergency Service, Hospital; Hematuria; Hospitalization; Humans; Ischemic Attack, Transient; Male; Middle Aged; Prostate; Prostatic Neoplasms; Sepsis; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography, Interventional; Urinary Retention; Urinary Tract Infections

Urinary tract infection (UTI) is a common health problem among pregnant women. Proper investigation and prompt treatment are needed to prevent serious life threatening condition and morbidity due to urinary tract infection that can occur in pregnant women. Recent report in Addis Ababa, Ethiopia indicated the prevalence of UTI in pregnant women was 11.6% and Gram negative bacteria was the predominant isolates and showed multi drug resistance. This study aimed to assess bacterial profile that causes urinary tract infection and their antimicrobial susceptibility pattern among pregnant women visiting antenatal clinic at University of Gondar Teaching Hospital, Northwest Ethiopia.. A cross-sectional study was conducted at University of Gondar Teaching Hospital from March 22 to April 30, 2011. Mid stream urine samples were collected and inoculated into Cystine Lactose Electrolyte Deficient medium (CLED). Colony counts yielding bacterial growth of 105/ml of urine or more of pure isolates were regarded as significant bacteriuria for infection. Colony from CLED was sub cultured onto MacConkey agar and blood agar plates. Identification was done using cultural characteristics and a series of biochemical tests. A standard method of agar disc diffusion susceptibility testing method was used to determine susceptibility patterns of the isolates.. The overall prevalence of UTI in pregnant women was 10.4%. The predominant bacterial pathogens were Escherichia coli 47.5% followed by coagulase-negative staphylococci 22.5%, Staphylococcus aureus 10%, and Klebsiella pneumoniae 10%. Gram negative isolates were resulted low susceptibility to co-trimoxazole (51.9%) and tetracycline (40.7%) whereas Gram positive showed susceptibility to ceftriaxon (84.6%) and amoxicillin-clavulanic acid (92.3%). Multiple drug resistance (resistance to two or more drugs) was observed in 95% of the isolates.. Significant bacteriuria was observed in asymptomatic pregnant women. Periodic studies are recommended to check the outcome of asymptomatic bacteriuria and also monitor any changes in the susceptibility patterns of urinary tract pathogens in pregnant women.

Topics: Adolescent; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Asymptomatic Diseases; Bacteriuria; Ceftriaxone; Colony Count, Microbial; Cross-Sectional Studies; Drug Resistance, Multiple, Bacterial; Escherichia coli; Ethiopia; Female; Hospitals, University; Humans; Klebsiella pneumoniae; Microbial Sensitivity Tests; Middle Aged; Pregnancy; Prevalence; Staphylococcus aureus; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Catheter-associated urinary tract infections (CAUTIs) constitute the majority of nosocomial urinary tract infections (UTIs) and pose significant clinical challenges. These infections are polymicrobial in nature and are often associated with multidrug-resistant pathogens, including uropathogenic Escherichia coli (UPEC). Urinary catheterization elicits major histological and immunological alterations in the bladder that can favor microbial colonization and dissemination in the urinary tract. We report that these biological perturbations impact UPEC pathogenesis and that bacterial reservoirs established during a previous UPEC infection, in which bacteriuria had resolved, can serve as a nidus for subsequent urinary catheter colonization. Mannosides, small molecule inhibitors of the type 1 pilus adhesin, FimH, provided significant protection against UPEC CAUTI by preventing bacterial invasion and shifting the UPEC niche primarily to the extracellular milieu and on the foreign body. By doing so, mannosides potentiated the action of trimethoprim-sulfamethoxazole in the prevention and treatment of CAUTI. In this study, we provide novel insights into UPEC pathogenesis in the context of urinary catheterization, and demonstrate the efficacy of novel therapies that target critical mechanisms for this infection. Thus, we establish a proof-of-principle for the development of mannosides to prevent and eventually treat these infections in the face of rising antibiotic-resistant uropathogens.

Topics: Adhesins, Escherichia coli; Animals; Bacterial Adhesion; Biofilms; Catheter-Related Infections; Cross Infection; Drug Therapy, Combination; Escherichia coli Infections; Female; Fimbriae Proteins; Gene Deletion; Mannosides; Mice; Mice, Inbred C57BL; Molecular Weight; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder; Urinary Catheters; Urinary Tract Infections; Uropathogenic Escherichia coli

Topics: Aged; Anti-Bacterial Agents; Diagnosis, Differential; Drug Eruptions; Female; Humans; Leg Dermatoses; Purpura; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vasculitis, Leukocytoclastic, Cutaneous

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

For women with recurrent urinary tract infections (rUTI), the contribution of antibiotic use versus patient-related factors in determining the presence of antimicrobial resistance in faecal and urinary Escherichia coli, obtained from the same patient population, has not been assessed yet. Within the context of the 'Non-antibiotic prophylaxis for recurrent urinary tract infections' (NAPRUTI) study, the present study assessed determinants of antimicrobial resistance in E. coli isolated from urinary and faecal samples of women with rUTIs collected at baseline. Potential determinants of resistance were retrieved from self-administered questionnaires. From 434 asymptomatic women, 433 urinary and 424 faecal samples were obtained. E. coli was isolated from 146 (34%) urinary samples and from 336 (79%) faecal samples, and subsequently tested for antimicrobial susceptibility. Multivariable analysis showed trimethoprim/sulfamethoxazole (SXT) use three months prior to inclusion to be associated with urine E. coli resistance to amoxicillin (OR 3.6, 95% confidence interval: 1.3-9.9), amoxicillin-clavulanic acid (OR 4.4, 1.5-13.3), trimethoprim (OR 3.9, 1.4-10.5) and SXT (OR 3.2, 1.2-8.5), and with faecal E. coli resistance to trimethoprim (OR 2.0, 1.0-3.7). The number of UTIs in the preceding year was correlated with urine E. coli resistance to amoxicillin-clavulanic acid (OR 1.11, 1.01-1.22), trimethoprim (OR 1.13, 1.03-1.23) and SXT (OR 1.10, 1.01-1.19). Age was predictive for faecal E. coli resistance to amoxicillin (OR 1.02, 1.00-1.03), norfloxacin and ciprofloxacin (both OR 1.03, 1.01-1.06). In conclusion, in women with rUTI different determinants were found for urinary and faecal E. coli resistance. Previous antibiotic use and UTI history were associated with urine E. coli resistance and age was a predictor of faecal E. coli resistance. These associations could best be explained by cumulative antibiotic use.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Feces; Female; Humans; Netherlands; Odds Ratio; Surveys and Questionnaires; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urine

Topics: Aged; Aged, 80 and over; Anti-Infective Agents, Urinary; Female; Hospitalization; Humans; Hyperkalemia; Incidence; Ontario; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

BACKGROUND The German guideline recommends trimethoprim (TMP) for the treatment of uncomplicated lower-urinary-tract infections (uLUTI) in primary care. In the authors' research network, the participating general practitioners (GPs) were asked why they prescribe mostly quinolones instead. The GPs stated the perception of a high rate of therapy failure of TMP and strongly rejected the guideline. OBJECTIVE To examine prescribing behaviour for uLUTI and whether a practice test of TMP might effect a change in prescribing habits. METHODS The study was conducted using observational and qualitative elements. A first focus-group (n=6) assessed reasons for current prescribing behaviour. In a 3-month practice test, patients with uLUTI were prescribed TMP (150 mg twice for 3 days). In a second focus group, the GPs (n=12) were presented with the results of the practice test. RESULTS The first focus group revealed that prescribing was mainly driven by former hospital training and what was perceived as common therapy. GPs felt no need to change a successful regimen. In the practice test, TMP had a success rate of 94% (84 episodes of uLUTI). The second focus group revealed that the practice test had strongly changed opinions in favour of TMP. Self-reflection and ownership of data acquisition were seen as major contributions for change in prescribing. After the test period, TMP remained the antibiotic most often prescribed. CONCLUSION Internal evidence and peer-group opinion are strong determinants for clinical decisions. A self-conducted practice test, together with self-reflection in a peer group, strongly supports the process of change.

Topics: Anti-Infective Agents, Urinary; Attitude of Health Personnel; Evidence-Based Medicine; Focus Groups; General Practitioners; Germany; Guideline Adherence; Humans; Nitrofurantoin; Practice Guidelines as Topic; Practice Patterns, Physicians'; Qualitative Research; Quinolones; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Urinary tract infections (UTIs), the most common form of bacterial infection in kidney transplant recipients, recently have been demonstrated to be detrimental for long-term graft outcome. Therefore, reinforcing antibiotic prophylaxis might be vital, in addition to basic hygiene recommendations, surgical care, and prophylaxis by trimethoprim-sulfamethoxazole.. In 2006, a Legionella pneumophila contamination of our department's water pipes meant that all the patients undergoing renal transplantation underwent a 1-month regimen of ofloxacin (OFLO) (200 mg every other day). We took this opportunity to measure the incidence of UTI, including acute pyelonephritis (APN), in 100 consecutive patients transplanted before (n = 50) and after (n = 50) this treatment decision was reached. We also studied the antimicrobial resistance profiles in our department and in the rest of the hospital.. No patient developed Legionnaire's disease. A dramatic decrease in the incidence of UTI (-63%) was also seen in patients undergoing OFLO treatment. Logistic regression analysis demonstrated that the use of OFLO was independently associated with a reduction in UTI (odd ratio [OR] = 0.31%, 95% confidence interval [CI] 0.11-0.84, P = 0.02) and APN (OR = 0.21%, 95% CI 0.07-0.98, P = 0.045). This protection was sustained during the whole first year post transplantation. As for resistance rates, we observed a decrease in the susceptibility of Pseudomonas aeruginosa to ciprofloxacin in our nephrology department, compared with that observed in the rest of the hospital. The incidence of multi-resistant bacteria was stable.. Our unintentional extension of prophylactic antibiotherapy with OFLO gave rise to a dramatic decrease in the 1-year incidence of UTI and APN in kidney recipients. Emergence of resistant strains is, however, a major concern.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Drug Resistance, Bacterial; Drug Therapy, Combination; Female; Fluoroquinolones; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Incidence; Kidney Transplantation; Legionella pneumophila; Legionnaires' Disease; Male; Middle Aged; Ofloxacin; Pyelonephritis; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Despite significant improvements in renal transplantation (RTX), certain basic issues remain unresolved such as the routine use of perioperative antibiotic prophylaxis (PAP). To address the need for PAP, we retrospectively evaluated the clinical course of 349 consecutive RTX patients who did not receive any PAP except for Bactrim. Of the 349 transplant recipients, 77% received induction therapy with low-dose rabbit antithymocyte globulin (rATG) and the others were treated with basiliximab. All patients received triple immunosuppression with tacrolimus, mycophenolic acid, and prednisone. Seven patients (2%) developed wound infections. Wound infections were more common in obese and older patients. All wound infections were superficial and responded well to wound drainage and outpatient antibiotic therapy. Six patients (1.7%) experienced a urinary tract infection (UTI) within the first postoperative month. UTIs were more common in the patient with ureteral stent compared to nonstented patients (11.4% vs 0.3%, P<.001). No patient or graft was lost due to perioperative bacterial infections (PBI). Our study shows that despite many predisposing factors, PBI are rare following RTX even in the absence of PAP. Therefore, in order to avoid emergence of multiantibiotic-resistant pathogens, excessive costs, and antibiotic-related adverse events, we suggest that PAP should be used only in selected circumstances such as in recipients older than 60 or when the body mass index is greater than 35.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Animals; Anti-Bacterial Agents; Antibodies, Monoclonal; Antilymphocyte Serum; Bacterial Infections; Basiliximab; Body Mass Index; Child; Child, Preschool; Drug Resistance, Bacterial; Female; Humans; Immunosuppressive Agents; Infant; Infant, Newborn; Kidney Transplantation; Male; Middle Aged; Mycophenolic Acid; Prednisone; Rabbits; Recombinant Fusion Proteins; Retrospective Studies; Tacrolimus; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Drug Therapy, Combination; Fosfomycin; Humans; Male; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

From January 2007 to December 2009, an annual Canadian national surveillance study (CANWARD) tested 2,943 urinary culture pathogens for antimicrobial susceptibilities according to Clinical and Laboratory Standards Institute guidelines. The most frequently isolated urinary pathogens were as follows (number of isolates, percentage of all isolates): Escherichia coli (1,581, 54%), enterococci (410, 14%), Klebsiella pneumoniae (274, 9%), Proteus mirabilis (122, 4%), Pseudomonas aeruginosa (100, 3%), and Staphylococcus aureus (80, 3%). The rates of susceptibility to trimethoprim-sulfamethoxazole (SXT) were 78, 86, 84, and 93%, respectively, for E. coli, K. pneumoniae, P. mirabilis, and S. aureus. The rates of susceptibility to nitrofurantoin were 96, 97, 33, and 100%, respectively, for E. coli, enterococci, K. pneumoniae, and S. aureus. The rates of susceptibility to ciprofloxacin were 81, 40, 86, 81, 66, and 41%, respectively, for E. coli, enterococci, K. pneumoniae, P. mirabilis, P. aeruginosa, and S. aureus. Statistical analysis of resistance rates (resistant plus intermediate isolates) by year for E. coli over the 3-year study period demonstrated that increased resistance rates occurred only for amoxicillin-clavulanate (from 1.8 to 6.6%; P < 0.001) and for SXT (from 18.6 to 24.3%; P = 0.02). For isolates of E. coli, in a multivariate logistic regression model, hospital location was independently associated with resistance to ciprofloxacin (P = 0.026) with higher rates of resistance observed in inpatient areas (medical, surgical, and intensive care unit wards). Increased age was also associated with resistance to ciprofloxacin (P < 0.001) and with resistance to two or more commonly prescribed oral agents (amoxicillin-clavulanate, ciprofloxacin, nitrofurantoin, and SXT) (P = 0.005). We conclude that frequently prescribed empirical agents for urinary tract infections, such as SXT and ciprofloxacin, demonstrate lowered in vitro susceptibilities when tested against recent clinical isolates.

Topics: Adolescent; Adult; Amoxicillin; Anti-Bacterial Agents; Canada; Ciprofloxacin; Clavulanic Acid; Escherichia coli; Female; Humans; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Middle Aged; Proteus mirabilis; Pseudomonas aeruginosa; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Young Adult

To analyze the costs of nitrofurantoin use compared to those of other antibiotics recommended for treatment of uncomplicated urinary tract infection (UTI).. We used a decision analysis model to perform cost-minimization and sensitivity analyses to determine the level of trimethoprim-sulfamethoxazole (TMP-SMX) and fluoroquinolone resistance that would favor the use of nitrofurantoin as a first-line empirical treatment of uncomplicated UTIs. The model used a program perspective to evaluate costs.. Nitrofurantoin was cost-minimizing when the prevalence of fluoroquinolone resistance exceeded 12% among uropathogens or the prevalence of TMP-SMX resistance exceeded 17%. On 2-way sensitivity analysis, variables that had a significant impact on our cost-minimization threshold included cost of antibiotics and probability of clinical cure with antibiotics.. From a payer perspective, nitrofurantoin appears to be a reasonable alternative to TMP-SMX and fluoroquinolones for empirical treatment of uncomplicated UTIs, especially given the current prevalence of antibiotic resistance among community uropathogens. On the basis of efficacy, cost, and low impact on promoting antimicrobial resistance, clinicians should consider nitrofurantoin as a reasonable alternative to TMP-SMX and fluoroquinolones for first-line therapy for uncomplicated UTIs.

Topics: Adult; Aged; Anti-Infective Agents, Urinary; Confounding Factors, Epidemiologic; Cost Control; Cost-Benefit Analysis; Costs and Cost Analysis; Cystitis; Decision Support Techniques; Decision Trees; Drug Administration Schedule; Drug Resistance, Bacterial; Female; Fluoroquinolones; Humans; Middle Aged; Models, Statistical; Nitrofurantoin; Practice Guidelines as Topic; Research Design; Sensitivity and Specificity; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Cephalosporins; Costs and Cost Analysis; Cystitis; Decision Support Techniques; Female; Humans; Nitrofurantoin; Risk Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

An 86-year-old Caucasian male developed hyponatremia while on trimethoprim-sulfamethoxazole (TMP-SMX) 80/400 mg, one tablet by mouth twice daily. Upon discontinuation of therapy, his serum sodium and symptoms improved. He was inadvertently rechallenged several months later with TMP-SMX and had similar symptoms and laboratory abnormalities. TMP-SMX-induced hyponatremia is a rare occurrence. Previous publications have most often reported this phenomenon in combination with hyperkalemia. However, this patient represents a case of TMP-SMX-induced hyponatremia independent of hyperkalemia and provides a rare opportunity to observe a challenge and rechallenge with the offending medication. Although the mechanism behind this adverse drug reaction remains unclear, a score of 7 on the Naranjo probability scale indicates a probable likelihood that TMP-SMX was the cause of the hyponatremia in this patient. This case demonstrates that TMP-SMX can result in the development of hyponatremia independent of hyperkalemia. Health care providers should be aware of the potential for hyponatremia associated with TMP-SMX and consider monitoring electrolytes and renal function during therapy.

Topics: Aged, 80 and over; Anti-Infective Agents, Urinary; Humans; Hyponatremia; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Biological Availability; Dietary Supplements; Dose-Response Relationship, Drug; Double-Blind Method; Evidence-Based Medicine; Female; Humans; Plant Preparations; Premenopause; Randomized Controlled Trials as Topic; Secondary Prevention; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections; Vaccinium macrocarpon

Topics: Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Child, Preschool; Drug Resistance, Microbial; Evidence-Based Medicine; Humans; Infant; Kidney Diseases; Pyelonephritis; Randomized Controlled Trials as Topic; Recurrence; Review Literature as Topic; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

The case of a patient who developed aseptic meningitis, hemolytic anemia, hepatitis, and orthostatic hypotension simultaneously during treatment with trimethoprim-sulfamethoxazole is described.. A healthy 37-year-old African- American man was receiving treatment with trimethoprim-sulfamethoxazole double strength. This was the patient's first experience with trimethoprim- sulfamethoxazole, and he was not taking any other medications during the treatment period. He had been taking trimethoprim-sulfamethoxazole for approximately eight days when he revisited his family physician, complaining of headaches, dizziness, difficulty with speech, weakness, and itching on the trunk of his body and legs, where a maculopapular rash was noted. Orthostatic hypotension was also noted at that visit, with a standing blood pressure measurement of 95/80 mm Hg. Based on these findings and since the patient had no signs of infection, his physician instructed him to discontinue the drug. The patient was admitted to the emergency department of a local hospital within two days due to ongoing headache, elevated temperature, and nuchal rigidity, symptoms suggestive of meningitis. Because of the presence of hemolysis, the patient underwent testing for glucose-6-phosphate dehydrogenase (G6PD) deficiency, for which he tested positive. The patient was discharged five days after admission and referred to a hematology clinic for follow-up. The patient has since returned to his routines of daily living and has reported no fatigue or other lingering adverse symptoms.. A 37-year-old African- American man with G6PD deficiency developed hemolytic anemia, hepatitis, orthostatic hypotension, and aseptic meningitis simultaneously after using trimethoprim-sulfamethoxazole.

Topics: Adult; Anemia, Hemolytic; Anti-Infective Agents, Urinary; Chemical and Drug Induced Liver Injury; Glucosephosphate Dehydrogenase Deficiency; Hemolysis; Humans; Hypotension, Orthostatic; Liver Function Tests; Male; Meningitis, Aseptic; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Child; Child, Preschool; Female; Humans; Secondary Prevention; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Child; Humans; Risk Factors; Secondary Prevention; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Child; Drug Resistance, Bacterial; Humans; Secondary Prevention; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

To report a case of clinically significant hypoglycemia attributed to the concomitant use of trimethoprim/sulfamethoxazole (TMP/SMX) and repaglinide by a diabetic patient.. A 76-year-old diabetic patient with impaired renal function and no history of hypoglycemia was receiving treatment with repaglinide 1 mg 3 times daily. Five days after TMP/SMX therapy was started for a urinary tract infection, the man developed symptomatic hypoglycemia. Repaglinide and TMP/SMX were stopped and intravenous D-glucose was administered to normalize glucose levels. Repaglinide, but not TMP/SMX, was reintroduced 5 days later and no other hypoglycemic episode occurred. Objective causality assessments revealed that the interaction was probable (World Health Organization-Uppsala Monitoring Centre) or possible (Horn Drug Interaction Probability Scale).. This interaction between TMP/SMX and repaglinide was predictable according to available pharmacokinetic data in healthy subjects. Trimethoprim induced CYP2C8 inhibition, thus increasing the plasma concentration of repaglinide. This interaction is mentioned in the repaglinide product information. To our knowledge, however, no case of symptomatic hypoglycemia associated with a combination of repaglinide and trimethoprim has been described before. This discrepancy may be explained by the subtherapeutic dosage used in the pharmacokinetic study. Moreover, our patient had impaired renal function, which may have led to trimethoprim accumulation and potentiated its interaction with repaglinide. A direct lowering of blood glucose levels due to sulfamethoxazole, also potentiated by renal failure, could also be involved in triggering hypoglycemia.. This interaction between TMP/SMX and repaglinide may have involved inhibition of CYP2C8 by trimethoprim. Clinicians should be aware that this association may lead to symptomatic hypoglycemia, particularly in patients with renal dysfunction.

Topics: Aged; Anti-Infective Agents, Urinary; Blood Glucose; Carbamates; Diabetes Complications; Diabetes Mellitus; Diabetic Neuropathies; Drug Interactions; Energy Intake; Humans; Hypoglycemia; Hypoglycemic Agents; Male; Piperidines; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Urinary tract infection (UTI) is a common complication among kidney transplant patients. UTI caused by multi-resistant extended-spectrum beta-lactamase producing bacteria (ESBL) have largely increased among the hospitalized patient population and especially kidney transplant recipients. We retrospectively studied 83 kidney transplant patients to evaluate the incidence and possible causative conditions of ESBL-related UTI over the last 6 years. ESBL production was determined by the antibiotic susceptibility profile of urine cultures. We compared the incidence in two 3-year periods, 2003-2005 (period 1) and 2006-2008 (period 2). An high incidence of ESBL-related UTI (16.8%) was observed in the posttransplant period performing 31% of the overall UTI incidence, with an increase over the last 3 years from 23.8% to 37.5%. ESBL-related UTI was related to previous episodes of UTI (78.6% vs 29.0%; P < .01) and reoperations (50.0% vs 12.9%; P < .05). We observed a progressively increasing incidence of 13%, 38%, and 45% of ESBL-related UTI among first, second, and third episodes, respectively. Age, gender, HLA mismatches, etiology of chronic kidney disease, diabetes mellitus, acute rejection, induction treatment, and type/level of immunosuppressants were similiar between the groups with or without ESBL-related UTI. We observed a high increased incidence of ESBL-related UTI among kidney transplant recipients, and particularly patients with recurrent UTI.

Topics: Adult; Anti-Bacterial Agents; beta-Lactamases; Cefazolin; Escherichia coli; Escherichia coli Infections; Female; Glomerulonephritis; Graft Rejection; Histocompatibility Testing; Humans; Kidney Transplantation; Male; Microbial Sensitivity Tests; Middle Aged; Postoperative Complications; Recurrence; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Some antibiotic agents, including cotrimoxazole, inhibit the metabolism of warfarin sodium and possibly increase the risk of hemorrhage. We examined the risk of upper gastrointestinal (UGI) tract hemorrhage in older patients receiving warfarin in combination with antibiotics commonly used to treat urinary tract infection, with a focus on cotrimoxazole.. This population-based, nested case-control study using health care databases in Ontario, Canada, between April 1, 1997, and March 31, 2007, identified residents 66 years or older who were continuously treated with warfarin. Cases were hospitalized with UGI tract hemorrhage. For each case, we selected up to 10 age- and sex-matched control subjects. We calculated adjusted odds ratios (aORs) for exposure to cotrimoxazole, amoxicillin trihydrate, ampicillin trihydrate, ciprofloxacin hydrochloride, nitrofurantoin, and norfloxacin within 14 days before the UGI tract hemorrhage.. We identified 134 637 patients receiving warfarin, of whom 2151 cases were hospitalized for UGI tract hemorrhage. Cases were almost 4 times more likely than controls to have recently received cotrimoxazole (aOR, 3.84; 95% confidence interval [CI], 2.33-6.33). Treatment with ciprofloxacin was also associated with increased risk (aOR, 1.94; 95% CI, 1.28-2.95), but no significant association was observed with amoxicillin or ampicillin (1.37; 0.92-2.05), nitrofurantoin (1.40; 0.71-2.75), or norfloxacin (0.38; 0.12-1.26). Compared with amoxicillin or ampicillin, cotrimoxazole prescription was associated with an almost 3-fold risk (ratio of ORs, 2.80; 95% CI, 1.48-5.32).. Among older patients receiving warfarin, cotrimoxazole is associated with a significantly higher risk of UGI tract hemorrhage than other commonly used antibiotics. Whenever possible, clinicians should prescribe alternative antibiotics in patients receiving warfarin.

Topics: Aged; Aged, 80 and over; Amoxicillin; Ampicillin; Anti-Infective Agents, Urinary; Anticoagulants; Case-Control Studies; Databases, Factual; Drug Interactions; Drug Therapy, Combination; Female; Gastrointestinal Hemorrhage; Humans; Male; Multivariate Analysis; Odds Ratio; Ontario; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Warfarin

The combination of trimethoprim/sulfamethoxazole is often used to treat uncomplicated urinary tract infections in children. The rationale for combining trimethoprim and sulfamethoxazole is that they may act synergistically to increase antibacterial activity. However, approximately 3% of patients show allergic reactions to sulfamethoxazole, of which some are serious (liver failure and Stevens-Johnson syndrome). We determined whether adding sulfamethoxazole is necessary to increase in vitro antibacterial activity for pediatric urinary tract infection compared to that of trimethoprim alone.. We prospectively identified 1,298 children with urinary tract infection (greater than 100,000 cfu/ml Escherichia coli) from a total of 4 American regions. In vitro susceptibility of bacterial isolates to sulfamethoxazole, trimethoprim and trimethoprim/sulfamethoxazole was determined using disk diffusion. Ampicillin susceptibility was tested at 2 sites. At 1 site all uropathogens from consecutive urinary isolates were evaluated.. E. coli susceptibility to trimethoprim was 70%, comparable to the 70% of trimethoprim/sulfamethoxazole (p = 0.9) and higher than the 56.9% of sulfamethoxazole (p <0.05). This susceptibility pattern was without regional differences. At 2 sites susceptibility to trimethoprim was significantly higher than to ampicillin. At 1 site the susceptibility of other uropathogens to trimethoprim and trimethoprim/sulfamethoxazole was similar to that of E. coli.. In children with urinary tract infection in vitro susceptibility to trimethoprim was comparable to that to trimethoprim/sulfamethoxazole and significantly higher than to sulfamethoxazole. This finding was similar at all sites. Adding sulfamethoxazole appears unnecessary and may represent a risk to patients. Trimethoprim can be used as an alternative to trimethoprim/sulfamethoxazole based on in vitro antibacterial susceptibility. Routine trimethoprim/sulfamethoxazole use for urinary tract infection should be carefully reevaluated.

Topics: Ampicillin; Analysis of Variance; Anti-Infective Agents, Urinary; Chi-Square Distribution; Child; Child, Preschool; Drug Combinations; Drug Therapy, Combination; Escherichia coli Infections; Female; Humans; Infant; Male; Microbial Sensitivity Tests; Prospective Studies; Sulfamethoxazole; Treatment Outcome; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

To assess the in vitro susceptibility of Actinobaculum schaalii to 12 antimicrobial agents as well as to dissect the genetic basis of fluoroquinolone resistance.. Forty-eight human clinical isolates of A. schaalii collected in Switzerland and France were studied. Each isolate was identified by 16S rRNA sequencing. MICs of amoxicillin, ceftriaxone, gentamicin, vancomycin, clindamycin, linezolid, ciprofloxacin, levofloxacin, moxifloxacin, co-trimoxazole, nitrofurantoin and metronidazole were determined using the Etest method. Interpretation of results was made according to EUCAST clinical breakpoints. The quinolone-resistance-determining regions (QRDRs) of gyrA and parC genes were also identified and sequence analysis was performed for all 48 strains.. All isolates were susceptible to amoxicillin, ceftriaxone, gentamicin, clindamycin (except three), vancomycin, linezolid and nitrofurantoin, whereas 100% and 85% were resistant to ciprofloxacin/metronidazole and co-trimoxazole, respectively. Greater than or equal to 90% of isolates were susceptible to the other tested fluoroquinolones, and only one strain was highly resistant to levofloxacin (MIC ≥32 mg/L) and moxifloxacin (MIC 8 mg/L). All isolates that were susceptible or low-level resistant to levofloxacin/moxifloxacin (n = 47) showed identical GyrA and ParC amino acid QRDR sequences. In contrast, the isolate exhibiting high-level resistance to levofloxacin and moxifloxacin possessed a unique mutation in GyrA, Ala83Val (Escherichia coli numbering), whereas no mutation was present in ParC.. When an infection caused by A. schaalii is suspected, there is a risk of clinical failure by treating with ciprofloxacin or co-trimoxazole, and β-lactams should be preferred. In addition, acquired resistance to fluoroquinolones more active against Gram-positive bacteria is possible.

Topics: Actinomycetaceae; Actinomycetales Infections; Amino Acid Sequence; Anti-Bacterial Agents; Ciprofloxacin; DNA Gyrase; DNA Topoisomerase IV; Drug Resistance, Bacterial; Fluoroquinolones; France; Humans; Microbial Sensitivity Tests; Molecular Sequence Data; Mutation; Sequence Analysis, DNA; Switzerland; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The pathogenesis of recurrent urinary tract infections (UTIs) in preschool children with anatomically correct urinary tract (UT) is rather obscure. In girls, the bladder wall changes of cystitis cystica (CC) may be per se responsible for UTIs recurrence. During the 20-year period, 127 preschool children (125 girls; median age: 6.1 years) with CC, in whom UT anomalies were excluded, were diagnosed. The mean duration of UTIs symptoms prior to diagnosis was 3.31 +/- 2.51 years. Cystoscopical findings were labelled as mild, moderate and severe in 22.8%, 39.4% and 37.8% of patients, respectively. Following the confirmation of CC, long-term chemoprophylaxis with sulfamethoxazole-trimethoprim/nitrofurantoin was administered. A one year UTI-free period after chemoprophylaxis discontinuation was defined as therapeutic success. With 2.5 years median duration of regular chemoprophylaxis this goal was achieved in 58 children mainly with mild/ moderate CC. Thirty children from "improved/unchanged" group taking regular prophylaxis had significant reduction of UTIs ("improved"). Only 12 children belonging to the same group taking regular prophylaxis and all children with irregular prophylaxis had approximately the same number of UTIs as before treatment ("unchanged"). The "improved/unchanged" outcomes were predominantly found in children with severe form of CC. Although urodynamic disturbances detected in more than 50% of patients in whom urodynamics was performed were not found influential on the disease outcome, they could be responsible for its development. The results of our study suggest that regular and long-lasting chemoprophylaxis remains a basis for successful treatment for majority of patients with CC, even those with severe forms. If not treated properly with chemoprophylactic agents and without fair compliance in taking drugs, the disease is prone to recurrent UTIs.

Topics: Antibiotic Prophylaxis; Child; Child, Preschool; Cystitis; Female; Humans; Male; Medication Adherence; Recurrence; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Acute generalized exanthematous pustulosis (AGEP) is characterized by sudden onset of non-follicular aseptic pustules with erythema often accompanied by fever and leukocytosis. While the most frequent cause of AGEP is drug reactions, especially antibiotics. Occasional cases have been described as parainfectious. An 82-year-old female presented with recurrent AGEP along with a chronic urinary infection with Escherichia coli. Her cutaneous findings resolved following antibiotic therapy and prophylaxis. To the bets of our knowledge, this is the first case of AGEP associated with an Escherichia coli urinary tract infection.

Topics: Aged, 80 and over; Anti-Infective Agents, Urinary; Biopsy; Diagnosis, Differential; Drug Eruptions; Drug Resistance, Microbial; Escherichia coli Infections; Female; Humans; Long-Term Care; Nitrofurantoin; Recurrence; Skin; Skin Diseases, Papulosquamous; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Incontinence; Urinary Tract Infections

Of 176 urine isolates from female students positive for Escherichia coli, 29.6% were trimethoprim-sulfamethoxazole resistant and none were nitrofurantoin resistant. Among students with a history of urinary tract infection (UTI) (n = 119), resistance to ciprofloxacin was 11.8%, compared to 1.8% among those without prior UTI. Nitrofurantoin should be considered for empirical therapy of lower tract UTI.

Topics: Adolescent; Adult; Ciprofloxacin; Drug Resistance, Microbial; Escherichia coli; Female; Humans; Nitrofurantoin; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Young Adult

Given reported increases in antibiotic resistance among elders with urinary tract infection (UTI) and pyelonephritis, the authors identified national rates and trends in emergency department (ED) trimethoprim-sulfamethoxazole (TMP-SMX) and fluoroquinolone prescribing for older adults from 1996 to 2005.. This was a retrospective analysis utilizing the ED component of the 1996-2005 National Hospital Ambulatory Medical Care Survey (NHAMCS). The authors included NHAMCS ED entries aged >or=18 years with a diagnosis of UTI or pyelonephritis; pregnancy was excluded. Records were divided into 18-64 years ("adults") and >or=65 years ("elders"). Primary outcome measures were prescription of TMP-SMX monotherapy, fluoroquinolone monotherapy, and combination therapy with two or more antibiotics. Estimated visit totals and rates were calculated and trends analyzed.. From 1996 to 2005, there were 5 million elder ED visits for UTI or pyelonephritis. Approximately 9.4% (95% confidence interval [CI] = 7.9% to 11%) of elders received TMP-SMX monotherapy with rates decreasing over time (p-value for trend = 0.031). Overall, 35% (95% CI = 32% to 38%) of elders received fluoroquinolone monotherapy, which increased from 21% (95% CI = 14% to 27%) in 1996 to 45% (95% CI = 39% to 50%) in 2005 (p-value for trend < 0.001). Therapy with a fluoroquinolone plus a second antibiotic was used in only 4.2% (95% CI = 3.1% to 5.3%) of older patients.. From 1996 to 2005, TMP-SMX monotherapy in elder ED patients decreased while fluoroquinolone therapy increased. The majority of older patients receiving fluoroquinolone therapy received a single agent. Given the continued prevalence of monotherapy for elder ED patients with UTI or pyelonephritis, antibiotic resistance patterns in these patients should be better characterized to ensure institution of appropriate empiric therapy.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Drug Prescriptions; Drug Therapy, Combination; Drug Utilization; Emergency Service, Hospital; Female; Fluoroquinolones; Humans; Linear Models; Logistic Models; Male; Middle Aged; Pyelonephritis; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Young Adult

In our study of nursing home residents with clinically suspected urinary tract infection who did not require the use of an indwelling catheter, we identified bacteria isolated from urine samples, the resistance patterns of these isolated bacteria, and the antibiotic therapy prescribed to the residents. Escherichia coli, the predominant organism isolated, frequently was resistant to commonly prescribed oral antibiotics. Trimethoprim-sulfamethoxazole remains the best empiric antimicrobial therapy for a urinary tract infection, but nitrofurantoin should be considered if E. coli is identified.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Drug Resistance, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Escherichia coli; Escherichia coli Infections; Female; Homes for the Aged; Humans; Male; Microbial Sensitivity Tests; Nitrofurantoin; Nursing Homes; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urine

Recent studies from North America and Europe have demonstrated community-wide clonal spread of uropathogenic Escherichia coli (UPEC). To investigate if a similar pattern of spread occurs in Brazil, we characterized UPEC from women with community-acquired urinary tract infection (UTI) in Rio de Janeiro. E. coli isolates from women with UTI in one public outpatient clinic were evaluated for antibiotic susceptibility, E. coli phylogenetic grouping, enterobacterial repetitive intergenic consensus (ERIC) 2 PCR and pulsed-field gel electrophoresis fingerprinting, and multilocus sequence typing. From March 2005 to November 2006, 344 patients were studied. Of these, 186 (54%) had confirmed UTI, 118 (63.4%) of which were caused by E. coli. More than 50% of these isolates were resistant to ampicillin and trimethoprim/sulfamethoxazole. Of these, 96 (81%) belonged to 19 ERIC2 clonal groups. The largest group included 15 isolates, all belonging to multilocus sequence typing group ST69 and phylogenetic group D; they had pulsed-field gel electrophoresis patterns sharing at least 89% similarity compared with the CgA reference strain ATCC BAA-457. CgA strains have been found to be widespread in the United States in the early 2000s. Clonal group E. coli strains accounted for a large proportion (52%) of all UTIs and 82% of the trimethoprim/sulfamethoxazole-resistant E. coli UTIs. Thus, as in North America and Europe, UPECs that cause UTI in Rio de Janeiro also show clonal distribution, and a substantial proportion of drug-resistant UTI is caused by a small set of genetically related E. coli strains.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Bacterial Typing Techniques; Brazil; Cross-Sectional Studies; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Escherichia coli Infections; Female; Humans; Middle Aged; Molecular Sequence Data; Prospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Uropathogenic Escherichia coli; Young Adult

Topics: Anti-Infective Agents, Urinary; Child; Humans; Sample Size; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Age Factors; Aged; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Empiricism; Female; Humans; Long-Term Care; Nursing Homes; Rhode Island; Secondary Prevention; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Prophylactic antibiotics are commonly used for prevention of urinary tract infections (UTIs) in children. It was postulated that the organisms and resistance patterns of breakthrough infections would differ with the choice of antimicrobial prophylaxis. This was a retrospective descriptive study of all breakthroughs UTI from 2000 to 2006 in children over 1 month of age discharged from a referral children's hospital in Tehran, Iran on continuous antibiotic prophylaxis for UTIs. Fifty-seven children discharged on prophylaxis had breakthrough UTIs of which 32 (56%) had a previously diagnosed urinary tract anomaly. Escherichia coli was responsible for the majority of infections irrespective of choice of prophylaxis. Thirty-three of 56 breakthrough UTIs (59%) were with organisms that were resistant to the prophylactic antibiotic. There was an increased incidence of resistance to prophylaxis in children on cefixime (16 of 22; 78%) when compared with children on cephalexin (7 of 19; 37%; p=0.02) and a trend toward increased resistance when compared with children on trimethoprim-sulfamethoxasole (3 of 8; 37%) (p=0.10). In conclusion, the resistance pattern of organisms causing breakthrough UTIs varies with the choice of prophylaxis which should be taken into consideration in chosing empiric therapy for such infections.

Topics: Adolescent; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Cefixime; Child; Child, Preschool; Cross Infection; Cross-Sectional Studies; Drug Resistance, Bacterial; Female; Hospitals, Pediatric; Humans; Infant; Iran; Male; Retrospective Studies; Secondary Prevention; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urine

Urinary tract infections (UTI) are among the most prevalent infectious diseases, and their financial burden on society is substantial. Management of UTIs has been complicated by the emergence of resistance to most commonly used antibiotics. Increasing prevalence of resistance has led to a gradual evolution in the antibiotics used to treat UTIs. The aims of this study were to determine the TMP/SMX (trimethoprim/sulfamethoxazole) resistance rate in patients with uncomplicated UTIs and to determine which empiric antibiotics are prescribed in the emergency department for the outpatient management of UTI. Between June 2004 and May 2005, archives of the emergency department were searched retrospectively and the files of patients diagnosed with UTI were reviewed. Patients' demographical data, urine culture results, pathogen microorganisms, and TMP/SMX and fluoroquinolone (FQ) resistance rates were recorded. We obtained information from 274 files of patients who had been diagnosed with UTI. The most frequently isolated pathogen was Escherichia coli (54%). Of the 274 patients diagnosed with UTI, 251 had been started on empiric antibiotics. The most frequently prescribed antibiotics were FQs (85%), and the first choice in this group was ofloxacin (58%). The resistance rate for TMP/SMX was 34% and all of the resistant microorganisms were E. coli. The resistance rate for the FQ group was 16.4% and resistant microorganisms were E. coli. In the treatment of UTIs in our patient population, the most prescribed antibiotics were FQs. At the same time it was found that resistance rates against FQ antibiotics are as high as 16.4%. Unfortunately, in our population, in the near future, empiric FQ use may result in bacterial resistance.

Topics: Adolescent; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Aza Compounds; Ceftriaxone; Drug Resistance, Microbial; Escherichia coli Infections; Female; Fluoroquinolones; Humans; Male; Middle Aged; Moxifloxacin; Quinolines; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Young Adult

While the spectrum of opportunistic infections due to HIV infection has been widely discussed, there are very limited data available in south India on certain incident infections especially urinary tract infections (UTI) in HIV-infected subjects.. Bacterial aetiology of 350 symptomatic UTI in HIV-infected subjects and the drug resistance pattern of the Escherichia coli isolates tested between June 2005 and July 2007 at the YRG Centre for AIDS Research and Education, a tertiary HIV Referral Centre in Chennai has been described here.. E. coli was the most common etiological agent of UTI in HIV patients, followed by Staphylococcus aureus, Klebsiella pneumoniae, Enterococcus faecalis, Pseudomonas aeruginosa, Proteus spp. and Staphylococcus epidermidis. Twenty-nine E. coli isolates were multi-drug-resistant and 83.3% of the isolates were resistant to sulfamethoxazole-trimethoprim.. Urinary pathogens in HIV-infected patients demonstrate high antimicrobial resistance and with majority of therapy for UTIs being empiric, constant updates of the aetiological agents and their drug susceptibility pattern would largely be beneficial to clinicians in choosing the right drug.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Urinary; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; HIV Infections; Humans; India; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To describe attitudes of paediatricians and paediatric nephrologists regarding antibiotic prophylaxis for urinary tract infection (UTI) and determine the factors associated with its use.. A self-administered questionnaire was mailed to Canadian paediatricians (1136) and paediatric nephrologists (42).. The response rate was 58.1% (684 physicians); 436 who had made a decision about antibiotic prophylaxis for childhood UTI in the previous year were included in the analysis. Of these, 407 (93.3%) were certified in paediatrics and 29 (6.7%) were paediatric nephrologists. Most respondents prescribed prophylaxis for children with grade III-V vesicoureteral reflux (VUR) (96.5%-98%); 69.8 and 92.8% prescribed it for children with grades I and II VUR, respectively. Factors significantly associated with use of prophylaxis for children with grade I VUR were frequency of decision-making about prophylaxis, city size and province. Fifteen percent of physicians felt that their practice regarding antibiotic prophylaxis for children with VUR was evidence based. A hundred one respondents (24.3%) prescribed prophylaxis for infants with a first febrile UTI in the absence of VUR. Nineteen percent felt that their practice regarding antibiotic prophylaxis for these infants was evidence based. Prescription of prophylaxis for children >12 months with recurrent UTI in the absence of VUR was influenced by frequency of pyelonephritis (88.5% of respondents) and presence of voiding dysfunction (53.8%). Nine percent of physicians felt that their practice for these children was evidence based.. Opinions of Canadian paediatricians and paediatric nephrologists regarding antibiotic prophylaxis for UTI in children vary widely, probably because of the paucity of solid evidence about prophylaxis.

Topics: Amoxicillin; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Canada; Child; Child, Preschool; Data Collection; Female; Health Knowledge, Attitudes, Practice; Humans; Male; Nitrofurantoin; Pediatrics; Practice Patterns, Physicians'; Prescriptions; Surveys and Questionnaires; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

There is growing concern regarding antimicrobial resistance worldwide, particularly of Escherichia coli, and the first choice of an antimicrobial agent for empiric treatment of pediatric urinary tract infection (UTI) is not well established.. The medical records from January 1991 to December 2005 for all children under 18 years of age admitted to Tri-Service General Hospital, Taipei for their first UTI were reviewed. Two study periods, early (1991-2000) and late (2001-2005), were chosen during the 15 year period for evaluating the trend of antimicrobial resistance.. Of the 368 isolates, E. coli was the most common pathogen (81.0%), followed by Klebsiella pneumoniae (6.5%), Enterococcus spp. (6.0%), and Proteus mirabilis (3.5%). Of the 368 isolates, 77.4% were resistant to ampicillin, 44.6% to co-trimoxazole, 27.2% to cephalothin, 15.0% to gentamicin, and 8.4% to nitrofurantoin. In the early (1991-2000) and late (2001-2005) study periods, 199 isolates (54.1%) and 169 isolates (45.9%), respectively, were compared. The resistance to antimicrobial agents for overall pathogens in the early and late study periods, respectively, was as follows: 68.8% and 88.0% to ampicillin, 48.9% and 46.6% to co-trimoxazole, 26.8% and 28.9% to cephalothin, 16.2% and 19.8% to gentamicin, and 8.7% and 9.0% to nitrofurantoin.. Among commonly used antimicrobial agents for the treatment of pediatric UTI, there is a trend towards increasing resistance to ampicillin and a persistently low resistance rate to gentamicin, cephalosporin, and nitrofurantoin. Parenteral first-generation cephalosporins, gentamicin, and oral nitrofurantoin should be considered for first-line agents, given the resistance patterns of this study.

Topics: Adolescent; Ampicillin; Anti-Bacterial Agents; Bacterial Infections; Cephalothin; Child; Child, Preschool; Drug Resistance, Bacterial; Drug Therapy, Combination; Enterococcus; Escherichia coli; Female; Gentamicins; Humans; Infant; Infant, Newborn; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Nitrofurantoin; Prevalence; Proteus mirabilis; Retrospective Studies; Taiwan; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The prevalence of antimicrobial resistance among uropathogenic E. coli varies widely worldwide; to guide empirical therapy is necessary to have local, up-to-date susceptibility data.. We tested 907 isolates from patients in Mexico City by disk diffusion and further characterized ciprofloxacin, cephalosporin and nitrofurantoin resistant strains.. Isolates were mostly resistant to ampicillin (74%), trimethoprim-sulfamethoxazole (60.1%) and ciprofloxacin (32.6%). The most effective drug was netilmicin (5.1% resistant) and the most effective of oral drugs was nitrofurantoin (7.4% resistant). Sixty-percent of ciprofloxacin-resistant strains had minimal inhibitory concentrations of 125 microg/ml or higher, well beyond urinary concentrations at the end of the 12-hour inter-dose period for standard oral regimes. Extended-spectrum beta-lactamases were detected in 6% of strains, most of them from community-acquired infections. All strains resistant to nitrofurantoin carried a 20 Kb plasmid, which when transformed into a susceptible recipient, conferred resistance to nitrofurantoin, ampicillin, sulfonamides, streptomycin, and partially protected against ciprofloxacin.. Drugs considered of choice against uncomplicated urinary tract infections are facing high resistance prevalences and resistance determinants formerly seen only at hospitals are now among community strains. Treatment guidelines from developed countries might not reflect these local trends.

Topics: Ampicillin; Anti-Bacterial Agents; Ciprofloxacin; Community-Acquired Infections; Drug Resistance, Multiple, Bacterial; Escherichia coli Infections; Female; Humans; Mexico; Microbial Sensitivity Tests; Netilmicin; Nitrofurantoin; Pregnancy; Prevalence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Uropathogenic Escherichia coli

Empiric treatment of community-acquired urinary tract infections (CA-UTI) is determined by the antibiotic sensitivity patterns of uropathogens in a population. This study was conducted to determine patterns of resistance amongst CA-uropathogens in India, to help establish local guidelines on treatment of CA-UTI.. 531 consecutive positive urine cultures taken from adult non-pregnant females attending outpatient clinics of five hospitals in Delhi, India, were analysed. Sensitivity testing was done for ciprofloxacin, trimethoprim-sulphamethoxazole (SXT), amoxicillin, amoxicillin-clavulanate, amikacin, nitrofurantoin, piperacillin-tazobactam and meropenem in each isolate.. E. coli comprised 68%; Klebsiella 16.9%; Proteus 5.5%; Enterobacter 5.3%; Staphylococcus saprophyticus 2.8%; and others 1.5% of the isolates. Furthermore, 26.9% of the gram negative isolates were ESBL producers. Antibiotic sensitivity of all the gram negative organisms showed that 35.8% were sensitive to ciprofloxacin; 30% to SXT; 17.7% to amoxicillin; 41.6% to amoxicillin/clavulanate; 75.6% to amikacin; 65.7% to nitrofurantoin; 90.2% to piperacillin-tazobactam; and 100% to meropenem.. High levels of ESBL producers among gram negative CA-uropathogens was seen in our country. This, along with the alarming rate of resistance to ciprofloxacin, SXT and amoxicillin, precludes the use of these commonly used antibiotics for empiric treatment of CA-UTI in India.

Topics: Adolescent; Adult; Aged; Ampicillin; Anti-Infective Agents, Urinary; Ciprofloxacin; Community-Acquired Infections; Drug Resistance, Multiple, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Humans; India; Middle Aged; Nitrofurantoin; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Child; Humans; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

The aim of this study was to characterize the pathogens and their antibiotic susceptibilities in defined groups of children (total number 694) with urinary tract infection (UTI) regarding age, first UTI (FUTI) or recurrent UTI (RUTI), renal abnormalities or vesico-ureteric reflux (VUR) in order to optimize empirical antibiotic therapy and prophylaxis. In patients aged between 1 month and 24 months with a first febrile UTI (FUTI; n = 205) the leading pathogen was Escherichia coli (E. coli) (83.4%). In comparison with patients with FUTI, those with RUTI (n = 24) had more Enterococcus and Enterobacter infections and higher resistance rates of E. coli against trimethoprim (TMP), trimethoprim/sulfamethoxazole (SXT) or ampicillin (AMP). Boys with ultrasound-detected renal abnormalities (n = 71) showed 14.2% Pseudomonas and 59.1% E. coli infections versus girls (n = 48) (2.1% Pseudomonas and 93.7% E. coli). Of 390 patients who underwent voiding cysto-urethrography, 31.5% had VUR. Of them, 45.5% received antimicrobial prophylaxis with SXT (n = 30) or cefazolin (n = 26). There was no difference between girls (n = 242) and boys (n = 148) regarding the frequency of VUR and pathogens. There were more TMP- and SXT-resistant E. coli cultures from patients with VUR (37.8%) than from those without VUR (25.8%). Treatment with TMP, SXT and AMP alone appeared to be insufficient in many cases because of high resistance rates of E. coli and other uropathogens.

Topics: Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Child; Child, Preschool; Drug Resistance, Bacterial; Drug Therapy, Combination; Escherichia coli; Female; Humans; Infant; Kidney; Male; Microbial Sensitivity Tests; Pseudomonas; Retrospective Studies; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To assess adherence to evidence-based guidelines for the diagnosis and management of uncomplicated urinary tract infection (UTI) in a family medicine residency clinic setting.. We retrospectively reviewed the medical records of female patients seen in 2005 at the Mayo Clinic Family Medicine Center in Scottsdale, Ariz, who were identified by International Classification of Diseases, Ninth Revision code 599.0 (UTI). We assessed documentation rates, use of diagnostic studies, and antibiotic treatments. Antibiotic sensitivity patterns from outpatient urine culture and sensitivity analyses were determined.. Of 228 patients, 68 (30%) had uncomplicated UTI. Our physicians recorded essential history and examination findings for most patients. Documentation of the risk of sexually transmitted disease differed between residents and attending physicians and was affected by patient age. Urine dipstick and urine culture and sensitivity analyses were ordered in 57 (84%) and 52 (76%) patients, respectively. Eighty percent of patients with positive results on urine dipstick analyses also had urine culture and sensitivity analyses. Sulfamethoxazole-trimethoprim (SMX-TMP) was used as initial therapy in 26 patients (38%). Sixty-one percent of SMX-TMP and ciprofloxacin prescriptions were appropriately provided for 3 days. Escherichia coil was sensitive to SMX-TMP in 33 (94%) of 35 cultures. Treatment was not changed in any patient with an uncomplicated UTI because of results of urine culture and sensitivity analyses. Antibiotic sensitivity patterns for outpatients were significantly different from those for inpatients.. Only 30% of our patients had uncomplicated UTI, making their management within clinical guidelines appropriate. However, of those patients with uncomplicated UTI, less than 25% received empirical treatment as suggested. Urine culture and sensitivity analyses were performed frequently, even in patients who already had positive results on a urine dip-stick analysis. Although SMX-TMP is effective, it is underused. On the basis of these findings, we hope to provide interventions to increase SMX-TMP prescription, decrease use of urine culture and sensitivity analyses, and increase the frequency of 3-day antibiotic treatments at our institution.

Topics: Adult; Anti-Infective Agents, Urinary; Cohort Studies; Drug Administration Schedule; Female; Guideline Adherence; Humans; Medical Records; Microbial Sensitivity Tests; Middle Aged; Physical Examination; Practice Guidelines as Topic; Retrospective Studies; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Drug Resistance, Bacterial; Female; Fluoroquinolones; Humans; Predictive Value of Tests; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Uncomplicated urinary tract infection (UTI) is one of the most common infections encountered and treated in outpatients. A set of guidelines published in 1999 by the Infectious Diseases Society of America recommends trimethaprim-sulfamethoxazole as first-line therapy.. We undertook a study of cross-sectional data describing the use of ambulatory medical services in the United States by women > or = 18 years of age who had uncomplicated UTI. Data from 1996 to 2001 were obtained from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey to (1) examine the prescribing practices for the treatment of uncomplicated UTI and (2) determine whether these practices were influenced by the recommendation in the Infectious Diseases Society of America guidelines. The major outcomes measurement was to evaluate whether antibacterial selection was influenced by the Infectious Diseases Society of America guidelines. Data were analyzed by year, treatment in private offices vs. hospital clinics, race, geographic location, the specialty of the prescribing health care provider, and the payment method of the patient.. We identified 2339 cases of uncomplicated UTI. Trimethaprim-sulfamethoxazole and ciprofloxacin were the most commonly prescribed drugs. Despite the Infectious Diseases Society of America guidelines, the use of trimethaprim-sulfamethoxazole did not change significantly (odds ratio, 0.89; 95% confidence interval, 0.60-1.30; P = .53), whereas the use of ciprofloxacin increased significantly (odds ratio, 1.75; 95% confidence interval, 1.11-2.75; P < or = .016). Similar results were obtained after adjusting for age, geographic region, race, physician specialty, payment method, and whether the visit was by a new or returning patient.. Despite the Infectious Diseases Society of America recommendation of trimethaprim-sulfamethoxazole as first-line therapy for uncomplicated UTI, physicians in the United States have not altered their prescribing practices. Adjustment for age, geographic region, race, physician specialty, and payment method confirmed a lack of adherence to this recommendation.

Topics: Acute Disease; Adult; Aged; Ambulatory Care; Anti-Infective Agents, Urinary; Cross-Sectional Studies; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Utilization; Female; Guideline Adherence; Humans; Logistic Models; Longitudinal Studies; Male; Middle Aged; Probability; Severity of Illness Index; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

Maternal urinary tract infections in pregnancy showed an association with a higher rate of preterm birth in previous studies. The aim of this study was to check this relationship, and in addition to evaluate the efficacy of recent medical treatments. The population-based large control (without any defects) data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities was evaluated. Of 38,151 newborn infants, 2188 (5.7%) had mothers with urinary tract infections during pregnancy, and 90% of these maternal diseases were prospectively and medically recorded. The prevalence of pre-eclampsia and polyhydramnios showed an association with urinary tract infections during pregnancy. Pregnant women with urinary tract infections in pregnancy had a somewhat shorter gestational age (0.1 week) and a higher proportion of preterm births (10.4% vs 9.1%). These differences were correlated with the severity of urinary tract infections. However, the preterm-inducing effect of maternal urinary tract infections is preventable by some antimicrobial drugs such as ampicillin, cefalexin and cotrimoxazole. In conclusion, maternal urinary tract infections during pregnancy increase pre-eclampsia and polyhydramnios, and in addition the rate of preterm birth; however, the latter is preventable by appropriate drug treatments.

Topics: Adolescent; Adult; Ampicillin; Anti-Bacterial Agents; Case-Control Studies; Cephalexin; Child; Female; Health Surveys; Humans; Hungary; Infant, Newborn; Male; Polyhydramnios; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Premature Birth; Prospective Studies; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Isolates of Escherichia coli belonging to clonal group A (CGA), a recently described disseminated cause of drug-resistant urinary tract infections in humans, were present in four of seven sewage effluents collected from geographically dispersed areas of the United States. All 15 CGA isolates (1% of the 1,484 isolates analyzed) exhibited resistance to trimethoprim-sulfamethoxazole (TMP-SMZ), accounting for 19.5% of the 77 TMP-SMZ-resistant isolates. Antimicrobial resistance patterns, virulence traits, O:H serotypes, and phylogenetic groupings were compared for CGA and selected non-CGA isolates. The CGA isolates exhibited a wider diversity of resistance profiles and somatic antigens than that found in most previous characterizations of this clonal group. This is the first report of recovery from outside a human host of E. coli CGA isolates with virulence factor and antibiotic resistance profiles typical of CGA isolates from a human source. The occurrence of "human-type" CGA in wastewater effluents demonstrates a potential mode for the dissemination of this clonal group in the environment, with possible secondary transmission to new human or animal hosts.

Topics: Bacterial Typing Techniques; Base Sequence; DNA, Bacterial; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Fimbriae Proteins; Genes, Bacterial; Humans; Phylogeny; Random Amplified Polymorphic DNA Technique; Sewage; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Virulence

Elderly patients living in nursing homes can easily find themselves unable to carry out their daily activities, once they become ill, even with infectious diseases of a slight to mild degree, and rapid treatment is required to cure them of their malaise. However, treatment is often difficult due to the presence of drug-resistant bacteria. This study was designed to evaluate the efficacy of the selective use of antimicrobial agents based on a sensitivity test of isolated bacteria.. Possible pathogenic bacteria were isolated from cultures of pharyngeal swabs or urine obtained from patients with chronic febrile conditions or urinary tract infections, resistant to antimicrobial treatment. The efficacy of the treatment was evaluated based on release from febrile conditions and improvement of activities of daily living (ADL) accompanied by the disappearance of possible pathogenic bacteria following the use of selective antimicrobial agents.. The outcome of 14 cases with sustaining febrile conditions and 3 cases with urinary tract infections was reviewed. Most of them showed a good response to treatment with remarkable improvement in ADL. In some cases, patients were switched from one antimicrobial agent to another each time new pathogenic bacteria were detected in the culture. A combination of rifampicin and sulfamethoxazole/trimethoprim (RFP/ST) was found to be the most convenient and effective treatment in patients with MRSA or drug-resistant Streptococcus pneumoniae. Levofloxacin (LVFX)-resistant Escherichia coli were detected together with MRSA in our 3 patients with urinary tract infections, corresponding to the frequent use of LVFX in our community.. Identification of possible pathogenic bacteria and the use of proper antibiotic agents based on a sensitivity test are very effective in the treatment of elderly patients with chronic febrile conditions arising from the presence of drug-resistant bacteria. Careful use of fluoroquinolones is required in patients in whom MRSA is or had once been detected. This is beneficial not only for the elderly patients themselves but is also useful in preventing the spread of drug-resistant bacteria.

Topics: Activities of Daily Living; Aged; Aged, 80 and over; Anti-Infective Agents, Urinary; Antibiotics, Antitubercular; Drug Resistance, Bacterial; Female; Homes for the Aged; Humans; Male; Nursing Homes; Respiratory Tract Infections; Rifampin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Adverse skin reactions to drugs are frequent, with rates of reaction to many commonly used drugs exceeding 1%. We describe a 29-year-old woman admitted with a history of itching, rash, vesicles on her hands and soles, and edema on her tongue and oropharynx after trimethoprim-sulfamethoxazole, ciprofloxacin, methenamine anhydromethylene citrate, piroxicam, azithromycin, and ceftriaxone intake. Erythema multiforme (EM) was diagnosed by skin biopsy after oral challenge with piroxicam. EM lesions reappeared after oral challenge with levofloxacin. Although EM is quite common with trimethoprim-sulfamethoxazole and there are some reports of EM appearing after intake of ciprofloxacin, it has rarely been attributed to piroxicam and no reports have identified levofloxacin as a cause.

Topics: Adult; Anti-Infective Agents; Anti-Inflammatory Agents, Non-Steroidal; Azithromycin; Ceftriaxone; Ciprofloxacin; Drug Hypersensitivity; Erythema Multiforme; Female; Humans; Levofloxacin; Methenamine; Ofloxacin; Piroxicam; Skin Tests; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Two patients, a girl and a boy, both aged 8.5 years, presented with serious side effects caused by ceftriaxone and co-trimoxazole, respectively. The first patientwas treated with ceftriaxone (100 mg/kg/day with a body weight of 35.6 kg) on suspicion of a neuroborreliosis, but developed an acute cholecystitis with cholelithiasis 3 weeks after the antibiotic had been withdrawn. He underwent a laparoscopic cholecystectomy. Ceftriaxone binds calcium in the biliary tract, forming biliary sludge or stones. The second patient developed thrombocytopenia during treatment with co-trimoxazole (58 mg/kg/day with a body weight of 25.4 kg) because of a urinary-tract infection. After discontinuation of the co-trimoxazole the thrombocytopenia resolved spontaneously. The pathophysiological mechanism involved may be either a direct toxic effect of trimethoprim or an immune-mediated reaction to sulfamethoxazole. According to current guidelines, the dosage of the drug was too high in both cases. It is important to ensure a correct dosage in children, since side effects are potentially dose-related.

Topics: Anti-Bacterial Agents; Body Weight; Ceftriaxone; Child; Cholelithiasis; Dose-Response Relationship, Drug; Female; Humans; Male; Thrombocytopenia; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

During a 1-year period, from November 2003 to October 2004, urinary Escherichia coli isolates were collected from 20 clinical microbiology laboratories across Spain. The main objective was to assess the resistance of E. coli to the antimicrobials most commonly prescribed for community-acquired urinary tract infections depending on the patient's age. A total of 2,230 valid E. coli strains from female outpatients were isolated and sent to a single central reference laboratory for confirmation and susceptibility testing using an agar dilution method. A two-sided chi-squared test was used to assess the differences in resistance between age groups (< or =65 and >65 years). E. coli resistance was found to be more common to ampicillin (52.1%), cotrimoxazole (26%) and quinolones (18%), whereas resistance to amoxicillin-clavulanic acid, cefuroxime axetil and fosfomycin were below 3%. In women older than 65 years, resistance to ciprofloxacin reached up to 29% compared with 13% of those in the under 65 age group (p <0.001). For cotrimozaxole, rates were 32% vs. 23% (p <0.001) and for ampicillin 56% vs. 50% (p=0.02), respectively. It was concluded that fosfomycin, amoxicillin-clavulanic acid and cefuroxime axetil are the most suitable antimicrobials for empirical treatment in Spain given the high 18% and 26% resistance rates to quinolones and cotrimoxazole, respectively. Being older than 65 years of age was associated with higher resistance rates to ciprofloxacin (29%). These results should be considered when recommending empirical therapy for acute cystitis in women.

Topics: Adult; Age Factors; Aged; Ampicillin Resistance; Anti-Bacterial Agents; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Middle Aged; Spain; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To evaluate the effect of urinary bladder double voiding technique on the incidence of urinary tract infection in the transplant patients with double J stents after the removal of the urethral catheters in the post-transplant period, we evaluated 65 recipients of live kidney transplant in whom we inserted double J stents and urethral catheters at the time of transplantation. After removing the urethral catheters on post-operation day six, we instructed a group of 30 patients to double void their bladders within five minutes after the first micturition. The rest of the patients served as controls. Urine cultures were repeated frequently before and at the time of removal of urethral catheters and double J stents to detect the incidence of urinary tract infection in both groups. All recipients received cotrimoxazol prophylactically. The group of patients who performed the double voiding technique had significantly lower incidence of positive urine cultures than the control group at the time of removing the double J stents (1 (3.3%) vs. 12 (34.2%) respectively). We conclude that double voiding may reduce risk of urine infection in patients with double J stents in renal allograft ureters.

Topics: Adult; Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Catheters, Indwelling; Device Removal; Female; Humans; Kidney Transplantation; Male; Middle Aged; Stents; Transplantation, Homologous; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urethra; Urinary Bladder; Urinary Catheterization; Urinary Tract Infections

The aim of this study was to comprise the efficacy of chronic therapy with fosfomycin, co-trimoxazole and nitrofurantoin in the treatment and prevention of recurrent urinary tract infections (UTI) in type 2 diabetic women.. The study comprised 90 women aged 50-70 years, who suffered from the UTI (isolated bacterial uropathogen sensitive to fosfomycin, co-trimoxazole and nitrofurantoin). Women were divided into 3 groups. Group I comprised patients, who have been treated with fosfomycin, group II with co-tromixazole and group III with nitrofurantoin. Observation period lasted 9 months and for the 6 months patients were treated with antimicrobial agents. Efficacy of antimicrobial treatment was estimated when both clinical cure and bacteriological eradication of uropathogens were achieved.. There were no significant differences in the percentage of patients between study groups, who achieved therapeutic successes after 3 and 6 months of the antimicrobial treatment (NS). Three months after discontinuation of treatment episodes of UTI were observed significantly rarely in group treated with fosfomycin in comparison with the group treated with nitrofurantoin (p = 0.01) and co-trimoxazole (p = 0.02).. Fosfomycin, co-trimoxazole and nitrofurantoin are safe and effective antimicrobial methods to cure and prevent UTI. Fosfomycin is associated with rarely recurrence of UTI than nitrofurantoin and co-trimoxazole in the period without its taking.

Topics: Aged; Anti-Infective Agents, Urinary; Diabetes Mellitus, Type 2; Female; Fosfomycin; Humans; Microbial Sensitivity Tests; Middle Aged; Nitrofurantoin; Secondary Prevention; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urine

The principles behind the primary localization of lesions in fixed drug eruption are still unknown. Studies investigating the predilection areas indicated drug-related, trauma-related or inflammation-related specific site involvement in fixed drug eruption. This study presents new findings of primary site involvement on the maximal points of Head's zones. In the 3 cases reported here, fixed drug eruption lesions were located at specific sites; the so-called maximal points of Head's zones, which are known to be the most active dermatomal areas of an underlying visceral pathology. An underlying internal disturbance was found in all 3 patients, corresponding to the organ-related maximal point of Head's zones in each case. In conclusion, the primary location of the fixed drug eruption lesions on the maximal points of the Head's zones according to the well-known neurophysiological map is an important observation in studying the predilection areas.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Drug Eruptions; Female; Gastroesophageal Reflux; Humans; Middle Aged; Naproxen; Piroxicam; Skin; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In an era of increasing antimicrobial resistance, knowledge of local antimicrobial susceptibility patterns of common uropathogens is essential for prudent empiric therapy of community-acquired urinary tract infections.. To define antimicrobial susceptibility of Gram-negative uropathogens in northern Israel over a 10 year period and to compare it with patterns of antibiotic use in the same community.. We tested the susceptibility of all Gram-negative urinary isolates from outpatients at HaEmek Medical Center over the years 1995, 1999, 2002 and 2005 to common antimicrobial agents. MIC90 of Escherichia coli to some of these agents was determined and antibiotic consumption data over the years 2000-2005 (DDD/1000/day) were obtained.. We observed a rise in susceptibility rates of E. coli to amoxicillin-clavulanate, trimethoprim-sulfamethoxazole and nitrofurantoin and of other Gram-negative isolates to amoxicillin-clavulanate, ceftriaxone and cephalothin. Susceptibility rates of all Gram-negative uropathogens to ciprofloxacin decreased significantly. MIC90 of E. coli for all drugs tested remained stable. There was a significant decrease in the use of nitrofurantoin and TMP-SMX and a significant increase in the use of ampicillin, cephalothin and ceftriaxone.. Antibiotic resistance patterns mostly remained unchanged or improved slightly. There was, however, a constant decrease in susceptibility of all Gram-negative uropathogens to ciprofloxacin. Antibiotic use patterns could not explain the changes seen in antibiotic susceptibility patterns.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Infective Agents, Urinary; Ciprofloxacin; Community-Acquired Infections; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Gram-Negative Bacteria; Humans; Israel; Microbial Sensitivity Tests; Nitrofurantoin; Population Surveillance; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Escherichia coli Infections; Female; Humans; Secondary Prevention; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A multidrug-resistant Escherichia coli clonal group (designated CgA) has been isolated from women with cystitis and pyelonephritis in several communities. This study was designed to determine if CgA can cause community-acquired bloodstream infections.. All community-acquired bloodstream infections caused by E. coli identified at the San Francisco General Hospital between May 2001 and May 2003 were included. The diagnosis of septicemia was based on admission diagnosis. E. coli isolates were characterized by antibiotic susceptibility profile, enterobacterial repetitive intergenic consensus (ERIC2) PCR, serogrouping, and pulsed field gel electrophoresis (PFGE).. A total of 127 individuals with a community-acquired bloodstream infection were identified; 48 (39%) were trimethoprim-sulfamethoxazole (SXT)-resistant. CgA, as defined by ERIC2 PCR, was responsible for 19 (15%) of these infections. Infection with a CgA isolate was associated with an admission diagnosis of cystitis or pyelonephritis (p=0.01). By PFGE, none of the CgA isolates were indistinguishable to the prototype cystitis strain; however, nine bloodstream isolates differed by fewer than six bands.. CgA can cause community-acquired bloodstream infections, but does not appear to cause a disproportionate number of severe extraintestinal infections. This study provides evidence that UTI-causing clonal groups can cause a wide spectrum of disease and are an important clinical and public health concern.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Child; Child, Preschool; Community-Acquired Infections; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Escherichia coli; Escherichia coli Infections; Female; Humans; Infant; Infant, Newborn; Male; Microbial Sensitivity Tests; Middle Aged; Polymerase Chain Reaction; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The goal of this study was to assess how resistance to quinolones, fluoroquinolones and trimethoprim/sulfamethoxazole relates to the virulence potential and phylogenetic background of clinical Escherichia coli isolates.. Among 150 uropathogens (21% resistant to quinolones, 12% resistant to fluoroquinolones and 29.3% resistant to trimethoprim/sulfamethoxazole), E. coli phylogenetic group, 15 virulence-associated genes and 7 O antigens were analysed. Clonal group A (CGA) and genomic PCR profiles were studied among trimethoprim/sulfamethoxazole-resistant isolates.. Isolates susceptible to the three antimicrobial agents were significantly associated with phylogenetic group B2, whereas resistant isolates exhibited shifts to non-B2 groups (quinolone and fluoroquinolone-resistant isolates to group A; trimethoprim/sulfamethoxazole-resistant isolates to group D). Diverse virulence traits, including UTI-associated O antigens, were significantly less frequent among resistant isolates, particularly those resistant to fluoroquinolones (median score, 3.9 virulence factors/strain) and also to quinolones (5.2) or trimethoprim/sulfamethoxazole (6.4), as compared with the corresponding drug-susceptible isolates (median scores of 7.9, 8.6 and 7.9, respectively). Among 44 trimethoprim/sulfamethoxazole-resistant isolates, 3 (6.8%) belonged to CGA. All these 3 CGA strains caused pyelonephritis (P=0.02) and exhibited the consensus virulence profile of previously described CGA strains from abroad.. E. coli isolates resistant to quinolones, trimethoprim/sulfamethoxazole and especially fluoroquinolones were associated with reductions in virulence traits and shifts to non-B2 phylogenetic groups. Moreover, fluoroquinolone resistance usually occurred in low-virulence E. coli group A isolates rather than in isolates from groups B2 and D which had lost virulence traits. CGA accounted for 23% of trimethoprim/sulfamethoxazole-resistant E. coli producing pyelonephritis.

Topics: Adult; Anti-Bacterial Agents; Data Interpretation, Statistical; Escherichia coli; Escherichia coli Infections; Female; Fluoroquinolones; Genotype; Humans; O Antigens; Quinolones; Reverse Transcriptase Polymerase Chain Reaction; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Virulence Factors

To describe the distribution of trimethoprim-sulfamethoxazole resistance genes and the role of horizontal gene transfer and clonal expansion in recent increases of antibiotic resistance rates among uropathogenic Escherichia coli in Europe and Canada.. We identified antibiotic resistance alleles sul1, sul2, sul3 and dfr along with type 1 and type 2 integrons among 350 uropathogenic E. coli isolates from a cross-sectional study of acute, uncomplicated, community-acquired urinary tract infections in 16 western European countries and Canada (ECOSENS).. Trimethoprim resistance gene distributions showed no regional dependency (P = 0.84). The most common trimethoprim resistance gene was dfrA1, which occurred in 37.9% of dfr containing isolates. Similarly, the sulfamethoxazole resistance gene distributions did not vary significantly by region (P = 0.20). sul2, the most common sulfamethoxazole resistance gene, was found in 77.9% of sulfamethoxazole-resistant isolates. The distribution of type 1 and type 2 integrons varied slightly by region (P = 0.04) with type 1 integrons being the more common (85.9%). We observed 34 combinations of the sul genes, dfr genes and integron types; the most common combinations were broadly disseminated across every region examined.. Horizontal gene transfer plays a larger role than clonal expansion in the increase of trimethoprim-sulfamethoxazole resistance levels in Europe and Canada.

Topics: Anti-Bacterial Agents; Canada; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Europe; Gene Transfer, Horizontal; Humans; Integrons; Microbial Sensitivity Tests; Sulfamethoxazole; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Aged; Anti-Infective Agents, Urinary; Cardiomyopathies; Cardiomyopathy, Dilated; Diagnosis, Differential; Electrocardiography; Female; Humans; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Ciprofloxacin-resistant Escherichia coli isolates (n = 1,858) from outpatient midstream urine specimens at 40 North American clinical laboratories in 2004 to 2005 were frequently resistant to ampicillin (79.8% of isolates) and trimethoprim-sulfamethoxazole (66.5%); concurrent resistance to cefdinir (9.0%) or nitrofurantoin (4.0%) was less common. Only 10.8% of isolates were resistant to ciprofloxacin alone. Fluoroquinolone-resistant isolates of E. coli from urine were frequently multidrug resistant.

Topics: Adolescent; Adult; Ampicillin; Anti-Infective Agents, Urinary; Cefdinir; Cephalosporins; Ciprofloxacin; Drug Resistance, Bacterial; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Fluoroquinolones; Humans; In Vitro Techniques; Male; Microbial Sensitivity Tests; Middle Aged; Nitrofurantoin; North America; Outpatients; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Uncomplicated urinary tract infections (UTI) are treated with beta-lactams, co-trimoxazole, quinolones and fosfomycin tromethamine. Due to increasing resistance of causative pathogens, antibiotics should be used by considering their pharmacodynamic and pharmacokinetic characteristics. beta-lactams have time-dependent activity and should not be used once-daily. Co-trimoxazole should be restricted due to increasing chemoresistance. Fluoroquinolones play a primary role in the treatment of serious and complicated infections. Fosfomycin tromethamine is active against most urinary tract pathogens. In vitro time-kill kinetics of fosfomycin against Escherichia coli and Proteus mirabilis showed primarily concentration-dependent activity, with a prolonged post-antibiotic effect (3.4 to 4.7h). Based on these results a single 3g dose of fosfomycin guarantees optimal efficacy against common uropathogens with an AUC(urine)/MIC ratio of 500.

Topics: Anti-Infective Agents; beta-Lactams; Fluoroquinolones; Fosfomycin; Humans; Nitrofurantoin; Quinolones; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We studied 100 well-characterized E. coli blood isolates from patients with urosepsis for their susceptibility to nalidixic acid, ampicillin and trimethoprim-sulfamethoxazole, according to prevalence of virulence factors, phylogenetic groups and subgroups, PAI II(J96)-like domains (determined by physical linkage of cnf1, hly and hra) and PAI I(CFT073)-like domains (determined by physical linkage of papGII to the hly locus). Nalidixic acid resistance was associated with a lower prevalence of sfa/foc, K1 antigen, pathogenicity island II(J96)-like domains, subgroup B2/I and a shift towards group A.

Topics: Ampicillin; Anti-Infective Agents; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Genomic Islands; Humans; Microbial Sensitivity Tests; Nalidixic Acid; Phylogeny; Polymerase Chain Reaction; Sepsis; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Virulence Factors

Topics: Anti-Infective Agents, Urinary; Community-Acquired Infections; Drug Resistance, Multiple, Bacterial; Emergency Service, Hospital; Female; Humans; Risk Factors; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The changing pattern of antimicrobial resistance in the causative microorganisms of urinary tract infection (UTI) in childhood is a growing problem. The aims of this study were to assess the resistance patterns of urinary isolates to commonly used antimicrobials and to evaluate the options for empirical treatment of UTI. A prospective cross-sectional analysis of bacteria isolated from children with UTI was performed between January 2003 and January 2004. Resistance to antibiotics was analysed in three age groups: Group I, < or =12 months; Group II, 13-60 months; and Group III, >60 months. A total of 165 urinary pathogens were isolated from 131 patients. Mean patient age was 63.7+/-49.8 months. The most common causative agent was Escherichia coli (87% of cases) followed by Klebsiella pneumoniae (10%). Resistance to ampicillin (74.2%) and co-trimoxazole (61.3%) was significant in all isolates. Nitrofurantoin was the most active agent against E. coli (2.2% resistant isolates), followed by amikacin (4.9%), ceftriaxone (7.5%) and ciprofloxacin (12%). None of the isolates from Group I patients were resistant to ciprofloxacin and a low resistance rate (7.1%) was noted for amikacin. In Group II patients, none of the isolates were resistant to amikacin, and ceftriaxone was the second most suitable antibiotic (resistance rate 2.2%). In Group III patients, the lowest resistance rate was against nitrofurantoin (2.7%). In conclusion, we observed that the use of ampicillin and co-trimoxazole as a single agent for empirical treatment of a suspected UTI would not cover the majority of urinary pathogens in our region. Whilst amikacin, with a negligible resistance rate, was suitable in all age groups, gentamicin might still be useful as an empirical treatment of UTI in children aged >1 year. Nitrofurantoin could be included as a reasonable alternative in the empirical treatment of lower UTI in older children.

Topics: Adolescent; Age Factors; Amikacin; Ampicillin; Antibiotic Prophylaxis; Bacterial Infections; Ceftriaxone; Child; Child, Preschool; Ciprofloxacin; Drug Resistance, Bacterial; Escherichia coli; Female; Gentamicins; Humans; Infant; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Nitrofurantoin; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey; Urinary Tract Infections

In this investigation, the urine samples obtained in a single oral-dose pharmacokinetic study were examined for their bactericidal activity against a range of relevant urinary tract pathogens.. Six healthy volunteers received a single oral dose of ten oral antibiotics available in Croatia. Urine samples were taken every 2 h during the whole dosing interval of the particular antibiotic. The urinary bactericidal activity was tested by determination of urinary bactericidal titers.. All antibiotics showed a significant urinary bactericidal activity against non-extended spectrum beta-lactamase Escherichia coli and Proteus mirabilis. Fluoroquinolones displayed high and persisting levels of urinary bactericidal activity against all gram-negative bacteria and Staphylococcus saprophyticus.. Average urinary bactericidal activity can be predicted from in vitro susceptibility testing, but we expect that there will be patients with a low level of urinary bactericidal activity.

Topics: Acetamides; Administration, Oral; Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; beta-Lactamases; Biomarkers; Cefadroxil; Ceftibuten; Cefuroxime; Cephalexin; Cephalosporins; Ciprofloxacin; Disk Diffusion Antimicrobial Tests; Female; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Gram-Positive Bacteria; Gram-Positive Bacterial Infections; Humans; Linezolid; Middle Aged; Norfloxacin; Oxazolidinones; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Infection due to extended-spectrum beta-lactamase (ESBL)-producing microorganisms is an emerging problem in the community; a high proportion of these microorganisms have been isolated from urine samples of women with uncomplicated urinary tract infections (UTI). The options for oral treatment of uncomplicated UTI are limited because of the multiple drug resistance typical of ESBL-producing strains.. The in vitro activity of fosfomycin (FOS) was determined against 428 ESBL-producing strains, including 290 (68%) E. coli and 138 (32%) K. pneumoniae. Activity of fosfomycin was compared with that of amoxicillin-clavulanate (AMC), ciprofloxacin (CIP) and cotrimoxazole (SxT). MICs of AMC, CIP, and SxT, and detection of ESBL production were tested by the broth microdilution method, whereas FOS MICs were determined by the agar dilution method. ESBLs were characterized by isoelectric focusing, polymerase chain reaction (PCR) and direct sequencing of encoding genes. The genetic relationship among the isolates was determined by REP-PCR.. Among the 428 ESBL-producing isolates studied, 417 (97.4%) were susceptible to FOS (MIC < or = 64 microg/mL). The resistance rate of E. coli to FOS was 0.3%, and was lower than resistance to AMC (11.7%), whereas the resistance rate of K. pneumoniae was 7.2% and was equal to resistance to AMC. SxT and CIP were the least active antibiotic agents against ESBL-producing isolates (sensitivity < 50%). There were no differences in fosfomycin activity against strains expressing different types of ESBLs.. Fosfomycin showed maintained activity against ESBL-producing strains and did not present co-resistance with other antimicrobial groups.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; beta-Lactam Resistance; beta-Lactamases; Ciprofloxacin; Cross Infection; Escherichia coli; Escherichia coli Infections; Fosfomycin; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Multicenter Studies as Topic; Substrate Specificity; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We describe a case of a urinary tract infection with an unusual pathogen, Photobacterium damsela, in a pregnant female. This pathogen has been described as having a virulent life threatening nature, so a detailed history and prompt treatment is needed.

Topics: Adult; Anti-Bacterial Agents; Cefazolin; Female; Gentamicins; Gram-Negative Bacterial Infections; Humans; Photobacterium; Pregnancy; Pregnancy Complications, Infectious; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To evaluate the variance in rates of physician adherence to guidelines for the empiric treatment of uncomplicated urinary tract infection (UTI) in women recommending either trimethoprim-sulfamethoxazole (TMP-SMX) or nitrofurantoin, in all relevant physician subspecialities practising in a managed care community setting in Israel.. Data were derived from the computerised medical records of Maccabi Healthcare Services, a health maintenance organisation (HMO) in Israel providing care to more than 1.6 million members nation-wide. The study population included women aged 18-75 years without risk factors for complicated UTI who were treated empirically with antibiotics for a diagnosis of acute cystitis or UTI. The data set consisted of 64,236 initial physician-patient encounters from July 2000 to June 2002. Physician adherence to guidelines was calculated by comparing the proportion of cases treated with each individual drug. A binary regression model was used to evaluate factors associated with suboptimal adherence to the guidelines.. Nitrofurantoin was the most frequently prescribed drug (18.51%), followed by TMP-SMX (17.04%) for a crude rate of adherence of 35.6%. Adherence was observed to be highest in cases treated by urologists (OR=2.8, 95%CI: 2.4, 3.3), followed by gynaecologists (OR=1.9, 95%CI: 1.7, 2.31), with family practice as the referent speciality. The medical school attended was also found to be significant.. Physician speciality was found to be significantly associated with rate of adherence to guidelines, with higher rates being observed amongst specialities such as urologists who presumably have greater familiarity with the subject matter.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Urinary; Drug Utilization Review; Family Practice; Female; Guideline Adherence; Humans; Middle Aged; Nitrofurantoin; Physicians; Practice Guidelines as Topic; Practice Patterns, Physicians'; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

An understanding of the microbial origin of infectious diseases and the introduction of antimicrobial therapy stimulated more advances in the management of urinary tract infections (UTIs) in the 20th century than had occurred in the previous 5 centuries.. Numerous resources were used to collect the information described in this review. Medical texts from the 19th and 20th century contain information regarding the traditional contemporary treatment of UTI during those eras. Early volumes of the Journal of Urology from the beginning of the 20th century describe the first attempts at chemotherapy for UTI. MEDLINE searches were used to collect appropriate information after 1969. Modern medical journals and modern medical texts were used to collect information on antimicrobial therapy since the late 1960s through today.. Numerous advances in the diagnosis and management of UTI were made during the 20th century. Advances in microbiological and chemical assays have facilitated the development of historical uroscopy into modern day urinalysis and culture techniques, which are the cornerstone of UTI diagnosis. Imaging technologies, including x-ray, ultrasound, nuclear imaging, magnetic resonance and computerized tomography, have been particularly helpful in the diagnosis of complicated or recurrent UTIs. Major innovations in nonpharmacological therapy include noninvasive shock wave lithotripsy and percutaneous drainage of kidney abscesses. The most profound advance in UTI management during the 20th century was the discovery of antimicrobial agents. Nitrofurantoin was the first truly effective and safe antimicrobial therapy for UTI but its spectrum of activity is limited. Broad use of amoxicillin (and other beta-lactams) after its introduction in the 1970s led to the development of resistance to this antimicrobial, prompting a gradual change to trimethoprim/sulfamethoxazole (TMP/SMX) as first line therapy for UTI. However, wide use of TMP/SMX also resulted in the progressive emergence of resistance, limiting the clinical usefulness of this therapy in the modern management of UTI. Fluoroquinolones offer an attractive alternative to TMP/SMX, and American and European guidelines recommend their empirical use in areas where TMP/SMX resistance is 10% or higher.. The development of antimicrobial therapy was the defining moment of 20th century medicine and one of the key innovations in medical history. While the initial promise of antimicrobials has been validated in clinical practice, overuse of certain agents has led to the emergence of resistance, illustrating the importance of using evidence based strategies to select therapy.

Topics: Anti-Infective Agents, Urinary; beta-Lactams; Fluoroquinolones; Humans; Nitrofurantoin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinalysis; Urinary Tract Infections

The multistate occurrence of cases of urinary tract infection (UTI) caused by trimethoprim-sulfamethoxazole (TMP-SMZ)-resistant Escherichia coli strains belonging to a single clonal group (designated as clonal group A [CgA]) in the United States has raised an intriguing hypothesis that these infections may have been spread by contaminated food products. The present study attempted to determine if CgA strains could be traced to food animals.. A total of 495 animal and environmental E. coli isolates, which belonged to serogroups O11, O17, O73, and O77 and were collected between 1965 and 2002 by the Gastroenteric Disease Center at Pennsylvania State University (University Park, PA), were further subtyped by antimicrobial drug susceptibility, enterobacterial repetitive intergenic consensus (ERIC2) PCR, random amplified polymorphic DNA analysis, pulsed-field gel electrophoresis (PFGE), and virulence profile pattern.. Of 495 isolates, 128 (26%) had an ERIC2 PCR electrophoretic pattern indistinguishable from that of the human prototype CgA strain, and 14 CgA isolates were resistant to TMP-SMZ. Cluster analysis of PFGE patterns showed that 1 of these 14 isolates, obtained from a cow in 1988, was 94% similar to a CgA uropathogenic human-associated E. coli strain. The pattern for this isolate was included among a cluster of PFGE patterns for 5 human-associated UTI isolates that were >80% similar to each other.. These observations suggest that drug-resistant, uropathogenic human-associated E. coli strains potentially have an animal origin. The possibility that human drug-resistant UTI could be a foodborne illness has serious public health implications.

Topics: Animals; Anti-Bacterial Agents; Bacterial Typing Techniques; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Genotype; Humans; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Virulence Factors; Zoonoses

Topics: Acute Disease; Animals; Anti-Bacterial Agents; Bacterial Typing Techniques; Escherichia coli; Escherichia coli Infections; Female; Food Microbiology; Humans; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Zoonoses

Among 1,102 recent Escherichia coli clinical isolates, clonal group A was identified in 17 of 20 (U.S. and non-U.S.) geographic locales, mainly among U.S. isolates (9% vs. 3%; p < 0.001) and those resistant to trimethoprim-sulfamethoxazole (10% vs. 1.7%; p < 0.001). The extensive antimicrobial resistance and virulence profiles of clonal group A may underlie its recent widespread emergence.

Topics: Anti-Infective Agents; Child; Communicable Diseases, Emerging; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Male; Microbial Sensitivity Tests; Phylogeny; Prevalence; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections; Virulence

Antibiotic resistance is increasingly complicating the management of urinary tract infection. We investigated the extent to which a group of Escherichia coli called clonal group A (CGA), which is associated with resistance to trimethoprim-sulfamethoxazole (TMP-SMZ), accounted for TMP-SMZ resistance among a prospectively collected set of uropathogenic and rectal E. coli isolates from a university population in Michigan.. Resistant and susceptible uropathogenic E. coli isolates (45 each) and 79 randomly selected rectal E. coli isolates were evaluated for CGA status by use of 2 definitions of this group-- the enterobacterial repetitive intergenic consensus sequence 2 (ERIC2)-polymerase chain reaction (PCR) pattern A fingerprint and the C288T single nucleotide polymorphism (SNP) in the fumC gene. We compared virulence gene profiles and molecular mechanisms of resistance to TMP-SMZ between isolates classified as CGA by both approaches to better characterize the relationship between isolates.. Of the 45 isolates that exhibited ERIC2-PCR pattern A, one-half (23 of 45) were resistant to TMP-SMZ, and 16 contained the C288T SNP. The pattern A isolates were diverse, exhibiting multiple mechanisms of resistance to TMP-SMZ and various combinations of virulence factors. C288T SNP isolates showed less variation, with 15 of 16 resistant to TMP-SMZ and a 1.8-kb class I integron bearing the dfrA17 gene present in 14 of 15 resistant isolates. Twelve of 16 exhibited the same combination of virulence genes. Pulsed-field gel electrophoresis patterns for these 12 isolates were unique.. CGA, as defined by the fumC C288T SNP, appears to be distantly clonal but is not an outbreak-related group. The widespread group has likely evolved through lateral transfer of genes conferring virulence and antibiotic resistance.

Topics: Adolescent; Adult; DNA Fingerprinting; Drug Resistance, Multiple, Bacterial; Escherichia coli; Female; Humans; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Virulence

We describe a rare adverse reaction to trimethoprim-sulfamethoxazole (TMP-SMX; Septra, Bactrim) in an immune-competent female adolescent. She was prescribed TMP-SMX for a urinary tract infection, which she had developed while being treated in the hospital for an extensive leg cellulitis. Shortly after receiving her third dose of TMP-SMX, she developed an acute altered mental status with agitation as well as vivid visual and auditory hallucinations. After prompt discontinuation of TMP-SMX, the patient slowly began to improve and was able to return to her baseline mental status within 10 days. No residual mental status changes were present. Despite the recent emergence of multidrug-resistant bacterial pathogens, TMP-SMX, one of the first-generation broad-spectrum antibiotics, continues to be widely prescribed, in part because of its low cost and its easy availability. It is generally well tolerated and is associated with relatively few adverse effects. More common toxicities associated with TMP-SMX include hypersensitivity reactions, bone marrow suppression, and gastrointestinal side effects. Central nervous system toxicity is very rare; when reported, it has been in an immune-compromised or an elderly patient.

Topics: Acute Disease; Administration, Oral; Adult; Akathisia, Drug-Induced; Cellulitis; Female; Humans; Immunocompetence; Psychoses, Substance-Induced; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Over the last 10 years the treatment of choice for urinary tract infections (UTIs) in Turkey has changed from co-trimoxazole to quinolones owing to the rate of resistance to co-trimoxazole and its high level of therapeutic failure. The resistance ratio of 1939 UTI Escherichia coli from outpatients (1994-2003) was evaluated by Kirby-Bauer disc diffusion method for the aforementioned antibiotics to determine the change in resistance. The co-trimoxazole resistance ratio decreased during this period, with the highest ratio in 1996 (69.3%) and the lowest ratio in 2003 (38.5%) (P < 0.001). The lowest resistance ratios occurred in 1995 (4.1%) for ofloxacin and in 1996 (5.2%) for ciprofloxacin, and the highest resistance ratios occurred in 2002 (25.3% and 27.6%) for ofloxacin and ciprofloxacin, respectively (P < 0.001, P < 0.001). These findings emphasise that antibiotic usage policies, especially empirical therapies, should be based on antimicrobial resistance surveillance studies.

Topics: Anti-Bacterial Agents; Drug Resistance, Bacterial; Escherichia coli Infections; Fluoroquinolones; Humans; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey; Urinary Tract Infections

A 50-year-old woman was admitted to our emergency room because of progressive weakness. She collapsed the night before admission. Skin and mucosa were pale, she denied major infections or bleedings. An alcohol abuse was known for many years. Because of edema she received a therapy with triamteren, an infection of the urinary tract was treated with cotrimoxacol.. In addition to thrombocytopenia (50 Gpt/l) and leukocytopenia (1,51 10 (9)/l) we diagnosed a hyperchromic and macrocytic anemia (Hb 3,6 mmol/l [5,8 g/dl], Hk 0,17, MCH 2.52 fmol, 116,8 fl). Folic acid was decreased to 0.677 ng/ml, whereas levels of cobalamin, ferritin and iron were normal. Examination of bone marrow showed a hypercellular marrow with typical megaloblastic features of erythropoiesis and granulopoiesis. A systemic hematological disorder could be ruled out. The folic acid deficiency in our patient was the result of a long time alcohol abuse and a simultaneous therapy with mild folate antagonists (triamteren and cotrimoxacol).. The patient received folic acid (5 mg/d orally). Within one week the peripheral blood counts increased to normal, the follow up bone marrow examination showed a hyperplastic marrow with normal hematopoietic maturation.. Folic acid deficiency can be aggravated because of simultaneous therapy with mild folate antagonists. In addition to megaloblastic anemia this can lead to thrombocytopenia and/or leukocytopenia. Therefore in patients with pancytopenia a deficiency of folic acid should be ruled out.

Topics: Alcoholism; Anemia, Macrocytic; Anti-Infective Agents, Urinary; Diagnosis, Differential; Diuretics; Edema; Female; Folic Acid; Folic Acid Antagonists; Folic Acid Deficiency; Humans; Middle Aged; Pancytopenia; Triamterene; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Sexual intercourse has been established as one of the most important risk factors for both isolated and recurrent uncomplicated infections of the urinary tract. Prophylactic therapy requires only a small dose of an antimicrobial agent, which is generally given at bedtime for 6 to 12 months. An alternative method is to give an antimicrobial agent for six months post-intercourse. It is still unknown which of the two methods is most effective. A total of 123 women with suspected sexually induced recurrent cystitis (mean age 28 years, range 15 to 65) and a history of recurrent urinary tract infection (UTI) (the last one within the last six months) were subjected to prophylactic therapy for six months. Half of them were treated with low-dose trimethoprim-cotrimoxazole (TMP-SMX) and cefaclor given orally post-intercourse (spontaneous usage), while the other half were treated with low-dose TMP-SMX and cefaclor given at bedtime. The response to the prophylactic therapy was classified as continued cure in 106 cases (86.17%), failure in 13 cases (10.56%), and unknown in four cases (3.25%). TMP-SMX administered in continuous nightly prophylaxis showed similar efficacy and tolerability as cefaclor post-intercourse.. To determine the efficacy of prophylaxis in women with recurrent sex induced cystitis and compare the post-intercourse versus the conventional bedtime given long-term, low-dose use of prophylactic antimicrobials.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Urinary; Cefaclor; Cystitis; Female; Humans; Middle Aged; Secondary Prevention; Sexual Behavior; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Staphylococcus lugdunensis is being increasingly reported as a pathogen with an outcome resembling that of Staphylococcus aureus rather than coagulase-negative staphylococci. The authors describe a case of a child with left grade II vesicoureteral reflux and pyelonephritis caused by Staphylococcus lugdunensis. The child was successfully treated with cefotaxime.

Topics: Cefotaxime; Child; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Immunocompetence; Risk Assessment; Staphylococcal Infections; Staphylococcus; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Acute Disease; Anti-Infective Agents, Urinary; Cystitis; Drug Resistance; Escherichia coli; Humans; Klebsiella pneumoniae; Staphylococcus; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Current guidelines for the empiric treatment of uncomplicated urinary tract infection in women recommend that first-line trimethoprim-sulfamethoxazole (TMP-SMX) or ofloxacin be given for 3 days and nitrofurantoin for 5 days. Increasing the duration of treatment raises costs, and perhaps, the incidence of adverse effects, without contributing to effectiveness. The aim of this study was to investigate physician adherence to these recommendations.. The electronic patients record system of a nationwide health management organization in Israel was reviewed for all primary care visits by adult women treated empirically for cystitis or urinary tract infection from January 2001 to June 2002 (n = 7738 patient-physician encounters). The proportion of cases treated according to the guidelines, with regard to duration, was calculated for each drug used.. Rate of adherence was 3.36% for cases of TMP-SMX treatment (95%CI: 2.56%, 4.15%), 22.23% for nitrofurantoin (95%CI: 19.81%, 24.65%) and 4.08% for ofloxacin (95%CI: 2.88%, 5.28%). The crude rate of adherence for all cases of treatment with these drugs was 8.67% (95%CI: 7.82%, 9.52%).. The high rate of nonadherence observed (91.33%) indicate a need for a remedial education program for physicians to improve empiric treatment of urinary tract infection in women. Since this issue is of global importance, we believe our evaluation can serve as model for other settings and countries.

Topics: Adolescent; Adult; Aged; Drug Utilization; Female; Humans; Middle Aged; Nitrofurantoin; Ofloxacin; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The management of urinary tract infection in children faces the problem of the emergence of resistant strains to antibiotics. The aim of this study is to precise the frequency of the different germs and their susceptibility to antibiotics.. We report a retrospective study concerning 200 cases of urinary tract infection hospitalised in the paediatric department of Monastir between January 1995 and December 2000. There were 58 boys and 142 girls aged between two months and 14 years with a mean age of 5 years. The frequency of urinary tract infection is 1.85%.. The most common causative agent is Escherichia coli in 75.5% of cases, followed by Proteus mirabilis (10%) then by Klebsiella pneumoniae (6%). Escherichia coli is predominant in girls, whereas Proteus mirabilis and Klebsiella pneumoniae are likely encountred in boys. Of all the strains, 96% are resistant to ampicillin, amoxicillin and cefalotin, 67% to amoxicillin + clavulanic acid and 34% to cotrimoxazole. A resistance to ampicillin, amoxicillin and cefalotin is noted in 96% of the germs. The resistance is of 67% for amoxicillin + clavulanic-acid and of 34% for cotrimoxazole. However, third generation cephalosporins and aminoglycosides remain usually active on the majority of strains incriminated in these infections a part from Pseudomonas.

Topics: Adolescent; Age Factors; Aminoglycosides; Amoxicillin; Ampicillin; Ampicillin Resistance; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Bacteria; Cephalosporin Resistance; Cephalosporins; Cephalothin; Child; Child, Preschool; Clavulanic Acid; Drug Resistance, Bacterial; Enterobacteriaceae Infections; Escherichia coli; Female; Humans; Infant; Klebsiella pneumoniae; Male; Penicillin Resistance; Proteus mirabilis; Retrospective Studies; Sex Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Trimethoprim-sulfamethoxazole (TMP-SMX) and nitrofurantoin were until recently the two drugs recommended in clinical guidelines in Israel for empiric treatment of uncomplicated urinary tract infection (UTI) in women.. The objective of this study is to evaluate the economic impact of physician non-adherence to these recommendations. DESIGN SETTING AND PATIENTS: Data were derived from the electronic patient records of the Leumit Health Fund. Cases of women aged 18 to 75 with a diagnosis of acute cystitis or UTI that were empirically treated with antibiotics from January 2001 to June 2002 were identified. The final sample comprised 7738 physician-patient encounters. The proportion of cases treated with each individual drug was calculated, and the excess expenditure because of non-adherence to guidelines from the perspective of the Health Maintenance Organization (HMO) was evaluated using 5 days of therapy with nitrofurantoin as the reference treatment.. TMP-SMX was the most frequently prescribed drug (25.81%), followed by nitrofurantoin (14.71%) representing a 40.52% rate of adherence to the guidelines. Drugs from the fluoroquinolone family were prescribed in 22.82% of cases. Cost of treatment in approximately 70% of the cases exceeded the expected cost of the guideline therapy.. Suboptimal adherence to the guidelines resulted in a significant and avoidable waste of the health plan's resources in both drugs and money.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Urinary; Cost-Benefit Analysis; Costs and Cost Analysis; Female; Guideline Adherence; Health Care Costs; Health Maintenance Organizations; Humans; Medical Records Systems, Computerized; Middle Aged; Nitrofurantoin; Practice Guidelines as Topic; Practice Patterns, Physicians'; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The case of a mentally ill man inadvertently treated with trimethoprim-sulfamethoxazole (TMP-SMX) for 2 y is presented. Quantitative stool cultures revealed a substantially suppressed Gram-negative aerobic flora, while Enterococcus spp. and anaerobes were not affected. Yeasts were moderately increased. TMP-SMX represents an attractive antimicrobial for immunocompromized patients who need the integrity of their intestinal anaerobic flora for colonization resistance.

Topics: Adult; Dose-Response Relationship, Drug; Drug Administration Schedule; Follow-Up Studies; Humans; Intestinal Mucosa; Long-Term Care; Male; Mental Disorders; Risk Assessment; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Catheterization; Urinary Tract Infections

Topics: Biopsy; Drug Eruptions; Exanthema; Humans; Keratinocytes; Male; Middle Aged; Postoperative Complications; Prostatectomy; Skin; Skin Diseases, Vesiculobullous; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Costa Rica; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Humans; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In vitro surveillance data from across the United States indicate that approximately 10%-20% of urinary Escherichia coli isolates from female outpatients are resistant to trimethoprim-sulfamethoxazole (TMP-SMX). Alternative therapies for uncomplicated urinary tract infections in women include fluoroquinolones and nitrofurantoin, but the activities of these agents against TMP-SMX-resistant isolates are rarely reported. Among TMP-SMX-resistant urinary E. coli isolates tested in US laboratories from 1998 through 2001, 9.5% (5767 of 60,414) were resistant to ciprofloxacin and 1.9% (1214 of 63,817) were resistant to nitrofurantoin; 10.4% of ciprofloxacin-resistant isolates (683 of 6560) were resistant to nitrofurantoin. An association between resistance to fluoroquinolones and nitrofurantoin in E. coli has not been previously reported and warrants further study.

Topics: Anti-Bacterial Agents; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Fluoroquinolones; Humans; Microbial Sensitivity Tests; Nitrofurantoin; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Antimicrobial drug use is believed to be an important risk factor for the emerging problem of antimicrobial drug resistance, yet strong evidence for the causal relationship in community settings has been limited. Detailed analysis of this risk factor at the level of the individual patient has been hampered by limited availability of drug exposure data among patients with outpatient infections. We used a novel data system to identify patterns of individual antimicrobial drug exposures associated with trimethoprim-sulfamethoxazole-resistant urinary tract infections (UTIs).. This was a retrospective case-control study. Subjects were veterans with Gram-negative UTIs seen at the Philadelphia VA Medical Center from 1 July 1996 to 31 December 1999. Subjects were linked to a national VA outpatient pharmacy database. Cases and controls were identified based on the results of trimethoprim-sulfamethoxazole susceptibility testing.. Three hundred and ninety-three veterans with UTIs could be linked to electronic pharmacy records. The overall rate of trimethoprim-sulfamethoxazole drug resistance was 13%, without significant annual variation. Antimicrobial drug exposure within 6 months was strongly associated with the probability of a trimethoprim-sulfamethoxazole-resistant infection (OR = 4.1, 95% CI 2.2-7.5). This association extended to exposure to other antimicrobial drugs in addition to trimethoprim-sulfamethoxazole and the overall association displayed a dose-response relationship in terms of the number of prior drug exposures.. Prior antimicrobial drug exposure is a strong risk factor for infection with trimethoprim-sulfamethoxazole-resistant Gram-negative bacteria among patients with UTIs.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Urinary; Case-Control Studies; Female; Gram-Positive Bacteria; Humans; Microbial Sensitivity Tests; Middle Aged; Retrospective Studies; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To evaluate the prevalence of resistance of the various urinary tract infection (UTI) pathogens obtained from patients in an urban pediatric emergency department (PED), and to identify risk factors for infection with resistant strains.. The data were collected retrospectively in an urban, academic PED in northeastern Florida. The microbiology-computerized database was used to identify all positive urine cultures from October 1999 through June 2000. All patients aged 17 years or less, whose urine specimen was collected in the ED and grew cultures with greater than 10,000 colony forming units (CFU) per milliliter of a single organism on Maconkey or blood agar, were included. The medical records of the patients were reviewed and selective demographic and clinical data were collected. Patients were excluded if their charts were unavailable for review or if the pathogen that grew in culture was a suspected contaminant. All patients lacking clinical symptoms of UTI (frequency, dysuria, abdominal pain, fever, or urgency) and whose urine was collected by clean-catch were excluded if their culture grew between 10,000 and 100,000 CFU. Resistance to trimethoprim-sulfamethoxazole (T-S) was estimated for the subset of gram-negative pathogens. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated to compare rates of resistance among patients with and without the following risk factors: age greater than 4 years; current or recent antibiotic use; day care attendance; and previous UTI.. A total of 126 urine cultures were identified for inclusion. Of these, 45 patients were excluded, leaving 81 who met the study criteria. The majority of isolated organisms were Escherichia coli, accounting for 89% of the patients (n = 72). Other organisms identified were Klebsiella 3.7%, Proteus 1.2%, Citrobacter 1.2%, Staphylococcus 1.2%, and Enterococcus 3.7% (all in children < 4 years old). The resistance to T-S was 6.5% (95% CI = 0.9% to 12.1%) for gram-negative pathogens. Overall, 48% of gram-negative isolates were resistant to one or more antibiotics, any resistance (95% CI = 36.5% to 59.5%). T-S resistance was nominally higher for older children and for those with a history of antibiotic use, although not to a significant degree. Children less than age 4 were more likely to have any resistance (OR 2.6; 95% CI = 1.0 to 6.7).. The resistance to T-S in this study was 6.7% for gram-negative pathogens. These rates are lower than rates reported in adult populations, international pediatric studies, and the authors' hospital antibiograms, demonstrating the importance of local, population-specific data in selecting antibiotics. This study did not identify any statistically significant risk factors for resistance to T-S, but suggests that those with a recent history of antibiotic use may be at highest risk. While children less than 4 years old with gram-negative pathogens have nominally lower rates of T-S resistance, they are at higher risk for resistance to one or more antibiotics (any resistance) and are at risk for UTI caused by enterococcus (uniformly nonsusceptible to T-S). Prospective studies are needed to validate these results and to identify predisposing factors for urinary pathogens with antibiotic resistance.

Topics: Anti-Infective Agents, Urinary; Child; Child, Preschool; Drug Resistance, Bacterial; Emergency Service, Hospital; Female; Gram-Negative Bacteria; Humans; Male; Prevalence; Retrospective Studies; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Bacterial Agents; beta-Lactamases; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The antimicrobial resistance profiles, comprising 12 antibiotics, of 2478 isolates of Escherichia coli from the ECO.SENS Project involving women with acute uncomplicated urinary tract infection at 252 community health care centres in 17 countries were determined. Resistance to ampicillin alone (6.3%) and sulfamethoxazole alone (5.4%) were the most common 'single resistances'. Multiple resistance was most common in Spain and least common in Finland. The main associated-resistance profiles involved ampicillin/sulfamethoxazole (8.7%) and ampicillin/sulfamethoxazole/trimethoprim/trimethoprim-sulfamethoxazole (6.4%). The most common profile of multiple resistance was ampicillin/sulfamethoxazole/trimethoprim/trimethoprim-sulfamethoxazole/nalidixic acid/ciprofloxacin. Twenty-one isolates, half of which came from Spain, were resistant to seven antibiotics or more. Three isolates, one from Spain and two from Portugal, were resistant to nine of the 12 antibiotics investigated.

Topics: Ampicillin Resistance; Anti-Bacterial Agents; Canada; Drug Resistance, Microbial; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Europe; Female; Humans; Microbial Sensitivity Tests; Population Surveillance; Sulfamethoxazole; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Academic Medical Centers; Anti-Infective Agents; Drug Resistance, Microbial; Drug Utilization; Emergency Service, Hospital; Fluoroquinolones; Guideline Adherence; Practice Guidelines as Topic; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We wanted to investigate the antimicrobial susceptibility of urinary tract pathogens in uncomplicated lower urinary tract infections in adult women in Norway.. Urine samples from 312 adult women with symptoms of uncomplicated urinary tract infections from eight general practices were included.. Significant bacteriuria was found in 187 samples (60%). E coli was isolated from 153 (82%) of these samples. Other isolated uropathogens were S saprophyticus 18 (10%), Proteus spp 6 (3%), Klebsiella spp 4 (2%), Enterobacter spp 2 (1%), enterococci 1 (0.5%) and other Gram-positive bacteria 3 (1,5%). No fungi were isolated. Of the E coli isolates, 1 %, 1 % and 9 % were resistant to nitrofurantoin, mecillinam and trimetoprim respectively. All S saprophyticus isolates were sensitive to nitrofurantoin and trimetoprim.. Antibiotic resistance of urinary tract pathogens causing uncomplicated urinary tract infections in adult women in general practice is still low in Norway.

Topics: Adult; Aged; Amdinocillin; Ampicillin; Ampicillin Resistance; Anti-Infective Agents, Urinary; Bacteriuria; Ciprofloxacin; Drug Resistance, Bacterial; Female; Gram-Positive Bacterial Infections; Humans; Middle Aged; Nitrofurantoin; Penicillins; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The treatment of urinary tract infection (UTI), the most common bacterial infection in most Western countries, is a global clinical and economic issue. Trimethoprim-sulfamethoxazole (TMP-SMX) and nitrofurantoin are the two drugs currently recommended in clinical guidelines in Israel for uncomplicated UTI in women.. This study evaluates physician preferences for treatment and adherence to guidelines.. Data were derived from the electronic records of Leumit Health Fund, one of four health management organizations in Israel. Non-pregnant women aged 18-75 years with a diagnosis of acute cystitis or UTI without risk factors for complicated UTI who were empirically treated with antibiotics from January 2001 to June 2002 were identified. The final sample comprised 7738 physician-patient encounters. Physician prescription behavior was analyzed by evaluating the proportion of treatments with each individual drug. A binary regression model was implemented to identify factors associated with suboptimal adherence to the guidelines.. TMP-SMX was the most frequently prescribed drug (25.81%), followed by nitrofurantoin (14.71%), for a 40.52% rate of adherence to the guidelines [95% confidence interval (CI)=39.42, 41.61]. Drugs from the fluoroquinolone family were prescribed in 22.82% of cases. Prescription behavior was also influenced by non-clinical, non-pharmacological factors, such as physician specialty, geographic setting and patient age.. The majority of cases of UTI in the present study were not treated according to the current guidelines. Fluoroquinolones, though not recommended and relatively costly, were prescribed extensively. These results highlight the necessity for a remedial education program within the health care system designed to improve adherence to the guidelines for the treatment of UTI in women. As this issue is of global importance, this evaluation may serve as a model for similar studies in other settings or countries.

Topics: Adult; Aged; Anti-Infective Agents, Urinary; Drug Utilization; Female; Fluoroquinolones; Guideline Adherence; Humans; Israel; Managed Care Programs; Middle Aged; Nitrofurantoin; Practice Patterns, Physicians'; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

One of my patients presented with bacteriuria early in her pregnancy. Urine culture was positive for Escherichia coli. I would like to prescribe a trimethoprim-sulfamethoxazole combination because it worked well for her in the past. What is known about the safety of this medication during early pregnancy?. Evidence-based studies report an association between trimethoprim-sulfonamide combinations in early pregnancy and several major malformations, such as neural tube defects and cardiovascular defects. If clinically possible, physicians are advised to use alternative antimicrobial medications for treatment of urinary tract infections during early pregnancy.

Topics: Abnormalities, Drug-Induced; Adult; Anti-Infective Agents; Contraindications; Escherichia coli Infections; Female; Humans; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Trimester, First; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Antibiotic resistance is increasing in Escherichia coli, the most common cause of urinary tract infections, but its epidemiology has not been well described. We evaluated the epidemiology of trimethoprim-sulfamethoxazole-resistant E. coli in a large, public health care system in Denver, Colorado.. Outpatients with E. coli urinary tract infections during the first 6 months of 1998 were evaluated retrospectively. A prospective study was then performed to confirm the rate of trimethoprim-sulfamethoxazole resistance. We used several strain-typing methods (pulsed-field gel electrophoresis, ribotyping, serotyping) to evaluate the molecular epidemiology of the resistance.. The rate of trimethoprim-sulfamethoxazole resistance was similar in the retrospective (24% [161/681]) and prospective (23% [30/130]) phases of the study (P = 0.89). Almost all trimethoprim-sulfamethoxazole-resistant strains (98%) were resistant to at least one other antibiotic. Risk factors for infection with a resistant strain included age < or =3 years, Hispanic ethnicity, recent travel outside the United States, and a prior urinary tract infection. However, rates of resistance were >15% among nearly all of the subgroups. Most strains had high-level resistance (>1000 microg/mL) to trimethoprim-sulfamethoxazole. Of the 23 resistant isolates evaluated, 10 (43%) belonged to the clone A group. There was no correlation between conventional epidemiologic characteristics and the molecular mechanism of resistance or strain type.. Resistance to trimethoprim-sulfamethoxazole among E. coli isolates among patients in a Denver public health care system is common, with high rates of resistance even among patients without risk factors.

Topics: Adolescent; Adult; Anti-Infective Agents, Urinary; Child; Child, Preschool; Colorado; Community-Acquired Infections; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Male; Middle Aged; Molecular Epidemiology; Prospective Studies; Retrospective Studies; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Acute Disease; Anti-Infective Agents, Urinary; Drug Resistance, Bacterial; Female; Fluoroquinolones; Humans; Nitrofurantoin; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Acute Disease; Anti-Infective Agents, Urinary; Cephalexin; Drug Resistance, Bacterial; Female; Humans; Pregnancy; Pregnancy Tests; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The aim of this study was to investigate the molecular basis of an observed increasing resistance to trimethoprim and sulphonamides despite a simultaneous decline in co-trimoxazole consumption. The distribution of sulphonamide resistance genes sul1, sul2 and the recently discovered sul3 was studied in a collection of clinical isolates of Enterobacteriaceae.. PCR with primers specific for sul1, sul2 and sul3 was used to detect the three known sulphonamide resistance genes in the isolate collection. Sequence analysis was used for confirmation of results. Restriction endonuclease digestion and conjugational transfer assays were used for plasmid analysis.. In 64 sulphonamide-resistant isolates, 39 sul1 genes and 48 sul2 genes were detected. Twenty-five isolates carried both sul1 and sul2 and two were negative for both genes. With PCR and sequence analysis these two were shown to harbour the new sulphonamide resistance gene sul3, which was carried by different plasmids.. Sulphonamide resistance gene sul3, which is widespread among pigs in Switzerland, has now also been identified in two different clinical isolates of Escherichia coli, located in urinary tract infections in patients in Sweden.

Topics: Anti-Infective Agents; Conjugation, Genetic; Dihydropteroate Synthase; DNA, Bacterial; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Humans; Plasmids; Reverse Transcriptase Polymerase Chain Reaction; Sulfonamides; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adult; Anti-Infective Agents, Urinary; Child; Cystitis; Female; Humans; Male; Pregnancy; Pregnancy Complications, Infectious; Quinolones; Recurrence; Risk Factors; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urination Disorders

A study was conducted to examine the prevalence of antibiotic resistance in the strains of bacteria isolated from patients with suspected urinary tract infection. A total of 348 bacterial isolates were grown from semi quantitative urine culture and were of significant bacteriuria. The antibiotic susceptibility testing was performed on Muller-Hinton agar by disc diffusion method according to the standard criteria of the National Committee for Clinical Laboratory Standards, Antibiotic susceptibility testing revealed a high prevalence of resistance to ampicillin (55.4%) followed by nitrofurantoin (45.4%), gentamicin (45.1%), amikacin (41.4%) and co-trimoxazole (30.5%). E. coli and Klebsiella pneumonia showed 78.8 % and 75.3 % resistance to three or more drugs respectively. Cefotaxime (87.1%) appeared to be the most active antibiotic against the majority of isolates, followed by Norfloxacin (83.3%).

Topics: Adolescent; Adult; Amikacin; Ampicillin; Anti-Bacterial Agents; Child; Child, Preschool; Drug Resistance, Multiple; Escherichia coli; Female; Gentamicins; Humans; India; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Middle Aged; Nitrofurantoin; Prevalence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The Infectious Diseases Society of America advocates trimethoprim-sulfamethoxazole (SXT) as initial therapy for females with acute uncomplicated bacterial cystitis in settings where the prevalence of SXT resistance does not exceed 10 to 20%. To determine trends in the activities of SXT, ampicillin, ciprofloxacin, and nitrofurantoin among urine isolates of Escherichia coli from female outpatients, susceptibility testing data from The Surveillance Network (TSN) Database-USA (n = 286,187) from 1995 to 2001 were analyzed. Resistance rates among E. coli isolates to ampicillin (range, 36.0 to 37.4% per year), SXT (range, 14.8 to 17.0%), ciprofloxacin (range, 0.7 to 2.5%), and nitrofurantoin (range, 0.4 to 0.8%) varied only slightly over this 7-year period. Ciprofloxacin was the only agent studied that demonstrated a consistent stepwise increase in resistance from 1995 (0.7%) to 2001 (2.5%). In 2001, SXT resistance among E. coli isolates was >10% in all nine U.S. Bureau of the Census regions. At institutions testing > or =100 urinary isolates of E. coli (n = 126) in 2001, ampicillin (range, 27.3 to 98.8%) and SXT (range, 7.5 to 47.1%) resistance rates varied widely while ciprofloxacin (range, 0 to 12.9%) and nitrofurantoin (range, 0 to 2.8%) resistance rates were more consistent. In 2001, the most frequent coresistant phenotypes were resistance to ampicillin and SXT (12.0% of all isolates; 82.3% of coresistant isolates) and resistance to ampicillin, ciprofloxacin, and SXT (1.4% of all isolates; 9.9% of coresistant isolates). Coresistance less frequently included resistance to nitrofurantoin (3.5% of coresistant isolates) than resistance to ciprofloxacin (15.8%), SXT (95.7%), and ampicillin (98.1%). In conclusion, among urinary isolates of E. coli from female outpatients in the United States, national resistance rates to SXT were relatively consistent (14.8 to 17.0%) from 1995 to 2001 but demonstrated considerable regional and institutional variation in 2001. Therapies other than SXT may need to be considered in some locations.

Topics: Ampicillin; Anti-Infective Agents; Anti-Infective Agents, Urinary; Ciprofloxacin; Databases, Factual; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Female; Geography; Humans; Microbial Sensitivity Tests; Nitrofurantoin; Outpatients; Penicillins; Phenotype; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

Topics: Anti-Bacterial Agents; Contraindications; Drug Costs; Drug Resistance, Bacterial; Drug Utilization; Fluoroquinolones; Forecasting; Guideline Adherence; Humans; Nitrofurantoin; Practice Guidelines as Topic; Practice Patterns, Physicians'; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

One of the more perplexing aspects of urinary tract infections (UTIs) is their high propensity to recur. It has been proposed that recurrent infections are a result of the reintroduction of bacteria from the gastrointestinal tract (GIT) to the urinary tract (UT); however, since a significant subset of recurrent UTIs are caused by an identical bacterial strain, it has been challenging to formally prove this hypothesis for same-strain recurrences by using epidemiologic approaches. We present data here obtained by using a mouse model of UTIs in which it was shown that 36% (5 of 14) of mice infected with uropathogenic Escherichia coli (UPEC) will have at least one bacteriuric recurrence, with 21% (3 of 14) having more than one recurrence during a 6-week period after an acute UTI. Intraurethrally infected mice develop UPEC reservoirs in both their feces and their bladders. Ten days of trimethoprim-sulfamethoxazole (SXT) therapy reduces urinary recurrences and eradicates fecal colonization, whereas 3 days of SXT treatment has no effect over a twenty-eight-day observation period despite clearing fecal colonization acutely. Interestingly, SXT is unable to eradicate bacteria from the bladder reservoir even after a 10-day treatment regimen, thus demonstrating that the bladder reservoir can persist even in the face of long-term antibiotic therapy.

Topics: Animals; Anti-Infective Agents, Urinary; Bacteriuria; Disease Models, Animal; Escherichia coli; Escherichia coli Infections; Feces; Female; Mice; Mice, Inbred C57BL; Recurrence; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder; Urinary Tract Infections

The authors report a fatal case of acute bacterial myocarditis in a nonneutropenic child with acute lymphoblastic leukemia. She was admitted to the hospital with a urinary tract infection resulting from and remained persistently febrile despite resolution of the infection. On hospital day 4 signs of acute cardiac failure developed. Despite aggressive resuscitation measures, she died. Pathologic examination revealed the cause of death to be bacterial myocarditis. In addition, she was found to have a generalized decrease in her serum immunoglobulin levels. Acute bacterial myocarditis in patients with malignancy has been rarely reported. The rapid clinical deterioration and death in the patient in this report is particularly interesting.

Topics: Acute Disease; Agammaglobulinemia; Antineoplastic Combined Chemotherapy Protocols; Cefotaxime; Child; Drug Therapy, Combination; Fatal Outcome; Female; Humans; Immunocompromised Host; Klebsiella Infections; Klebsiella pneumoniae; Myocarditis; Oxacillin; Pericarditis; Pleurisy; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Remission Induction; Shoulder Pain; Tobramycin; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Ciprofloxacin; Drug Resistance, Multiple; Emigration and Immigration; Escherichia coli; Escherichia coli Infections; Humans; New York City; Trimethoprim, Sulfamethoxazole Drug Combination; Urban Population; Urinary Tract Infections

Urinary tract infections (UTI) are diseases which differ considerably regarding pathogenesis, natural history and management. Complicated UTI as well as uncomplicated acute pyelonephritis in women are managed with pretherapy urine and, possibly, blood culture. This is not the case, however, with the most frequent UTI, acute uncomplicated cystitis in women. Empirical management strategies, without pretherapy culture, are well established and widely used. The treatment of choice is trimethoprim-sulfamethoxazole (TMP-SMZ) and fluoroquinolones. E. coli cause the vast majority of these infections, and resistance to TMP-SMZ has been observed to increase considerably during the last decade. Data from Europe and Switzerland regarding resistance of etiologic agents causing acute uncomplicated cystitis are very limited. Indeed, these empirical management strategies have resulted in poor microbiological information, since only selected groups of women with UTI undergo urine culture. Data derived from laboratory isolates usually lack the necessary clinical and epidemiological correlations. Preliminary data allow some estimates of the clinical and microbiological success rates when treating TMP-SMZ resistant uropathogens with TMP-SMZ. TMP-SMZ should probably no longer be used if the prevalence of TMP-SMZ resistance among uropathogens causing acute uncomplicated cystitis is 20% or higher. In these cases, a fluoroquinolone during three days, amoxicillin-clavulanate during three to five days or nitrofurantoin during seven days should be given empirically. Non-antibiotic means of preventing UTI, such as increasing colonization resistance with lactobacilli, or the use of vaccines which provide inhibition of adherence of uropathogens to uroepithelial cells, show very promising experimental results. In order to survey and correct the value of our empirical strategies, more appropriate data on antimicrobial resistance and risk factors in the community are needed. This data can only be produced by a strong collaboration effort with networks of general practitioners.

Topics: Anti-Infective Agents, Urinary; Bacteria; Bacterial Infections; Drug Resistance; Humans; Microbial Sensitivity Tests; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Drug Resistance, Multiple; Escherichia coli; Escherichia coli Infections; Female; Hispanic or Latino; Humans; Prevalence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

This study evaluated whether trimethoprim-sulfamethoxazole (TMP-SMX) is effective for treatment of uncomplicated urinary tract infections (UTIs) due to TMP-SMX-resistant (TMP-SMX-R) pathogens. Healthy nonpregnant premenopausal women with symptomatic lower UTI were assessed for the presence of pyuria and bacteriuria; if either was present, a urine sample was cultured and TMP-SMX was prescribed. Clinical and microbiologic cure was assessed at days 5-9 and 28-42 after cessation of therapy. For 71%, of patients, cultures grew TMP-SMX-susceptible (TMP-SMX-S) microorganisms, and for 29%, cultures grew TMP-SMX-R organisms. Escherichia coli remained the predominant bacteria in both groups of cultures. At visit 2, microbiological cure had been achieved in 86% of the patients in the TMP-SMX-S group and 42% of those in the TMP-SMX-R group. Similar differences were found at visit 3 by clinical evaluation. Treatment with TMP-SMX of uncomplicated UTI caused by TMP-SMX-R microorganisms results in microbiologic and clinical failure. In high-resistance areas, TMP-SMX should not be the empiric drug of choice for uncomplicated UTI.

Topics: Adult; Anti-Infective Agents, Urinary; Cystitis; Drug Resistance, Bacterial; Female; Gene Frequency; Humans; Middle Aged; Premenopause; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Women

Topics: Anti-Infective Agents, Urinary; Drug Resistance, Microbial; Escherichia coli; Humans; Japan; Microbial Sensitivity Tests; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Evaluating the adherence factor of uropathogenic Escherichia coli is important for assessing the relative efficiency of antimicrobials when used at sub-minimal inhibitory concentration (sub-MICs). The microdilution method was used to determine the MICs of gentamicin, trimethoprim-sulfamethaxozole and penicillin. Then the efficacy of antimicrobial sub-MICs was determined by hemagglutination and adherence assays. Instead of showing nearly the same MICs, gentamicin had nearly twice the activity of trimethoprim-sulfamethaxozole. Gentamicin, as a "long acting" agent, can be accepted as being more effective than trimethoprim-sulfamethaxozole or penicillin, especially at sub-MICs, against adherence factors of uropathogenic E. coli, and can be used as monotherapy for urinary tract infections.

Topics: Anti-Bacterial Agents; Bacterial Adhesion; Escherichia coli; Gentamicins; Hemagglutination; Humans; Microbial Sensitivity Tests; Penicillins; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Aged; Aged, 80 and over; Anti-Infective Agents, Urinary; Biopsy, Needle; Drug Therapy, Combination; Follow-Up Studies; Humans; Male; Risk Assessment; Severity of Illness Index; Stevens-Johnson Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Escherichia coli is typically the causative organism in uncomplicated urinary tract infection (UTI). Resistance rates of E. coli to trimethoprim/sulfamethoxazole (TMP/SMX) are increasing, exceeding 10% in many communities. Guidelines recommend using alternative treatments in these areas. Providers must reevaluate policies to include considerations for E. coli resistance. A model was developed, with cases for illustration, to help organizations determine the resistance rate threshold, where TMP/SMX is no longer first-line therapy. Using published data, a 19% to 21% threshold was derived, supporting a previous report of 22%. The model can aid decision makers updating internal policies to conform with guidelines for the treatment of uncomplicated UTI and to improve care.

Topics: Anti-Bacterial Agents; Cost of Illness; Drug Utilization; Escherichia coli; Escherichia coli Infections; Humans; Practice Patterns, Physicians'; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

Uro-Vaxom was used in the treatment of recurrent urinary tract infections in 35 girls. Most of them (34/35) tolerated the drug very well, no side effect were observed. We stopped administration of the Uro-Vaxom in one girl, during the first month of treatment because of vomiting. This way efficiency of Uro-Vaxom was evaluated in the treatment of recurrent urinary tract infections in 34 girls. Uro-Vaxom was found to be a valuable drug, supporting antibiotic therapy in recurrent urinary tract infections caused by E. coli.

Topics: Adjuvants, Immunologic; Adolescent; Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Child; Child, Preschool; Drug Therapy, Combination; Escherichia coli; Escherichia coli Infections; Female; Furagin; Gentamicins; Humans; Recurrence; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Humans; Microbial Sensitivity Tests; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Humans; Microbial Sensitivity Tests; Risk Factors; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Decision Making; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Fluoroquinolones; Humans; Microbial Sensitivity Tests; Nitrofurantoin; Risk Factors; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Humans; Practice Guidelines as Topic; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Drug Resistance, Multiple, Bacterial; Economics, Pharmaceutical; Escherichia coli; Escherichia coli Infections; Humans; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

Infectious Diseases Society of America guidelines state that uncomplicated urinary tract infections (UTIs) should be treated empirically with trimethoprim-sulfamethoxazole (TMP-SMZ), unless the community resistance among uropathogens exceeds 10%-20%, in which case a fluoroquinolone (FQ) should be used. However, the data to support this threshold are limited. We performed a cost-minimization and sensitivity analysis to determine what level of TMP-SMZ resistance in a community should trigger FQ use. The mean cost of empirical treatment with TMP-SMZ was US$92 when the proportion of resistant Escherichia coli was 0%, $106 when it was 20%, and $120 when it was 40%. The mean cost of empirical FQ treatment was $107 at current levels of FQ resistance. When >22% of E. coli in a community are TMP-SMZ-resistant, empirical FQ therapy becomes less costly than TMP-SMZ therapy. Treatment guidelines for empirical treatment of UTIs may need modification, and the threshold trigger for empirical FQ use should be raised to >20% TMP-SMZ resistance.

Topics: Anti-Infective Agents; Anti-Infective Agents, Urinary; Computer Simulation; Cost Savings; Cost-Benefit Analysis; Costs and Cost Analysis; Decision Support Techniques; Decision Trees; Escherichia coli; Escherichia coli Infections; Fluoroquinolones; Humans; Microbial Sensitivity Tests; Practice Guidelines as Topic; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adolescent; Adult; Antibiotic Prophylaxis; Child; Female; Humans; Iran; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Prevalence; Reproducibility of Results; Retrospective Studies; Stents; Trimethoprim, Sulfamethoxazole Drug Combination; Ureter; Urinary Tract Infections

In the United States, trimethoprim-sulphamethoxazole (TMP-SMX) is the recommended first-line treatment for uncomplicated urinary tract infections (UTIs) in females, in regions with resistance rates of <10-20%. Unfortunately, current data on regional resistance is often not readily available to physicians and regional variability in resistance remains largely unknown. This report presents antimicrobial susceptibility data for TMP-SMX and three other commonly tested antimicrobials organized by state and region to demonstrate current regional variability in resistance in the US. In the last quarter of 1999, 5739 fresh clinical isolates of Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis and Staphylococcus saprophyticus were collected from 202 laboratories throughout the US. Susceptibility testing was performed against TMP-SMX, cephalothin, nitrofurantoin and ciprofloxacin using broth microdilution. Data were analyzed by patient age and specimen source, and by state and region. In the US as a whole, resistance to TMP-SMX was 16.8% for E. coli, 7.8% for K. pneumoniae, 12.1% for P. mirabilis and 3.0% for S. saprophyticus, but these rates showed considerable regional variation. By state, E. coli resistance ranged from 7.4% in Pennsylvania to 33.3% in Iowa (among states with > or =50 isolates tested). Regionally, resistance for all uropathogens taken together ranged from 8.5% in East South-Central to 22.8% in West South-Central. Ciprofloxacin demonstrated the broadest activity of the antimicrobials tested and was more active than TMP-SMX against all pathogens. Resistance to TMP-SMX among E. coli now approaches or exceeds 20% in some areas. As resistance among uropathogens reaches clinically significant levels in many areas, continued regional surveillance is essential to ensure the provision of effective empiric therapy for urinary tract infections.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Drug Resistance, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Humans; Microbial Sensitivity Tests; Middle Aged; Prevalence; Staphylococcal Infections; Staphylococcus; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

The management of urinary tract infections is complicated by the increasing prevalence of antibiotic-resistant strains of Escherichia coli. We studied the clonal composition of E. coli isolates that were resistant to trimethoprim-sulfamethoxazole from women with community-acquired urinary tract infections.. Prospectively collected E. coli isolates from women with urinary tract infections in a university community in California were evaluated for antibiotic susceptibility, O:H serotype, DNA fingerprinting, pulsed-field gel electrophoretic pattern, and virulence factors. The prevalence and characteristics of an antibiotic-resistant clone were evaluated in this group of isolates and in those from comparison cohorts in Michigan and Minnesota.. Fifty-five of the 255 E. coli isolates (22 percent) from the California cohort were resistant to trimethoprim-sulfamethoxazole as well as other antibiotics. There was a common pattern of DNA fingerprinting, suggesting that the isolates belonged to the same clonal group (clonal group A), in 28 of 55 isolates with trimethoprim-sulfamethoxazole resistance (51 percent) and in 2 of 50 randomly selected isolates that were susceptible to trimethoprim-sulfamethoxazole (4 percent, P<0.001). In addition, 11 of 29 resistant isolates (38 percent) from the Michigan cohort and 7 of 18 (39 percent) from the Minnesota cohort belonged to clonal group A. Most of the clonal group A isolates were serotype O11:H(nt) or O77:H(nt), with similar patterns of virulence factors, antibiotic susceptibility, and electrophoretic features.. In three geographically diverse communities, a single clonal group accounted for nearly half of community-acquired urinary tract infections in women that were caused by E. coli strains with resistance to trimethoprim-sulfamethoxazole. The widespread distribution and high prevalence of E. coli clonal group A has major public health implications.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Urinary; California; Cohort Studies; Community-Acquired Infections; DNA Fingerprinting; Drug Resistance, Multiple; Escherichia coli; Escherichia coli Infections; Female; Humans; Michigan; Middle Aged; Minnesota; Prevalence; Serotyping; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Virulence

Topics: Anti-Infective Agents, Urinary; Community-Acquired Infections; Disease Outbreaks; Escherichia coli; Escherichia coli Infections; Humans; Prevalence; Serotyping; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections; Virulence

Topics: Aged; Biofilms; Combined Modality Therapy; Enterococcus faecalis; Escherichia coli Infections; Gram-Positive Bacterial Infections; Humans; Kidney Calculi; Male; Microbial Sensitivity Tests; Nephrostomy, Percutaneous; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

This prospective study, performed in Fann University Teaching Hospital from January 1st to December 31st 1998, concern 1446 samples of urine. Enterobacteria (87.56%) were the most frequent aetiology, and Escherichia coli (48.7%) was the leading species in this family. The strains of E. coli present more resistant profil to beta-lactams (70.27%). Fluoroquinolons are active on more than 80% of the strains responsible of urinary tract infection in Dakar.

Topics: Anti-Infective Agents, Urinary; beta-Lactam Resistance; DNA, Bacterial; Drug Resistance, Bacterial; Enterobacteriaceae Infections; Female; Fluoroquinolones; Hospitals, University; Humans; Klebsiella Infections; Male; Microbial Sensitivity Tests; Nitroquinolines; Phenotype; Population Surveillance; Prevalence; Prospective Studies; Senegal; Sex Distribution; Trimethoprim, Sulfamethoxazole Drug Combination; Urban Health; Urinary Tract Infections

Melioidosis is a tropical disease caused by Burkholderia pseudomallei, which is common in southeast Asia and Australia, but which is rarely diagnosed in Scandinavia. An increasing number of cases are being reported among tourists to infected areas. We report the first Finnish case of melioidosis, which presented as urinary tract infection in a previously healthy male tourist.

Topics: Anti-Infective Agents, Urinary; Antibody Specificity; Burkholderia pseudomallei; Ceftazidime; Cephalosporins; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Humans; Immunoglobulin G; Male; Melioidosis; Microbial Sensitivity Tests; Middle Aged; Scandinavian and Nordic Countries; Travel; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Ampicillin, trimethoprim-sulfamethoxazole, mecillinam, nitrofurantoin, and ciprofloxacin mean resistance rates for 2,000 urinary tract isolates collected from outpatients across Canada in 1998 were 41.1, 19.2, 14.7, 5.0, and 1.8%, respectively. For Escherichia coli isolates alone (n = 1,681) comparable rates were 41. 0, 18.9, 7.4, 0.1, and 1.2%, respectively. The majority of E. coli isolates resistant to ampicillin, trimethoprim-sulfamethoxazole, or ciprofloxacin were susceptible (MIC, <16 microg/ml) to mecillinam.

Topics: Amdinocillin; Ampicillin; Anti-Infective Agents; Anti-Infective Agents, Urinary; Canada; Ciprofloxacin; Drug Resistance, Microbial; Escherichia coli; Microbial Sensitivity Tests; Nitrofurantoin; Penicillins; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adolescent; Female; Humans; Stevens-Johnson Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In continuous surveillance of routine samples from five Dutch laboratories, we studied resistance to the antibiotics most commonly prescribed for urinary tract infections (UTI) in The Netherlands, namely norfloxacin, amoxycillin, trimethoprim and nitrofurantoin, from 1989 to 1998 in >90000 Escherichia coli isolates. Resistance to norfloxacin increased from 1.3% in 1989 to 5.8% in 1998. Multiresistance, defined as resistance to norfloxacin and at least two of the other three antibiotics, increased from 0.5% in 1989 to 4. 0% in 1998. Multivariate analysis of the norfloxacin resistance demonstrated that this yearly increase (the odds ratio was 1.0 in 1989, 1.6 in 1992, 2.9 in 1995 and 6.1 in 1998) was independent of other determinants of resistance to norfloxacin, such as age, gender and origin of the isolate. Analysis of strata, classified by year, age and gender, demonstrated an association between prescription of fluoroquinolones (defined daily doses per case of UTI) and resistance to norfloxacin in E. coli (P < 0.001). There was no significant association with the prescription of nitrofuran derivatives (nitrofurantoin) and trimethoprim with or without sulphamethoxazole. The yearly increase of resistance to fluoroquinolones in E. coli from UTI may stem from increased prescription of fluoroquinolones for UTI. Resistance of E. coli to these agents is likely to increase further as fluoroquinolone use increases in future.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents; Anti-Infective Agents, Urinary; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Multivariate Analysis; Netherlands; Nitrofurantoin; Norfloxacin; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We evaluated by means of a bioassay the efficacy of 4 different antibiotics administered in a prophylactic dose to children with vesicoureteral reflux.. A total of 159 urine samples from 53 children taking prophylactic antibiotics with proved vesicoureteral reflux were tested. The children were divided into 4 groups according to the antibiotic given, which included nalidixic acid, cephalexin, cotrimoxazole and cefixime. Urine samples were collected in the morning, at noon and in the evening, and each sample was bioassayed for growth inhibition of a standard Escherichia coli. The urine volume used was specifically determined for each antibiotic, and growth inhibition by this specific volume was equivalent to that produced by standard diffusion disks. In addition, the specific gravity, which reflected urinary concentration of each sample, was measured.. Mean patient age plus or minus standard deviation of the 4 groups was 53 +/- 41 for nalidixic acid, 23 +/- 34 for cephalexin, 55 +/- 35 for cotrimoxazole and 47 +/- 35 months for cefixime, respectively. In children less than 2 years old specific gravity was higher in the morning (1.021 +/- 0.0006 versus 1.0008 +/- 0.0004 at 8 a.m. and 2 p. m., respectively, p <0.05). In contrast, in children older than 4 years the specific gravity was higher in the afternoon and evening hours (1.019 +/- 0.003 versus 1.007 +/- 0.003 at 2 p.m. and 8 a.m., respectively, p <0.05). The percentage of patients who demonstrated growth inhibition in all 3 samples of the test day was 7%, 6%, 69% and 44% for nalidixic acid, cephalexin, cotrimoxazole and cefixime, respectively (p <0.001 for cotrimoxazole and cefixime versus nalidixic acid and cephalexin. Divided into morning, noon and evening, the percentage of samples that demonstrated growth inhibition was 85.7%, 21.4% and 7.1% for nalidixic acid, 37.5%, 12. 5% and 6.3% for cephalexin, 100%, 92.3% and 76.9% for cotrimoxazole and 100%, 77.7% and 55.5% for cefixime, respectively. A direct correlation was found between specific gravity and growth inhibition (r = 0.55, p <0.001).. Urine concentration during the day is dependent on age with older children having more concentrated urine in the latter part of the day. Growth inhibition is enhanced by concentrated urine. Compared to nalidixic acid and cephalexin, cotrimoxazole and cefixime produce a sustained bactericidal effect for about 60% of a 24-hour day due to the longer half-life.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Biological Assay; Cefixime; Cephalexin; Child; Child, Preschool; Evaluation Studies as Topic; Female; Humans; Infant; Male; Nalidixic Acid; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Aged; Anti-Infective Agents, Urinary; Anticoagulants; Brain Ischemia; Drug Interactions; Drug Synergism; Hospitalization; Humans; Male; Nursing Assessment; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Warfarin

Topics: Anti-Infective Agents, Urinary; Drug Resistance, Microbial; Escherichia coli; Female; Humans; Pregnancy; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Child, Preschool; Escherichia coli Infections; Humans; Male; Nail Diseases; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

There are increasing concerns regarding antimicrobial resistance in Canada. Data are limited on the prevalence, patterns of resistance and risk factors associated with resistant organisms, including coliforms, in children. This study was done to address these issues as they relate to urinary tract isolates of Escherichia coli in a tertiary care pediatric centre in Ottawa.. A surveillance study was conducted from December 1992 to December 1994. Susceptibility testing of urinary tract isolates of E. coli was performed using a panel of antimicrobial agents. A case-control study was also conducted for subjects with isolates resistant to trimethoprim-sulfamethoxazole (T-S), this drug being used a representative "first-line" agent.. A total of 1636 consecutive isolates were obtained from 967 subjects. Of the 1636 isolates, 736 (45.0%) were resistant to ampicillin, 514 (31.4%) were resistant to T-S, 363 (22.2%) were resistant to both ampicillin and T-S, and 27 (1.7%) were resistant to both ampicillin and gentamicin. In the case-control study 274 children with isolates resistant to T-S were matched with 274 children who had T-S-sensitive isolates obtained during the study period or the preceding or subsequent 6 months. Multivariate analyses indicated that subjects who had received antimicrobials for more than 4 weeks in the previous 6 months were about 23 times more likely to have isolates resistant to T-S than were subjects without this risk factor (odds ratio [OR] 23.4, 95% confidence interval [CI] 12.0-47.6). Children with genitourinary tract abnormalities were 2.4 times more likely to have resistant isolates than those without such abnormalities (95% CI 1.2-4.5). Compared with children who had no hospital admissions in the previous year, those with 1 admission in that period were more likely to have resistant isolates (OR 2.3, 95% CI 1.4-7.5), as were those with 2 or more admissions in that period (OR 3.2, 95% CI 1.1-4.8). Compared with children aged 2-6 years, children under 2 years of age were less likely to have resistant isolates (OR 0.3, 95% CI 0.2-0.8).. Selective antimicrobial pressure and multiple admissions to hospital were among the risk factors associated with antimicrobial resistance. The finding of a low but definite level of resistance to both ampicillin and gentamicin is important for the selection of empiric therapy for sepsis in neonates. The role of inexpensive first-line agents in the outpatient treatment and prevention of urinary tract infections requires re-examination, particularly in children who have recently received antimicrobial therapy.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Case-Control Studies; Child; Child, Preschool; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Female; Humans; Infant; Logistic Models; Male; Microbial Sensitivity Tests; Ontario; Population Surveillance; Risk Factors; Statistics, Nonparametric; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A large majority of urinary tract infections are caused by coliform organisms. Trimethoprim-sulfamethoxazole (TMP-SMX) resistance among uropathogens is increasing in many areas. The objective of this study was to determine risk factors for TMP-SMX-resistant coliforms in patients with urinary tract infections.. Retrospective case-control study.. Emergency department of a tertiary care university hospital.. We studied 448 emergency department patients aged 14 years or older with a urinary tract infection caused by a coliform organism. Cases consisted of all patients with a culture-documented urinary tract infection caused by a TMP-SMX-resistant coliform, while control patients were those with a TMP-SMX-sensitive organism.. A univariate analysis of clinical variables associated with TMP-SMX resistance was performed. Multiple logistic regression was performed to determine independent predictors of TMP-SMX resistance. Resistance to TMP-SMX was seen in 15% of isolates. Numerous variables were associated with TMP-SMX resistance on the univariate screen. Independent predictors of resistance were diabetes (odds ratio [OR] 3.1; 95% confidence interval [CI] 1.2, 8.4), recent hospitalization (OR 2.5; 95% CI 1.1, 5.7), current use of antibiotics (OR 4.5; 95% CI 2.0, 10.2), and recent use of TMP-SMX (OR 5.1; 95% CI 2.2, 11.5). When those with recent hospitalization were excluded from analysis, independent predictors were current use of any antibiotic (OR 3.5; 95% CI 1.4, 8. 4) and recent use of TMP-SMX (OR 5.9; 95% CI 2.4, 14.3).. Coliforms resistant to TMP-SMX are common in our emergency department. Diabetes, recent hospitalization, and the use of antibiotics, particularly the use of TMP-SMX, are independent risk factors for TMP-SMX resistance. Clinicians should consider these findings when deciding on antimicrobial therapy for patients with urinary tract infections.

Topics: Adult; Anti-Infective Agents, Urinary; Case-Control Studies; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Humans; Male; Retrospective Studies; Risk Factors; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Children with urinary tract infections (UTI) are at risk of renal scarring which may lead to impaired renal function and hypertension. This study examines the risk factors that predispose to recurrent UTI in children and the role of recurrent UTI in renal scarring.. A group of 290 children under 5 years of age with a first symptomatic UTI were studied. Micturating cystourethrogram and dimercaptosuccinic acid (DMSA) renal scintigraphy were performed at entry, and DMSA was repeated 1 year later. Two hundred and sixty-one children (90%) were followed up at 1 year.. There were 46 confirmed recurrent infections in 34 children, a recurrence rate of 12%. Multiple recurrence occurred in 14/34 (34%) children. Age of less than 6 months on entry independently predicted for recurrent UTI (odds ratio (OR): 2.9)). Compliance with prophylactic antibiotics fell throughout the year of follow up. Vesicoureteric reflux (VUR) was present in 14/34 (34%) of the group with recurrent UTI, 69/256 (27%) without recurrence. Urinary tract infection was significantly associated with bilateral and intrarenal reflux; grade 3-5 reflux independently predicted for recurrent UTI (OR: 3.5). Recurrent UTI was significantly associated with high grade DMSA defects on entry, renal parenchymal defects at 1 year follow up, and new defects at 1 year.. The independent risk factors for recurrent UTI identified by this study were an age of less than 6 months at the index UTI and grade 3-5 VUR. These findings suggest more selective targeting may minimize problems associated with prophylaxis and improve outcomes for children with urine infection.

Topics: Anti-Infective Agents, Urinary; Child, Preschool; Female; Follow-Up Studies; Humans; Male; Patient Compliance; Radionuclide Imaging; Radiopharmaceuticals; Recurrence; Retrospective Studies; Risk Factors; Technetium Tc 99m Dimercaptosuccinic Acid; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To describe the clinical findings, treatment and results of long-term follow-up of a case of malacoplakia of the bladder.. After diagnostic endoscopic evaluation, transurethral resection of the lesion was performed and antibiotic therapy was administered. The same treatment was repeated 4 years later. During the following 10 years, the patient had a yearly endoscopic evaluation that showed no recurrence of the lesion.. Transurethral resection combined with antibiotic therapy is effective in the treatment of malacoplakia of the bladder. The importance of long-term follow-up of the patient is emphasized.

Topics: Anti-Bacterial Agents; Chronic Disease; Cystoscopy; Electrocoagulation; Escherichia coli Infections; Female; Follow-Up Studies; Hematuria; Histiocytes; Humans; Malacoplakia; Middle Aged; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder Diseases; Urinary Tract Infections

Topics: Age Factors; Aged; Antipsychotic Agents; Astemizole; Comorbidity; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Hypersensitivity; Infant; Risperidone; Schizophrenia; Seizures; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A patient presented with severe bactrim-induced neutropenia with a reversed CD4+/CD8+ lymphocyte ratio. R-metHUG-CSF at 300 micrograms daily produced a dramatic neutrophil response and the therapy was discontinued after 2 weeks.

Topics: Bone Marrow; CD4-CD8 Ratio; Filgrastim; Granulocyte Colony-Stimulating Factor; Hematopoietic Stem Cells; Humans; Immunologic Factors; Male; Neutropenia; Recombinant Proteins; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

This study assessed changing patterns of antibiotic resistance in Escherichia coli urinary tract infections at a university student health center during three periods: the first 6 months each of 1991, 1994, and 1997. Urine culture and sensitivity results were taken from available medical records of female patients having urine cultures during the three periods (1991, n = 739; 1994, n = 938; 1997, n = 863); age and ethnicity were also noted. In E. coli isolates (the majority of positive cultures), resistance to four antibiotics changed significantly: ampicillin (30% to 45% to 39%), carbenicillin (29% to 42% to 39%), tetracycline (29% to 40% to 23%), and trimethoprim/sulfamethoxazole (15% to 32% to 15%). The results raise questions regarding the future clinical reliability of several commonly used antibiotics in the treatment of urinary tract infection.

Topics: Adolescent; Adult; Age Factors; Ampicillin Resistance; Anti-Bacterial Agents; Carbenicillin; Cephalosporin Resistance; Cephalothin; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Ethnicity; Female; Humans; Los Angeles; Penicillin Resistance; Reproducibility of Results; Retrospective Studies; Student Health Services; Tetracycline Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urine

The purpose of this study was to determine the most cost-effective strategy for managing suspected urinary tract infections in otherwise healthy adult women presenting to their primary care physician with dysuria and no symptoms or signs of pyelonephritis. Several office-based management strategies are considered: empiric therapy, use of dipstick analysis, use of complete urinalysis, and several strategies using office or laboratory cultures.. We constructed a decision tree using model probabilities obtained from the literature. Where published probabilities were unavailable, we used extensive sensitivity analyses. Utilities were obtained from the Index of Well-Being. We obtained costs by surveying hospitals, physicians, and pharmacies.. The most cost-effective strategy is to treat empirically ($71.52 per quality-adjusted life month, QALM). When the cost of antibiotics exceeds $74.50 or if the prior probability of having a UTI is under 0.30, then treatment guided by the results of a complete urinalysis is preferred. While it was the preferred strategy, other strategies (complete urinalysis, culture and treat, and dipstick testing only) were associated with greater utility. The marginal cost-effectiveness of these strategies compared with empiric therapy ranged from $2964 to $48,460 per additional QALM.. The preferred strategy of empiric therapy is robust over a wide range of sensitivity analyses. While empiric therapy is associated with the best cost-utility ratio, doing a culture yields the greatest utility at greater incremental cost per QALM. Many primary care physicians already treat UTIs empirically with antibiotics. This study confirms that empiric therapy, while frowned upon by some, is a cost-effective strategy. Other strategies may be considered, but at greater marginal cost. Ultimately these findings need to be confirmed in clinical trials.

Topics: Adolescent; Adult; Ambulatory Care; Anti-Infective Agents, Urinary; Costs and Cost Analysis; Decision Trees; Female; Humans; Middle Aged; Quality of Life; Sensitivity and Specificity; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urination Disorders

Topics: Acidosis, Renal Tubular; Anti-Infective Agents, Urinary; Electrochemistry; Escherichia coli Infections; Humans; Hydrogen-Ion Concentration; Hyperkalemia; Male; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Aged; Anti-Infective Agents, Urinary; Humans; Hyperkalemia; Hypoaldosteronism; Male; Renin; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In this case report we present a female patient with recurrent urinary infection treated with trimethoprim/sulfamethoxazole, trimethoprim alone and ciprofloxacin. She developed adverse systemic symptoms and bilateral anterior uveitis following administration of the former two drugs, and in addition retinal haemorrhages after the use of trimethoprim. Uveitis and retinal haemorrhages are rare side effects of trimethoprim/sulfamethoxazole. To our best knowledge they have not been described as a side effect of trimethoprim alone.

Topics: Administration, Topical; Adult; Anti-Infective Agents, Urinary; Ciprofloxacin; Drug Therapy, Combination; Female; Follow-Up Studies; Glucocorticoids; Humans; Ophthalmic Solutions; Recurrence; Retinal Hemorrhage; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Uveitis, Anterior

Topics: Acute Disease; Anti-Bacterial Agents; Cystitis; Escherichia coli; Female; Fosfomycin; Humans; Randomized Controlled Trials as Topic; Staphylococcus; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adult; Antibiotic Prophylaxis; Bacteriuria; Ciprofloxacin; Female; Humans; Kidney Transplantation; Postoperative Complications; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urography; Vesico-Ureteral Reflux

Topics: Aged; Aged, 80 and over; Anti-Infective Agents, Urinary; Humans; Hyperkalemia; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Urinary tract infection remains an important health concern, particularly in women. It is important to differentiate between uncomplicated and complicated infections, because management strategies differ. Women 18 to 65 years of age with manifestations of uncomplicated lower urinary tract infection can be safely and effectively treated with a 3-day course of trimethoprimsulfamethoxazole (Bactrim, Cotrim, Septra) or trimethoprim alone (Proloprim, Trimpex) if pyuria is detected on urinalysis. Patients with any other manifestations require further diagnostic testing and more prolonged therapy. Urine cultures should be obtained only in patients with complicating factors, and urologic evaluation is warranted only if clearly indicated. Recurrent infection may require continuous antimicrobial prophylaxis. Catheter-related infection should be treated only if the patient is symptomatic. Infection in men may require 4 to 6 weeks of therapy because of possible prostatic involvement.

Topics: Anti-Infective Agents; Anti-Infective Agents, Urinary; Female; Fluoroquinolones; Humans; Male; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adult; Anti-Infective Agents, Urinary; Female; Humans; Patient Education as Topic; Photosensitivity Disorders; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adult; Aerospace Medicine; Anti-Infective Agents, Urinary; Female; Humans; Military Personnel; Thrombocytopenia; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

Trimethoprim-sulphamethoxazole (TMP-SMZ) is considered a safe drug for treatment of infectious bacterial diseases in children. Side-effects are rare and generally take the form of a hypersensitivity reaction to the sulphamethoxazole component of the drug. Hepatic injury usually presents as a transient elevation of liver enzymes, which is of little clinical relevance. Fulminant liver failure due to TMP-SMZ has been reported in only six adults and never in children. We here report a 5-year-old girl who developed fulminant liver failure 3 weeks after her third exposure to TMP-SMZ. After a biphasic clinical course she underwent successful liver transplantation.. Trimethoprim-Sulphamethoxazole may cause fulminant liver failure in children. The disease can run a biphasic clinical course and liver transplantation must be considered as the therapeutic option for these patients.

Topics: Biopsy; Child, Preschool; Escherichia coli Infections; Female; Hepatic Encephalopathy; Humans; Liver; Liver Function Tests; Liver Transplantation; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To determine the incidence of symptomatic urinary tract infections in HIV seropositive patients and to assess whether this varies with stage of disease, risk group or the use of co-trimoxazole as prophylaxis against Pneumocystis carinii pneumonia.. A retrospective case note review of 175 HIV-infected patients attending The Royal London Hospital between July 1988 and December 1992 was performed. A urinary tract infection was defined as a pure culture of > or = 10(5) colony forming units in a mid-stream specimen of urine from a patient with symptoms consistent with a urinary tract infection.. Urinary tract infections occurred in 10 (5.7%) of 175 patients, with an incidence of 1.49 per hundred patient years. Urinary tract infections were significantly more common in patients with AIDS or a CD4 lymphocyte count below 0.2 x 10(9)/l (or both) when compared to those without AIDS and a CD4 lymphocyte count above 0.2 x 10(9)/l (5.4 vs. 0.5 urinary tract infections per hundred patient years, p = 0.00005). Women with AIDS or a CD4 count below 0.2 x 10(9)/l (or both) had an incidence of urinary tract infection of 18.5 per hundred patient years. No significant difference was found between the incidence of urinary tract infections in those taking co-trimoxazole as Pneumocystis carinii pneumonia prophylaxis and those taking alternative or no prophylaxis (2.6 vs 6.4 per hundred patient years, p = 0.39).. Urinary tract infection represents a considerable health problem amongst HIV infected patients. Our data show that urinary tract infections are more common in patients with advanced compared with early HIV infection. Cotrimoxazole, when taken by patients as prophylaxis against Pneumocystis carinii pneumonia did not appear to reduce the incidence of urinary tract infection.

Topics: CD4 Lymphocyte Count; Female; HIV Seropositivity; Homosexuality; Humans; Incidence; Male; Pneumonia, Pneumocystis; Retrospective Studies; Risk Factors; Sex Factors; Substance-Related Disorders; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To report a patient with 2 consecutive reversible drug-induced liver disorders and the application of International Consensus Meeting Criteria for the screening and diagnosis of drug-induced liver disorders.. An 88-year-old man in a chronic care institution developed abdominal discomfort and jaundice after finishing a 10-day course of trimethoprim/sulfamethoxazole therapy for a urinary tract infection (UTI). The jaundice and the symptoms resolved spontaneously and the final diagnosis was symptomatic drug-induced liver injury, mixed type. After 1 month, the same patient received a course of cefadroxil therapy for another UTI. He developed an asymptomatic drug-induced liver injury, mixed type. Six months later, the patient received oral penicillin therapy and then ciprofloxacin, with no change in his liver function test results.. To our knowledge, there are only a few other reports in the literature of a drug-induced liver injury with cefadroxil therapy; more cases are reported with trimethoprim/sulfamethoxazole than with cefadroxil. The criteria of an International Consensus Meeting were helpful to evaluate both incidences of liver injury in this patient with the aim of establishing the diagnosis and causality assessment. Additionally, the criteria were used to show that the patient had 2 separate liver injuries.. Screening and diagnosis of drug-induced liver disorders depend on careful history taking and 5 specific biochemical liver tests. The evolution of the liver disorder induced by cefadroxil therapy probably was interrupted because of its early detection. Appropriate screening was done with the subsequent administration of new potentially hepatotoxic drugs.

Topics: Aged; Aged, 80 and over; Anti-Infective Agents, Urinary; Cefadroxil; Cephalosporins; Chemical and Drug Induced Liver Injury; Humans; Male; Penicillins; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Uro-Vaxom was used in the treatment of recurrent urinary tract infections in 28 girls. Most of them (27/28) tolerated the drug very well, no side effects were observed. We stopped administration of the Uro-Vaxom in one girl during the first month of treatment because of vomiting. Uro-Vaxom efficiency was, therefore, evaluated in 27 girls. Uro-Vaxom was found to be a valuable drug, supplementing antibiotic therapy in recurrent urinary tract infections caused by E. coli.

Topics: Adjuvants, Immunologic; Adolescent; Ampicillin; Anti-Infective Agents, Urinary; Child; Child, Preschool; Drug Therapy, Combination; Escherichia coli; Female; Furagin; Gentamicins; Humans; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We studied the antibiotic susceptibility of midstream urine isolates from patients with community-acquired urinary tract infections at Groote Schuur Hospital from 1986 to 1991. The majority of the isolates was resistant to amoxycillin and co-trimoxazole, and the proportion of resistant Escherichia coli isolates increased during the study period. In a prospective 4-month study in 1991 we found that the vast majority of isolates was susceptible to aminoglycosides, amoxycillin/clavulanate, second-generation cephalosporins and the new fluoroquinolones. Based on these findings amoxycillin and co-trimoxazole should no longer be prescribed for urinary tract infections unless a susceptible isolate has been cultured. Appropriate empirical oral agents are expensive and not generally available in the public sector. There is an urgent need to make these agents available in the public sector, but their use should be restricted as widespread use for the treatment of other infections would inevitably lead to the development of resistance.

Topics: Aged; Amoxicillin; Community-Acquired Infections; Drug Resistance, Microbial; Female; Humans; Male; Prevalence; Prospective Studies; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Aged; Aged, 80 and over; Cholestasis; Female; Humans; Respiratory Tract Infections; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Eleven antibiotics were tested against 1,194 Gram negative bacilli isolated from urinary tract infections at the National University Hospital Center at Cotonou. Among the betalactams tested, only cefotaxime remained active against most of the bacteria tested: 90% of the strains of Escherichia coli and 75% of the strains of Enterobacter cloacae were sensitive. Ampicilline, on the other hand, had lost its activity even on strains which are usually the most susceptible. Thirteen percent of the E. coli strains were sensitive. This reduction in antibiotic activity against bacterial strains in Cotonou, which concerned to various degrees the tetracyclines, chloramphenicol, cotrimoxazole, is less pronounced for the amino-sides (gentamicine and netilmicine), and the quinolones of which nalidixique acid was active against 83.9% of the strains of E. coli. The low frequency of isolation of wild type strains (sensitive to betalactams) is probably the consequence of strong selection pressure due to a massive, and uncontrolled use of antibiotics in Cotonou.

Topics: Aminoglycosides; Ampicillin; Anti-Bacterial Agents; Benin; Cefotaxime; Drug Resistance, Microbial; Gram-Negative Bacteria; Humans; Microbial Sensitivity Tests; Tetracyclines; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

An ongoing registration of resistance patterns of microorganisms in a large area in the Netherlands demonstrated a slow but steady increase of resistance to several antibacterials in the past ten years. For some bacteria and for some selected antimicrobial agents this increase was such that it might no longer be justifiable to choose them for empirical therapy. For Escherichia coli, resistance increased from 14% in 1982 to 28% in 1992 for co-trimoxazole and for trimethoprim and from 24% to 34% for amoxycillin. For nitrofurantoin the figures were 1.5% and 4.0%, respectively. Comparison with other areas in the Netherlands showed similar results, so it can be considered a nationwide problem which may have consequences for national antibiotic guidelines for the treatment of infections.

Topics: Anti-Infective Agents, Urinary; Bacteria; Drug Resistance, Microbial; Escherichia coli; Humans; Microbial Sensitivity Tests; Netherlands; Nitrofurantoin; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Infective Agents; Clavulanic Acids; Drug Resistance, Microbial; Drug Therapy, Combination; Escherichia coli; Escherichia coli Infections; Humans; Microbial Sensitivity Tests; Nalidixic Acid; Ofloxacin; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Drug-induced meningitis should be considered in differential diagnosis of meningeal irritation in patients receiving therapy with anti-infective, nonsteroidal anti-inflammatory, immunosuppressive, or other selected agents. This report describes a case of aseptic meningitis associated with use of trimethoprim-sulfamethoxazole in a patient without apparent underlying autoimmune disease. The patient recovered promptly after the offending agent was withdrawn. No specific treatment other than symptomatic and supportive care need be given. In all instances, however, infection must be excluded.

Topics: Adult; Female; Humans; Meningitis, Aseptic; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Within 24 hours of returning from a five-week holiday in Pakistan a 15-year-old girl developed vomiting and massive diarrhoea leading to severe dehydration with hypovolaemic shock. The diastolic blood pressure was no longer measurable and prerenal renal failure occurred with a serum creatinine of 4.4 mg/dl and metabolic acidosis (pH 7.21, base excess-16.9 mmol). Initially treatment consisted of rehydration (day 1: 9280 ml, day 2: 4850 ml). The patient's condition rapidly improved and she had voluminous stools. A concurrent urinary infection due to Klebsiella pneumoniae was first treated with cotrimoxazole. As a new strain of Vibrio cholerae, serogroup O 139, was isolated from stool, treatment was changed to tetracycline (50 mg/kg daily). Regaining a good general state she was transferred to an isolation ward on the 6th hospital day. The isolated cholera organism belongs to a nonagglutinating serogroup which is indistinguishable clinically and epidemiologically from the classical Vibrio strains which cause cholera. Since the end of 1992 this new serogroup has been causing an explosive spread of cholera in Bangladesh and India.

Topics: Adolescent; Agglutination Tests; Cholera; Dehydration; Feces; Female; Fluid Therapy; Germany; Humans; Klebsiella Infections; Klebsiella pneumoniae; Pakistan; Serotyping; Shock; Tetracycline; Travel; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vibrio cholerae

Topics: Adult; Age Factors; Aged; Bacteriuria; Escherichia coli Infections; Female; Humans; Male; Middle Aged; Prostatitis; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

An examination of transitional bladder epithelial cells from 69 urine specimens from 23 spinal cord injury patients showed the presence of adherent bacterial biofilms in 66 cases (96%). All patients were receiving antimicrobial therapy, primarily trimethoprim-sulfamethoxazole (41 of 69), without any apparent effect on the bladder colonization. The large number of bacteria that emerged with highly virulent and potentially multi-drug resistant characteristics, especially Enterococcus faecalis (33% of isolates), was of concern. These findings raise questions about the proved efficacy and effectiveness of antibiotics against uropathogenic biofilms adherent to tissues.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Bacterial Adhesion; Child; Female; Humans; Male; Middle Aged; Spinal Cord Injuries; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder; Urinary Bladder Diseases; Urinary Tract Infections; Urine

Topics: Contraindications; Female; Humans; Pregnancy; Pregnancy Complications, Infectious; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

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

Topics: Arthritis; Female; Humans; Ibuprofen; Meningitis, Aseptic; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Drug Utilization; Humans; Norway; Substance-Related Disorders; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

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

Topics: Adult; Blood Component Transfusion; Female; Humans; Immunoglobulins, Intravenous; Thrombocytopenia; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A 74 year old woman became progressively confused and developed visual hallucinations and delusions over a six day period, after the institution of routine oral trimethoprim-sulfamethoxazole therapy for a urinary tract infection. The medication was discontinued, and a marked improvement was noted 36 hours later. There was a complete return to normal mental functioning 60 hours after therapy was discontinued. The relationship between the patient's symptoms with the initiation and discontinuation of the medication suggests that the drug had a causal effect.

Topics: Aged; Delusions; Dose-Response Relationship, Drug; Escherichia coli Infections; Female; Hallucinations; Hip Prosthesis; Humans; Mental Status Schedule; Postoperative Complications; Psychoses, Substance-Induced; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents; Ciprofloxacin; Fluoroquinolones; Humans; Quinolones; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The group of microorganisms causing urinary tract infections includes the Enterobacteriaceae family, particularly E. coli, being the most commonly detected etiologic factor of the above infections. Research was conducted from 1983 to 1990 on 1102 E. coli strains isolated from patients with clinical diagnosis of urinary tract infection. Susceptibility of the bacteria to nitrofurantoin, Biseptol and nalidixic acid was determined by application of the paper-disk- plate technique. The percentage of nitrofurantoin susceptible strains during the time period of research remained on the low level of 6-20%. The susceptibility of the strains isolated from 1983 to 1987 to Biseptol was also low, 0-11%, however, in later years (1988-1990) the gradual increase of susceptibility was observed, reaching the level of 35% in 1990. The most active of the used chemotherapeutics turned out to be nalidixic acid proven to be effective against 34.3-56.3% of E. coli strains.

Topics: Escherichia coli; Humans; Microbial Sensitivity Tests; Nalidixic Acid; Nitrofurantoin; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urine

A case of prolonged urinary tract infection caused by Mycobacterium fortuitum in a 56-year old female patient is reported. The infection, which was resistant to therapy with conventional antituberculous agents, responded well to a combination of trimethoprim, sulfamethoxazole and doxycycline.

Topics: Chronic Disease; Doxycycline; Drug Therapy, Combination; Female; Humans; Middle Aged; Mycobacterium Infections, Nontuberculous; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Most reports of drug induced meningitis in systemic lupus erythematosus (SLE) have implicated ibuprofen. We describe a 46-year-old woman with SLE who developed aseptic meningitis abruptly after ingesting trimethoprim-sulfamethoxasole (TMP-SMX). This patient had received TMP-SMX twice before; each was associated with increasingly severe reactions, whose relationship with the use of TMP-SMX became apparent only in retrospect. A history of medication use should be sought in all patients with meningitis who have an underlying autoimmune disorder.

Topics: Female; Humans; Lupus Erythematosus, Systemic; Meningitis, Aseptic; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To evaluate the in vitro sensitivities of trimetoprim (TMP) in our area and to compare them with those to co-trimoxazole (CMX) a prospective study was carried out in females with uncomplicated lower urinary tract infection (UCLUTI), as a preliminary step for the possible use of a monodose of TMP in these patients. Fifty-five cases of UCLUTI were included. Escherichia coli was the predominating organism (70.9%). The general sensitivity to CMX was 80% and that to TMP 76.4%. The E. coli sensitivity to CMX was 79.5%, and 76.9% to TMP. The difference in the sensitivities to both antimicrobials was not statistically significant (p = 0.5). The routine introduction of TMP in the antibiogram would permit to evaluate the resistance to this antimicrobial in each area and, on the basis of the results, to assess the effectiveness of TMP in the treatment of UCLUTI.

Topics: Adolescent; Adult; Aged; Bacteria; Bacteriuria; Female; Humans; Microbial Sensitivity Tests; Middle Aged; Prospective Studies; Spain; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Staphylococcus saprophyticus urinary-tract infection has been reported to occur in sexually active young females and in geriatric patients with obstructive uropathy. We are discussing two young male children with S. saprophyticus urinary-tract infection. We draw attention to this bacterium which is emerging as an important pathogen in children with urinary-tract infections.

Topics: Child; Humans; Male; Sex Factors; Staphylococcal Infections; Staphylococcus; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Aminoglycosides; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Female Urogenital Diseases; Humans; Male Urogenital Diseases; Tetracyclines; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A total of 87 children were treated for lower urinary tract infection. The infection site was determined on the basis of symptoms and laboratory findings. The patients were assigned to four groups, medicated for 3 and for 14 days with nitrofurantoin or cotrimazole. Results from the short and long-term therapies have not shown any significant differences: 9 out of 43 patients in the 3-day therapy group and 8 out of 44 in the 14-day group presented recurrences within one month.

Topics: Adolescent; Child; Child, Preschool; Drug Administration Schedule; Female; Humans; Infant; Male; Nitrofurantoin; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

One week after treatment of a urinary infection with co-trimoxazole (twice daily 160 mg trimethoprim and 800 mg sulphamethoxazole) a 21-year-old man suddenly started to vomit, accompanied by watery diarrhoea, abdominal swelling and weight loss of 5 kg. Plain X-ray film of the abdomen while standing showed multiple fluid levels in the small intestine of the upper and lower abdomen. Serum IgE concentration was elevated to 325 U/ml. There was a leukocytosis of 25,800/microliters, with a differential count of 45% eosinophils. Protein-rich ascites contained numerous eosinophils and the mucosa of the terminal ileus and the duodenum was infiltrated with eosinophils, findings which indicated eosinophilic gastroenteritis. All symptoms regressed completely within 10 days of stopping co-trimoxazole and administering prednisolone (50 mg/day). Four years later a similar episode of eosinophilic gastroenteritis developed after the patient had taken trimethoprim with a sulphonamide (once daily 180 mg trimethoprim and 820 mg sulphadiazine). It again quickly responded to short-term administration of glucocorticoids.

Topics: Adult; Drug Hypersensitivity; Eosinophilia; Gastroenteritis; Humans; Male; Prednisolone; Recurrence; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To study the relation of preoperative infected urine and postprostatectomy wound infection in patients with and without indwelling bladder catheters.. Patients undergoing prostatectomy were evaluated for the presence of infected urine prior to prostatectomy and postoperative wound infection. They were further divided into patients with indwelling urinary catheter and catheter-free patients. All had received antibiotic prophylaxis.. One hundred fifty consecutive patients undergoing open prostatectomy--mean age was 67 years; 100 patients with an indwelling catheter for a mean period of 50 days; 50 catheter-free patients.. Wound infection was found in 19 of 81 (23.5%) and in 6 of 69 (8.7%) patients with infected and sterile urine, respectively (p = .028). In patients with indwelling catheters prior to operation, wound infection was 22.4% when urine was infected and 8.3% when it was not. In patients without catheters, infected urine was associated with 40% of wound infections, as compared with 8.9% of wound infections in patients with sterile urine. Organisms obtained from infected wound and urine were identical in 84% of cases. These results were obtained despite antibiotic prophylaxis.. Wound infection has been demonstrated to be a postprostatectomy complication directly related to the presence of urinary infection at surgery; thus, elective prostatectomy should be deferred until urine becomes sterile.

Topics: Aged; Aged, 80 and over; Anti-Infective Agents, Urinary; Bacteriuria; Enterobacteriaceae; Humans; Male; Middle Aged; Prospective Studies; Prostatectomy; Risk Factors; Surgical Wound Infection; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The periurethral flora was examined in 18 girls by use of a quantitative sampling method before, during, and three weeks after treatment with antibiotics for upper respiratory tract infections. Eight girls received amoxicillin. In five of them the anaerobic flora showed a reduction in total counts and in numbers of different species, and all eight girls got a heavy colonisation with enterobacteria during treatment. Three weeks after treatment the anaerobic and aerobic flora had reversed to the pretreatment composition. In 10 girls treated with trimethoprim-sulphamethoxazole the anaerobic flora remained unaffected and no enterobacterial overgrowth was registered during the study period. We propose that antibiotics could be one among several factors involved in the pathogenesis of urinary tract infection, by suppression of the anaerobic microflora and promotion of the colonisation with enterobacteria.

Topics: Adolescent; Amoxicillin; Child; Child, Preschool; Colony Count, Microbial; Enterobacteriaceae; Female; Gram-Negative Aerobic Bacteria; Humans; Otitis Media; Respiratory Tract Infections; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urethra; Urinary Tract Infections

Topics: Alprazolam; Anxiety Disorders; Drug Therapy, Combination; Female; Humans; Imipramine; Middle Aged; Panic; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We report a case of severe urinary tract infection caused by Shigella sonnei in a 3-year-old girl with vesico-ureteric reflux and no history of dysentery. Treatment with co-trimoxazole in a dose of 48 mg/kg for 10 days was given and the infection was eradicated. Possible sources of infection are discussed.

Topics: Child, Preschool; Dysentery, Bacillary; Female; Humans; Shigella sonnei; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urography; Vesico-Ureteral Reflux

Topics: Adult; Female; Humans; Middle Aged; Patient Compliance; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Acute Disease; Amoxicillin; Anti-Bacterial Agents; Female; Humans; Norfloxacin; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Cystitis; Female; Humans; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A 74-year-old woman had been treated with methotrexate over 2 years for rheumatoid arthritis. She was admitted to the hospital because of non-healing leg ulcers. After being treated with trimethoprim-sulphamethoxazole for a urinary-tract infection, she developed severe pancytopenia, followed by pneumonia and septic shock. The patient died shortly after. Concomitant treatment with methotrexate and sulphonamides should be strongly discouraged.

Topics: Aged; Arthritis, Rheumatoid; Drug Synergism; Drug Therapy, Combination; Female; Humans; Leg Ulcer; Methotrexate; Pancytopenia; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We searched the susceptibility of E. coli strains isolated from urine cultures of sick children with urinary tract infections to Nitrofurantoin, Co-trimoxazole, Gentamicin, Ampicillin and Amoxillin-Clavulonic acid. In our study, we compared the results of Farabi Hospital of Black Sea Technical University Medical Faculty, Hacettepe University Medical Faculty Children Hospital and Glasgow Royal Hospital for sick children and tried to show their regional and national differences for antibiotic susceptibility.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Bacteriuria; Child; Clavulanic Acids; Drug Therapy, Combination; Escherichia coli; Escherichia coli Infections; Gentamicins; Humans; Multicenter Studies as Topic; Nitrofurantoin; Scotland; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey; Urinary Tract Infections

A 24 year-old patient with a short-bowel syndrome receiving home parenteral nutrition in addition to oral feeding for 32 months was treated by oral trimethoprim-sulfamethoxazole for urinary tract infection. Three days later, he developed neurologic disorders associated with severe hyperchloremic acidosis and high plasma level of D-lactate. This is a rare complication of intestinal malabsorption due to small bowel by-pass or extensive resection due to transient alteration of intestinal microflora induced by the oral antibiotic treatment. Diagnosis requires a high indice of suspicion.

Topics: Acidosis, Lactic; Adult; Humans; Intestine, Small; Lactates; Malabsorption Syndromes; Male; Nervous System Diseases; Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Aged; Aged, 80 and over; Anti-Infective Agents; Bronchitis; Drug Combinations; Humans; Male; Postoperative Complications; Stevens-Johnson Syndrome; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The authors analysed the results of bacteriological examinations of 600 urine samples with special regard to the sensitivity of the different pathogenic agents to Sumetrolim (400 mg sulphamatoxazole + 80 mg trimethoprim per each tablet). Their observations were also summarized in tables. The effectiveness of Sumetrolim treatment (for 5 days daily 2 x 3 tablets, from the subsequent 10 days daily 2 x 1 tablet) used in 100 chronic prostatitis patients and in 100 patients suffering temporarily from chronic infection (who had undergone prostatectomy) has been analyzed. Sumetrolim has been found to be valuable in the urological practice especially in the treatment of chronic infections of long duration. Teh eventual side-effects of Sumetrolim have been discussed on the basis of references and own observations referring to the treatment of 200 patients. The therapy had to be discontinued in 21 cases, in 1 case because of toxicoderma responding well to therapy, in 3 cases because of mild cutaneous alteration, in 10 cases due to intensive diarrhoea, and in 7 cases because of other side-effects.

Topics: Bacteriuria; Humans; Male; Postoperative Complications; Prostatectomy; Prostatitis; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Humans; Streptococcal Infections; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adolescent; Adult; Ampicillin; Ampicillin Resistance; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Cephalosporins; Escherichia coli; Female; Gentamicins; Humans; Nitrofurantoin; Pregnancy; Pregnancy Complications, Infectious; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In a prospective study of low-dose antibacterial prophylaxis of childhood urinary tract infection (UTI), co-trimoxazole and trimethoprim (TMP) have been compared for efficacy in preventing UTI, for their effect on the rectal flora and for secular selection of TMP-resistant organisms. Between 1979 and 1986, 334 children who had proven infection of an unobstructed urinary tract complied in a regimen of low-dose prophylaxis together with measures to eliminate residual urine for at least 6 months. Of these children, 167 had vesico-ureteric reflux and 27 had renal scarring. There was no difference between the two drugs in compliance, which was very good, or in the occurrence of side-effects, which were minimal. Recurrence rates of further infection were 1 per 22 child years for the 226 children receiving cotrimoxazole and 1 per 18 child years for the 108 receiving TMP. All but one of these urinary pathogens were resistant to TMP and reinfection of the urinary tract generally occurred following lapses in attention to complete bladder emptying. Neither a secular increase in recurrent infections during this period, nor a significant change in the proportions of TMP-resistant faecal coliform organisms, was observed. TMP and co-trimoxazole appeared to be equally effective prophylactic agents.

Topics: Child; Drug Resistance, Microbial; Enterobacteriaceae; Female; Humans; Intestines; Male; Patient Compliance; Prospective Studies; Recurrence; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Urinary; Drug Combinations; Female; Follow-Up Studies; Humans; Middle Aged; Prospective Studies; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urethra; Urinary Tract Infections

The activity of fosfomycin trometamol (FOT) was compared with that of cotrimoxazole (COT) and norfloxacin (NOR) using urine as medium and 10(7) bacteria as inoculum, conditions as close as those found by the administration of the drugs in vivo during the course of a urinary tract infection. The minimum inhibitory concentrations (MIC) of all antibiotics against 100 strains isolated from urinary tract infections were found to be higher than the breakpoint. Concentrations of FOT corresponding to mean and maximal values found in urine after single dose administration within the 0-48 h interval killed the great majority of strains. COT and NOR, when tested under similar conditions, exhibited an antibacterial activity lower than and equal to that of FOT, respectively. In several strains belonging to different species the frequency of mutation to resistance to 2000 and 1000 micrograms/ml of FOT was very low (greater than 10(-7], whereas it was relatively high (1 x 10(-5) to 1 x 10(-7] for 150 micrograms/ml, the two former and the latter being the respective maximal, mean and minimal values found in urine after administration of a single dose.

Topics: Bacteria; Drug Combinations; Drug Resistance, Microbial; Fosfomycin; Humans; Microbial Sensitivity Tests; Mutation; Norfloxacin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urine

Urinary tract infections caused by staphylococci are usually attributed to Staphylococcus epidermidis or S. saprophyticus. The case study reported here describes a persistent urinary tract infection caused by S. haemolyticus in a 38-year-old male whose infection was ultimately resolved through the use of the antibiotic trimethoprim-sulfamethoxazole.

Topics: Adult; Anti-Infective Agents, Urinary; Cystitis; Drug Combinations; Humans; Male; Staphylococcal Infections; Staphylococcus; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adolescent; Anti-Infective Agents, Urinary; Child; Child, Preschool; Drug Administration Schedule; Drug Combinations; Female; Humans; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The management of female patients with recurrent urinary tract infections still remains a problem, and long-term prophylactic or short intermittent courses of antibiotics are the standard forms of therapy. In this report, 10 patients were examined for the effects of long- and short-term treatment with trimethoprim-sulfamethoxazole (TMP-SMX) antibiotics on the receptivity of uroepithelial cells to bacterial adherence. The urine of all patients was sterile while on antibiotic therapy. Few bacteria were found adherent to the cells from adult patients (group 1, mean age 36 years) on long-term antibiotics, but the cells were highly receptive to uropathogens in vitro, especially for Escherichia coli expressing mannose-resistant adhesins. Controls of age-matched adult females were included and in vitro adherence levels were found to be higher for those women with a history of urinary tract infection compared with those with no past record of infection. In the second group, elderly patients (mean age 87 years) presented with bacteriuria, and their uroepithelial cells were found to be colonized by uropathogens to a significantly greater extent than their controls. The adherent population was reduced during 7-day TMP-SMX antibiotic treatment, but increased posttherapy, particularly in two patients who subsequently became reinfected. The in vitro results showed that uroepithelial cells retain their receptivity to uropathogenic adherence, both during and after treatment. Although antibiotics eradicate uropathogens from the urinary tract, patients remain susceptible to recolonization by uropathogens and are at risk of reinfection after completion of therapy.

Topics: Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Urinary; Bacterial Adhesion; Cells, Cultured; Drug Combinations; Epithelium; Female; Humans; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract; Urinary Tract Infections

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Urinary; Child; Drug Combinations; Drug Resistance, Microbial; Drug Utilization; Family Practice; Female; Humans; Microbial Sensitivity Tests; Middle Aged; Nitrofurantoin; Sulfamethoxazole; Sulfonamides; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Drug Combinations; Fees, Pharmaceutical; Female; Humans; Prescription Fees; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Child; Child, Preschool; Drug Combinations; Female; Humans; Infant; Male; Nitrofurantoin; Pyelonephritis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Administration, Oral; Amdinocillin; Amdinocillin Pivoxil; Amoxicillin; Ampicillin; Anti-Bacterial Agents; Drug Combinations; Humans; Microbial Sensitivity Tests; Nalidixic Acid; Nitrofurantoin; Prospective Studies; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Ampicillin; Ampicillin Resistance; Anti-Infective Agents, Urinary; Drug Combinations; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Humans; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Although rare, urinary tract infections in children by salmonella species have been associated with a high incidence of structural anomalies. We report on a 5-year-old patient with Salmonella enteritidis urinary tract infection associated with ureteropelvic junction obstruction.

Topics: Child, Preschool; Drug Combinations; Humans; Male; Salmonella enteritidis; Salmonella Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Ureteral Obstruction; Urinary Tract Infections

A cost effectiveness analysis comparing single-dose with conventional antibiotic treatment for uncomplicated urinary tract infection is described. The analysis is based on aggregated effectiveness and side effect rates reported in the medical literature. A comparison of single-dose and conventional regimens of trimethoprim-sulfamethoxazole and amoxicillin indicates that single-dose regimens are preferable to conventional regimens of either drug, and that trimethoprim-sulfamethoxazole is preferable to amoxicillin, on the grounds both of days of morbidity averted and of medical care costs. Thus single-dose therapy is cost-effective compared to conventional treatment.

Topics: Amoxicillin; Anti-Infective Agents, Urinary; Cost-Benefit Analysis; Drug Administration Schedule; Drug Combinations; Female; Humans; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Trimethoprim-sulfamethoxazole in vitro activity was compared with ampicillin, tetracycline, sulfonamide and trimethoprim against isolates of 24 gram-negative and 11 gram-positive species. The incidence of more than 10% of strains with minimal inhibitory concentrations above 32 mg/l was restricted to Escherichia coli, Shigella spp., Klebsiella pneumoniae, Providencia rettgeri, Morganella morganii, methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis. Occasionally, Streptococcus pneumoniae and Haemophilus influenzae strains with MICs above 32 mg/l were identified. Co-trimoxazole in vitro activity was superior to the comparative drugs for the majority of species. Co-trimoxazole remains an active combination against major pathogens of infections of the upper and lower respiratory, urinary tract and enteric infections with a still low incidence of resistant organisms.

Topics: Anti-Bacterial Agents; Drug Combinations; Drug Resistance, Microbial; Escherichia coli; Humans; Microbial Sensitivity Tests; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Acute Disease; Amoxicillin; Anti-Infective Agents, Urinary; Drug Combinations; Humans; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Acute Disease; Adolescent; Adult; Aged; Drug Administration Schedule; Drug Combinations; Female; Humans; Middle Aged; Prospective Studies; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

For a total of 396 hospitalized urological patients with complicated and/or hospital-acquired urinary tract infections (UTI) urinary pathogens with colony counts of 10(5)/ml or more were determined, several species were then subclassified by epidemiological markers. The minimal inhibitory concentrations (MIC) were measured using the agar dilution method for seven penicillins and for four penicillin combinations, for six oral and 14 parenteral cefalosporins, for three older and five newer quinolones, for two aminoglycosides, for two monobactams, for trimethoprim alone and in combination with sulfamethoxazole, for fosfomycin and for imipenem. Sensitivity and resistance of the strains were defined using breakpoints according to DIN 58.940 or analogous concentrations. The bacterial spectrum and the rate of resistant strains were correlated to clinical aspects pertaining to sexual status, age and underlying abnormalities within the urinary tract. There was a statistical difference in the frequency of E. coli and enterococci between patients with (complicated UTI) and without (uncomplicated UTI) abnormalities. Within the group of complicated UTI Proteus spp. were found significantly more often in patients with urolithiasis, Klebsiella spp. and staphylococci in patients with prostatic tumours (benign and malignant), enterococci in patients with prostatic and other tumours and E. coli in patients with abnormalities other than urolithiasis or tumours. Almost all antibiotics tested could be used in patients with uncomplicated UTI for empiric or calculated therapy if a rate of resistance of up to 10% is acceptable. In patients with urolithiasis only the newer acylaminopenicillins, the newer (fluoro-)quinolones, trimethoprim in combination with sulfamethoxazole, fosfomycin and imipenem fulfill this criterion. In order to treat complicated UTI with underlying tumours within the urinary tract empirically only piperacillin, apalcillin, imipenem and some of the newer quinolones (ofloxacin, ciprofloxacin and pefloxacin) could be recommended. The same was true for patients with indwelling catheters still present or recently removed.

Topics: Aminoglycosides; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Cephalosporins; Cross Infection; Drug Combinations; Female; Hospitalization; Humans; Male; Microbial Sensitivity Tests; Penicillins; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We report 5 patients with repeated episodes of meningitis related to intake of trimethoprim containing compounds. On at least one occasion the patients received pure trimethoprim prior to reaction. Autoimmune disease was established in 3 of the patients. A close temporal relationship between drug intake and reaction was noted: symptoms appeared often within minutes. No evidence of infections was found. Lumbar puncture after recovery revealed normal values in 2 patients. This aseptic meningitis is most likely an adverse drug reaction and associated with trimethoprim intake. The reaction is infrequently reported in relation to drug sales but its incidence has probably been underestimated.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Urinary; Autoimmune Diseases; Drug Combinations; Female; Humans; Meningitis; Meningitis, Aseptic; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The effect of fosfomycin trometamol in comparison with that of norfloxacin and co-trimoxazole on the hemagglutination, yeast cell aggregation and adhesive properties of both gram-positive and gram-negative microorganisms was studied. The strains were isolated from the urine of patients with urinary tract infections, or from vaginal swabs. At sublethal concentrations (1/4 and 1/8 of the minimal inhibitory concentration), the ability of the bacteria to adhere to human uroepithelial cells was reduced by any of the 3 drugs assayed. The reduction corresponded to a decrease in the agglutinating activity of the gram-negative bacteria tested, such providing further evidence for the efficacy of the different chemoantibiotics. In particular, fosfomycin trometamol and norfloxacin proved to be more effective than co-trimoxazole in affecting the adhesive properties of all the strains employed.

Topics: Bacterial Adhesion; Drug Combinations; Escherichia coli; Fosfomycin; Hemagglutination; Humans; Microbial Sensitivity Tests; Norfloxacin; Proteus mirabilis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

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

Fosfomycin trometamol (FOT), a new soluble salt of fosfomycin, was developed especially for single-dose treatment in uncomplicated urinary tract infections. In this study, the minimum inhibitory concentrations (MICs) of FOT were measured both in nutrient broth and human urine and compared with calcium fosfomycin, pipemidic acid and cotrimoxazole. A total of 300 bacterial strains of different species from recent urinary infections were studied. Staphylococcus aureus showed the lowest MIC (0.38 micrograms/ml) and Pseudomonas spp. the highest (50 micrograms/ml) with fosfomycin salts in nutrient broth. The MIC of fosfomycin resulted in being higher than those for pipemidic acid and cotrimoxazole against Escherichia coli and Proteus rettgeri and lower for all the other species considered. The MIC values increased about ten times when urine was used as medium. No differences were observed between the two fosfomycin salts. The fosfomycin concentrations of 137-1500 micrograms/ml, easily obtained in urine of healthy adult subjects after a single dose of FOT (3g of fosfomycin), were able to kill all the strains, with the exception of Streptococcus faecalis. The bacterial adhesion of a resistant microorganism (P. aeruginosa) to the cells of the urinary tract, showed a 50% reduction after FOT treatment.

Topics: Bacteria; Cystitis; Drug Combinations; Escherichia coli; Fosfomycin; Humans; Microbial Sensitivity Tests; Pipemidic Acid; Pseudomonas aeruginosa; Staphylococcus aureus; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Drug Combinations; Humans; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The pharmacokinetics of four different sulfonamides i. e., sulfamethoxazole (SMZ). Sulfamoxole (SMO), Sulfadiazine (SDZ) and Sulfadimidine (SDD) in combination with trimethoprim (TMP) were studied in 12 healthy volunteers. Plasma and urine concentrations of sulfonamides were measured at different time intervals. No significant difference was observed in the area under the plasma curve (AUC) of SMZ, SMO and SDZ, while AUC of SMO was significantly higher than SDD only. Free (unmetabolized) SDZ urinary excretion during a 10-25 h period was significantly higher than SMZ, SMO and SDD. The results suggest that SDZ alone or in combination with TMP would be more effective in urinary tract infections as compared to other sulfonamides studied.

Topics: Adult; Anti-Infective Agents, Urinary; Drug Combinations; Female; Half-Life; Humans; Kinetics; Male; Middle Aged; Sulfadiazine; Sulfamethazine; Sulfamethoxazole; Sulfamoxole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Drug Combinations; Female; Humans; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adult; Agranulocytosis; Anti-Infective Agents, Urinary; Drug Combinations; Female; Humans; Neutropenia; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adult; Anti-Infective Agents, Urinary; Drug Combinations; Erythema; Humans; Male; Pigmentation Disorders; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We report a case of recurrent urinary tract infections owing to culture proved ureteral infection stones. Although ureteral catheterization studies unilaterally localized the infection to the upper urinary tract, the direct immunofluorescence antibody test indicative of upper tract infection was negative. The patient was cured of persistent urinary tract infection by antibiotics, ureterolithotomy, resection of the stenotic ureteral segment and ureteroureterostomy.

Topics: Adult; Drug Combinations; Humans; Male; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Ureteral Calculi; Urinary Tract Infections

Topics: Adolescent; Child; Child, Preschool; Drug Administration Schedule; Drug Combinations; Female; Humans; Infant; Nalidixic Acid; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The incidence of trimethoprim resistance was correlated with changes in prescription behaviour in the Nottingham area from 1978-1985. The prevalence of trimethoprim resistance among Enterobacteriaceae isolated from patients with urinary tract infection rose from 5% to 15% of total strains examined. Strains resistant to trimethoprim but susceptible to sulfamethoxazole appeared from 1980 onward and represented 35% of the total trimethoprim-resistant strains examined in 1985. Co-trimoxazole (trimethoprim + sulfamethoxazole) has been generally available for prescription in the United Kingdom since 1969, whereas trimethoprim alone was released in October 1979. By 1983, prescriptions in the form of trimethoprim alone accounted for approximately 50% (in hospitals) and 15% (in the community) of total trimethoprim usage in the Nottingham area. Although the introduction of trimethoprim alone seems to have had only a minor effect on overall resistance levels, it has greatly increased the proportion of trimethoprim-resistant strains which are susceptible to sulfamethoxazole. This was particularly evident in strains of Proteus spp., in which 52% of the total trimethoprim-resistant strains were sulfamethoxazole-susceptible in 1985.

Topics: Drug Combinations; Drug Resistance, Microbial; England; Enterobacteriaceae; Enterobacteriaceae Infections; Humans; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Drug Combinations; Female; Humans; Recurrence; Self Administration; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

This is a case report of a patient who developed severe drug eruptions suspected to have been caused by sulphamethoxazole-trimethoprim (ST) administered orally for the treatment of urinary infection after burn injury. He had been treated topically with silver sulphadiazine (AgSD) after injury. The immunological examinations revealed positive reactions to both drugs, so that it is surmised that AgSD created the sensitivity and might be concerned in these drug eruptions. For such reasons, it is advisable, especially in patients who have been previously treated with topical or oral sulphonamides or have had episodes of hypersensitivity to such drugs, to administer sulphonamides carefully, or if possible to avoid administration.

Topics: Adult; Anti-Infective Agents, Urinary; Burns; Drug Combinations; Drug Eruptions; Humans; Male; Patch Tests; Silver Sulfadiazine; Staphylococcal Infections; Sulfadiazine; Sulfamethoxazole; Sulfonamides; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

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

Topics: Anti-Infective Agents, Urinary; Bacterial Infections; Drug Combinations; Drug Resistance, Microbial; Humans; Microbial Sensitivity Tests; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Among 185 patients with nonneutropenic, community-acquired gram-negative bacillary bacteremias, clinical risk factors for cefoxitin resistance included any antibiotic taken within the last three weeks (25.6% cefoxitin resistance), long-term bladder catheterization or surgical urinary diversion (23.3%), hospitalization within the last 30 days (22.9%), and nursing home residence before admission (20.8%). Patients with none of these risk factors were less likely to have cefoxitin-resistant bacteremias (0.9%). When these risk factors were examined in the subgroups of urinary tract and non-urinary tract sources of community-acquired gram-negative bacillary bacteremia, they were also helpful in predicting sensitivity to trimethoprim-sulfamethoxazole and gentamicin. The presence of one or more of the risk factors identified may be a useful adjunct in determining initial empiric antimicrobial therapy for community-acquired gram-negative bacillary bacteremia.

Topics: Cefoxitin; Child; Clindamycin; Cross Infection; Drug Combinations; Drug Resistance, Microbial; Gentamicins; Gram-Negative Bacteria; Humans; Retrospective Studies; Risk; Sepsis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Catheterization; Urinary Diversion; Urinary Tract Infections

Antibiotic-associated colitis (pseudomembranous colitis) developed in four patients with spinal cord injury and taking oral trimethoprim-sulfamethoxazole. One hundred forty-eight (59%) of 251 patients with spinal cord injury who were evaluated had received this drug. Two of the four patients with pseudomembranous colitis did not promptly respond to therapy, and all four suffered significant further immobilization because of the disease. Pseudomembranous colitis readily occurs in at least certain population groups receiving trimethoprim-sulfamethoxazole.

Topics: Adult; Anti-Infective Agents, Urinary; Clostridium Infections; Diarrhea; Drug Combinations; Enterocolitis, Pseudomembranous; Humans; Male; Middle Aged; Premedication; Spinal Cord Injuries; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A 94-year-old man had pseudomembranous colitis while taking low dose trimethoprim-sulfamethoxazole for recurrent urinary tract infection. The suppressive effect of low dose trimethoprim-sulfamethoxazole on normal colonic flora appeared to be a factor in the development of pseudomembranous colitis in this patient.

Topics: Aged; Anti-Infective Agents, Urinary; Drug Combinations; Enterocolitis, Pseudomembranous; Humans; Male; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Aged; Chemical and Drug Induced Liver Injury; Cholestasis, Intrahepatic; Drug Combinations; Drug Hypersensitivity; Female; Humans; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Antimicrobial sensitivities, especially trimethoprim-sulfamethoxazole, were studied in all clinical isolates of Escherichia coli in an intensive care unit for over 18 months. Twenty-four per cent of strains were resistant to trimethoprim-sulfamethoxazole. Combined resistance to ampicillin +/- chloramphenicol (+/- tetracycline) and streptomycin (+/- kanamycin) with resistance to trimethoprim-sulfamethoxazole was demonstrated. These data confirm the previously reported increasing trimethoprim-sulfamethoxazole resistance which is probably plasmid-mediated and specify the resistances associated with trimethoprim-sulfamethoxazole resistance. These findings suggest that widespread prophylaxis in granulocytopenic patients with lower urinary tract infection by the trimethoprim-sulfamethoxazole association should be re-examined.

Topics: Anti-Bacterial Agents; Bacterial Infections; Drug Combinations; Drug Resistance, Microbial; Escherichia coli; Humans; Neutropenia; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A model of ascending urinary tract infection due to an isolate of Escherichia coli was developed in normal and streptozotocin-induced mice to compare the efficacy of norfloxacin and trimethoprim-sulphamethoxazole. Norfloxacin and trimethoprim-sulphamethoxazole both were effective in reducing the number of colony forming units of E. coli from the kidneys of normal experimentally-infected mice, although norfloxacin yielded a greater quantitative reduction of colony forming units. Norfloxacin was substantially more effective than trimethoprim-sulphamethoxazole in reducing the number of colony forming units from kidney homogenates when the test animals were diabetic. This study supports the initiation of clinical trials to evaluate norfloxacin in diabetic patients.

Topics: Animals; Anti-Infective Agents; Diabetes Mellitus, Experimental; Disease Models, Animal; Drug Combinations; Escherichia coli Infections; Female; Mice; Mice, Inbred Strains; Norfloxacin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In this study; E. coli strains isolated from 100 patients with urinary tract infections were investigated for their antibiotic susceptibility and metabolic deficiencies. The strains were found to be highly susceptible to gentamicin (%97), Bactrim (R) (%77) and resistant to the other antibiotics in changing but important degrees. Study of metabolic deficiencies revealed that 9 of the strains were in accord with the deficiency criteria and only one of them was thymin-dependent.

Topics: Adult; Aged; Anti-Bacterial Agents; Drug Combinations; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Female; Gentamicins; Humans; Male; Middle Aged; Sulfamethoxazole; Thymine; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Over six years (1978-83, inclusive) weekly laboratory records of organisms causing urinary tract infection in women aged 15-25 not attending hospital were kept prospectively and analysed. The incidence of infection with Staphylococcus saprophyticus defined by age and sex was confirmed. This organism caused an increasing proportion of infections in young women over the six years studied, and these infections showed noticeable seasonality. All but four isolates of S saprophyticus were sensitive to all the commonly used antimicrobial agents that were tested. This might be because the organism is not often present in the body as a commensal and therefore not subject to the selection pressures exerted by such agents. As infection with S saprophyticus has different clinical connotations from infection with other coagulase negative staphylococci it should be differentiated from them in routine laboratory practice.

Topics: Adolescent; Adult; Age Factors; Drug Combinations; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Prospective Studies; Seasons; Staphylococcus; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Urinary malakoplakia may pursue an aggressive clinical course with persistent infection, despite seemingly appropriate antibiotic therapy. The authors studied seven adult females with urinary malakoplakia. Specific immunocytochemical staining demonstrated intracellular Escherichia coli in malakoplakia tissue in four patients. In two of the four patients, the bacteria were present despite antibiotic-induced sterile urines at time of biopsy. Cessation of therapy consistently lead to recurrent bacteriuria in these patients. In one such patient, the intracellular bacilli were confirmed as E. coli by culture of crushed malakoplakia tissue and electron microscopic study; the organisms were a routine E. coli strain susceptible to multiple previously administered antibiotics. Only sequential treatment with bethanechol chloride and trimethoprim-sulfamethoxazole, however, eliminated the infection; all three drugs are thought to be capable of enhancing intracellular killing of bacteria. Conventional antibiotic therapy failed to halt progression of disease in other malakoplakia patients. The data indicate that intracellular bacteria may serve as a reservoir of persistent/recurrent infection in urinary malakoplakia. Optimal therapy should include therapeutic agents that may control intracellular organisms.

Topics: Adult; Aged; Bacteriological Techniques; Bacteriuria; Bethanechol; Bethanechol Compounds; Drug Combinations; Escherichia coli; Escherichia coli Infections; Female; Humans; Immunoenzyme Techniques; Malacoplakia; Male; Middle Aged; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urologic Diseases

The gamma-pyridone beta-carboxylic acids or 'quinolones' rival beta-lactam antibiotics in diversity of chemical structure and properties. Norfloxacin has a much wider spectrum than nalidixic acid which includes pseudomonas and Gram-positive cocci. It is also much more potent with MIC50 for Enterobacteriaceae of less than 0.06 mg/l. This high activity is reduced in the presence of urine--possibly due to pH, but probably not to clinically inadequate levels. The results of laboratory tests from around the world are reviewed; despite various techniques these are remarkably consistent. The wide spectrum of norfloxacin should make it useful for therapy of urinary tract infection, and for gut decontamination and enteric infections. The high potency should allow use of lower doses with possibly less toxicity than nalidixic acid.

Topics: Anti-Infective Agents, Urinary; Bacteria; Drug Combinations; Humans; Microbial Sensitivity Tests; Nalidixic Acid; Norfloxacin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In vitro susceptibility testing correctly predicted the outcome of ampicillin therapy in all 56 urinary tract infections (UTI) caused by coagulase-positive staphylococci (Staphylococcus aureus and S intermedius), in all 26 UTI caused by Proteus mirabilis, in 38 of 44 UTI caused by Escherichia coli, in 29 of 31 UTI caused by Streptococcus spp, in 8 of 10 UTI caused by Klebsiella pneumoniae, and in 16 of 20 UTI caused by other bacterial species. Thus, 173 of 187 (92.5%) isolates responded to ampicillin therapy in a manner predicted by in vitro susceptibility test results. In vitro susceptibility testing correctly predicted the outcome of therapy with trimethoprim-sulfa in 119 of 138 UTI caused by Escherichia coli, in 33 of 45 UTI caused by Klebsiella pneumoniae, in 38 of 43 UTI caused by Proteus mirabilis, in 21 of 25 UTI caused by Streptococcus spp, in 9 of 11 UTI caused by coagulase-positive staphylococci, and in 19 of 21 UTI caused by other bacterial species. Thus, 239 of 283 (84%) isolates responded to trimethoprim-sulfa therapy in a manner predicted by in vitro susceptibility test results.

Topics: Ampicillin; Animals; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Bacteria; Bacterial Infections; Dog Diseases; Dogs; Drug Combinations; Female; Male; Microbial Sensitivity Tests; Prognosis; Species Specificity; Sulfadiazine; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Two patients with uncomplicated enterococcal urinary tract infections were treated with trimethoprim-sulfamethoxazole based on in vitro susceptibilities. Bacteremia developed in both patients and they recovered only after the cessation of trimethoprim-sulfamethoxazole administration and institution of therapy with penicillin G potassium or vancomycin hydrochloride plus streptomycin sulfate. Although the enterococcus may appear susceptible to trimethoprim-sulfamethoxazole in vitro, it escapes the antifolate activity of the drug in vivo by its unique ability to incorporate preformed exogenous folates. The practice by clinical microbiology laboratories of reporting the susceptibilities of the enterococcus to drugs other than the penicillins or vancomycin is misleading and potentially dangerous.

Topics: Drug Combinations; Drug Therapy, Combination; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Penicillin Resistance; Penicillins; Sepsis; Streptococcal Infections; Streptococcus; Streptomycin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vancomycin

Topics: Acute Disease; Aminoglycosides; Anti-Bacterial Agents; Bacteriuria; Cystitis; Drug Combinations; Female; Fetus; Folic Acid; Humans; Male; Obstetric Labor, Premature; Pregnancy; Pregnancy Complications, Infectious; Pyelonephritis; Recurrence; Sulfamethoxazole; Tetracycline; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

All urinary pathogens from general practice and from hospital have been tested for sensitivity to a range of antimicrobial drugs for the last 12 years. During that period there have been marked changes. In general practice there has been a marked increase in the proportion of staphylococcal infections, from 5.1% to 14.8%, and a noticeable decrease in the proportion caused by Proteus mirabilis, from 9.2% to 4.1%. Similar, but smaller, changes have been seen in the proportions of hospital UTI caused by those organisms, while the proportion of hospital infections due to Klebsiella-Enterobacter spp. has fallen from 16.8% to 8.3%. These, and other, changes have been reflected in changing antibiotic sensitivity patterns. In particular, sensitivity of urinary pathogens to ampicillin/amoxycillin and to cephaloridine has continued to fall both in general practice and in hospital. In general practice UTI nalidixic acid-resistance is becoming more important as the proportion of Gram-positive urinary pathogens increases. There has been little change in sensitivity to trimethoprim or co-trimoxazole over the last 12 years.

Topics: Amoxicillin; Ampicillin; Anti-Bacterial Agents; Cephaloridine; Drug Combinations; Escherichia coli Infections; Humans; Microbial Sensitivity Tests; Penicillin Resistance; Proteus mirabilis; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Adhesion of a 3H-thymidine-labeled reference strain of enterococci to epithelial cells of buccal mucosa from 20 young female patients with rec. UTI (aged 3 to 15 years) and 19 urologically healthy girls was investigated. Bacterial attachment in children with rec. UTI was significantly higher statistically than in the healthy control group and did not show any alteration when tested separately during acute UTI (14 cases) and infection-free intervals (17 cases). There was no difference in adherence between patients with rec. UTI connected with diverse anomalies of the urinary tract (12 girls) and UTI patients without anomalies (8 girls). Within the patient group 3 cases under antimicrobial prophylaxis with co-trimoxazole showed bacterial adhesion similar to that in healthy controls. Our examination results lead to the assumption that attachment of enterococci to buccal epithelial cells can be used as a diagnostic criterion for rec. UTI.

Topics: Adolescent; Anti-Infective Agents, Urinary; Bacteriological Techniques; Cheek; Child; Child, Preschool; Drug Combinations; Epithelium; Female; Humans; Recurrence; Risk; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract; Urinary Tract Infections

Topics: Aged; Anti-Infective Agents, Urinary; Drug Combinations; Escherichia coli Infections; Female; Hematuria; Humans; Melena; Sulfamethoxazole; Thrombocytopenia; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Forty-two cases of children showing recurrent urinary tract infection were treated. Three treatment guides were used: the first group of children were given trimetoprim-sulphametoxazole (TMP-SMZ) only, the second and third ones were treated with TMP-SMZ and alternative nitrofurantoine in the former or nalidixic acid in the latter. After treatment a meaning reduction in frequency of urinary tract infection cases (p less than 0.001) were observed. Best results (lesser percentage of failures and lesser number of urinary tract infection cases per month of observation) were achieved in the second and third groups, probably due to a high percentage of resistance cases against TMP-SMZ found during prophylactic treatment (72.07).

Topics: Anti-Infective Agents, Urinary; Child; Child, Preschool; Drug Combinations; Drug Resistance, Microbial; Drug Therapy, Combination; Female; Humans; Male; Nalidixic Acid; Nitrofurantoin; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Child; Child, Preschool; Drug Administration Schedule; Drug Combinations; Humans; Nitrofurantoin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Drug Combinations; Female; Humans; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urination Disorders

A better understanding of the pathophysiology of urinary infection has markedly altered treatment programs. Single-dose therapy should be used for infections limited to the bladder. In contrast, treatment periods of 4-6 wk are needed to yield the best cure rates in upper tract infections. TMP/SMX thrice weekly has proved to be a successful prophylactic program for women with recurrent urinary infection. In contrast to the female, young children and men require longer therapy periods for urinary infection and should always have a detailed radiologic and urologic evaluation to eliminate the possibility of structural abnormalities.

Topics: Adolescent; Adult; Age Factors; Aged; Anti-Bacterial Agents; Bacteriuria; Child; Child, Preschool; Drug Combinations; Drug Therapy, Combination; Enterobacteriaceae Infections; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged; Sex Factors; Staphylococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adult; Aged; Anti-Infective Agents, Urinary; Drug Combinations; Female; Humans; Male; Middle Aged; Nicotinic Acids; Pipemidic Acid; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Child, Preschool; Cholestasis, Intrahepatic; Drug Combinations; Female; Humans; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The belief that a favorable physiological milieu in the urinary tract may augment the effectiveness of antimicrobial agents used to treat urinary tract infections was examined by using an experimental model of Escherichia coli-induced renal infection in rats. The effect of manipulating urinary pH and flow on the antimicrobial activities of gentamicin, carbenicillin, ampicillin, nitrofurantoin and co-trimoxazole was assessed. In addition, a potential synergistic effect of the sequential administration of gentamicin and cephalothin in the eradication of renal infection was investigated. Although significant physiological alterations were achieved, these did not affect the efficacy of the antimicrobial agents studied, and therapeutic failures were common.

Topics: Ampicillin; Animals; Anti-Infective Agents, Urinary; Carbenicillin; Diuresis; Drug Combinations; Female; Gentamicins; Hydrogen-Ion Concentration; Kidney; Kidney Diseases; Nitrofurantoin; Rats; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urine; Urodynamics

Eighty-one patients with proved preoperative sterile urine and undergoing transurethral resection of the prostate were studied. The patients were divided into 3 groups: group A received sulfamethoxazole-trimethoprim (ST) preoperatively and postoperatively for ten days; group B received ST in 2 divided doses, one pre- and one postoperatively; group C received no prophylaxis. In groups A and B, we found urinary infection in 3.8 per cent of patients compared with 32 per cent in group C. Performing prostatic chip cultures, we found that most urinary infections were unrelated to a prostatic source. When the prostate was infected, 75 per cent had infected urine postoperatively. We believe that prophylactic antimicrobial treatment should be given to all patients undergoing transurethral prostatectomy. However, it seems that immediate perioperative treatment suffices.

Topics: Aged; Anti-Infective Agents, Urinary; Drug Combinations; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Prostatectomy; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Co-trimoxazole is an effective antibacterial agent for the prophylaxis of urinary tract infection. Because experimental evidence raises the possibility that high-dose cotrimoxazole might interfere with normal somatic growth, the longitudinal growth and growth velocities were analysed in 114 girls receiving long-term, low-dose prophylactic cotrimoxazole. They were aged 2-12 years at the start of prophylaxis which was given in a daily dose of approximately 10 mg sulphamethoxazole (SMX) and 2 mg trimethoprim (TMP)/kg body weight for at least 6 months and for up to 6 years. There was no significant variation from normal in height or weight attained or in growth velocity overall in 114 girls, 51 of whom had vesico-ureteric reflux (VUR). No difference was found in growth velocity when periods of 6 months on or off prophylactic therapy were compared in 53 girls. Growth did not vary between cohorts of girls receiving co-trimoxazole prophylaxis for 2, 3 or 4 years and growth proceeded normally in the 51 girls with VU reflux. We have not found evidence that long-term, low-dose cotrimoxazole prophylaxis has any adverse effect upon somatic growth in girls with a previous urinary infection with or without vesico-ureteric reflux and who are otherwise healthy.

Topics: Body Height; Body Weight; Child; Child, Preschool; Drug Combinations; Female; Growth; Humans; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

One hundred and sixteen adults with symptoms of acute urinary tract infection were randomly collected into four groups and given single-dose or seven-day treatment with trimethoprim or co-trimoxazole. Of the 105 patients who completed the study, bacterial urinary infection was present in 70 patients (67 per cent). The rates for symptomatic and bacterial cures were high and indistinguishable between the groups, and there was no difference in the rate of recurrence of urinary infection in the six weeks after treatment. Side effects were lower in the group receiving single-dose trimethoprim (P=0.09).

Topics: Adolescent; Adult; Aged; Drug Administration Schedule; Drug Combinations; Female; Humans; Male; Middle Aged; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

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

Topics: Child; Child, Preschool; Drug Combinations; Female; Humans; Infant; Male; Nitrofurantoin; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract; Urinary Tract Infections

Topics: Adolescent; Child; Child, Preschool; Drug Combinations; Female; Humans; Male; Sulfamethoxazole; Thyroid Gland; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Age Factors; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Bacterial Infections; Child; Child, Preschool; Diagnostic Errors; Drug Combinations; Female; Humans; Infant; Infant, Newborn; Male; Nalidixic Acid; Nitrofurantoin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

9 children presenting with an ampicillin-sensitive coliform urinary tract infection were treated with talampicillin using 1 week of full-dose treatment followed by low-dose prophylaxis. The bowel coliforms were ampicillin-resistant at the start in one girl and became resistant in the remaining 8 within 4 months. During a total of 44 months of talampicillin therapy, 6 girls (2 with vesico-ureteric reflux) developed a symptomatic re-infection of the urinary tract, a recurrence rate of 1 per 7.3 months, or 1.6 recurrences per annum. A further 12 girls were given prophylactic talampicillin, 9 after an initial therapeutic course of co-trimoxazole for 1 week and 3 following a period of prophylaxis with low-dose co-trimoxazole. The rectal swab from one girl showed partial ampicillin resistance but 9 of the remaining 11 showed that a predominance of ampicillin-resistance coliforms had emerged in the bowel flora within 4 months. 5 of the 12 also developed a symptomatic ampicillin-resistant urinary infection within 4 months, a recurrence rate of 1 per 7.1 months or 1.7 recurrences per annum. Talampicillin, though very effective in treating urinary infection, is not recommended for the prevention of subsequent recurrence.

Topics: Ampicillin; Child; Child, Preschool; Drug Combinations; Female; Humans; Infant; Male; Recurrence; Sulfamethoxazole; Talampicillin; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

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

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Bacteriuria; Child; Child, Preschool; Drug Combinations; Female; Humans; Infant; Infant, Newborn; Male; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Bacterial Infections; Drug Combinations; Dysentery, Bacillary; Humans; Otitis Media; Pneumonia, Pneumocystis; Salmonella Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Child, Preschool; Drug Combinations; Humans; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The local tolerance of a new mode of application of Cotrimoxazole (Eusaprim i.m.) was tested in 104 patients by 12 general practitioners in the region of Northern Bavaria. The patients received 1--2 injections, after which the assessment of local tolerance of the injection was done.. Parameters were the subjective statements by the patients and the objective findings by the physicians. 102 out of 104 patients reported about a good or acceptable tolerance. The physicians found a good tolerance in 99 cases and an average one in 5 patients.

Topics: Abscess; Adolescent; Adult; Aged; Drug Combinations; Female; Gastroenteritis; Humans; Injections, Intramuscular; Male; Middle Aged; Respiratory Tract Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adult; Aged; Digestive System Surgical Procedures; Drug Combinations; Female; Humans; Male; Middle Aged; Postoperative Complications; Respiratory Tract Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Acute Disease; Animals; Drug Combinations; Drug Synergism; Drug Therapy, Combination; Female; Humans; Male; Sulfamethoxazole; Sulfonamides; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Administration, Oral; Adult; Bacteria; Child; Drug Combinations; Drug Interactions; Drug Resistance, Microbial; Dysentery, Bacillary; Humans; Infusions, Parenteral; Neutropenia; Nocardia Infections; Otitis Media; Pneumonia, Pneumocystis; Salmonella Infections; Sepsis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Cinoxacin; Drug Combinations; Female; Humans; Male; Middle Aged; Pyridazines; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adult; Anti-Infective Agents, Urinary; Cefaclor; Cephalexin; Drug Combinations; Female; Humans; Male; Middle Aged; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections