Antimicrobial Prophylaxis of Recurrent Urinary Tract Infections

Abstract

To study once-daily antimicrobial prophylaxis of urinary tract infections, we gave trimethoprim-sulfamethoxazole (40 mg/200 mg), trimethoprim (100 mg), nitrofurantoin macrocrystals (100 mg), or placebo to 60 women for 6 months. During prophylaxis, infections per patient year were comparable in the groups receiving trimethoprim (0.0), nitrofurantoin (0.14), or trimethoprim-sulfamethoxazole (0.15) and occurred less frequently than in patients receiving placebo (2.8; P less than 0.001, placebo versus each drug regimen). The effectiveness of prophylaxis was limited to the 6 months that antimicrobials were given, and infections were more likely to develop after prophylaxis in women who had three or more infections in the year before prophylaxis (P less than 0.005). Further, women whose preprophylaxis infection was positive for antibody-coated bacteria were more likely to have same-strain relapse when infections recurred (P = 0.001). Emergence of trimethoprim-resistant Escherichia coli was rare, but non-E. coli infections occurred more often after prophylaxis (P less than 0.05). Prophylaxis with these drugs is effective, well tolerated, and did not produce emergence of resistant E. coli but may predispose to non-E. coli urinary tract infections after its discontinuation.

Risk factors for fecal colonization with trimethoprim-resistant and multiresistant Escherichia coli among children in day-care centers in Houston, Texas

“…This frequency of Tmpr was higher than that previously reported among strains colonizing healthy U.S. adults (7) or adults receiving trimethoprim (TMP) (3,14,19,20), suggesting that diapered children attending DCC might be a reservoir of resistant E. coli in this country. The pilot study did not have a non-DCC group of diapered children for comparison.…”

“…This frequency of Tmpr was higher than that previously reported among strains colonizing healthy U.S. adults (7) or adults receiving trimethoprim (TMP) (3,14,19,20) Moreover, the overall Tmpr E. coli colonization rate of 19% was due primarily to one large DCC in which 37% of children were colonized with one predominant strain of multiresistant E. coli. Because DCC are an increasingly important part of life in the United States and because of the questions raised in our pilot study, we evaluated antibiotic resistance in 203 diapered children in 12 DCC and included two control groups: 51 children in a pediatric clinic and 64 medical students.…”

“…Since prevalence surveys were conducted on three occasions in DCC A, there were data from 46 children whose stools were tested two or three times at 6-to 10-week (3,7,14,19,20); perhaps as a corollary, clinical isolates of Tmpr E. coli have also remained uncommon (5,8,11,21). A second reason is that in this study and in our previous studies,'the presence of Tmpr has been an excellent indicator of the presence of multire'sistance and is a better indicator than resistance to either AMP or sulfonamides (13,17).…”

Recurrent Urinary Tract Infections Management in Women : A Review = الإلتهابات المتكررة للمسالك البولية عند النساء و طرق علاجها : مراجعة

“…Because of its poor efficacy, amoxicillin and ampicillin should not be used for the empirical treatment of UTIs. 48 TMP-SMX and fluoroquinolones prevent RUTI by inhibiting the recovery rate of uropathogens (especially E. coli) from the faecal reservoir, 52 while nitrofurantoin plays its role in the treatment of RUTI by sterilising the urine and inhibiting bacterial attachment. 24,53,54 A follow-up urinalysis and urine culture, also called the 'test of cure' , is not indicated in women with uncomplicated UTIs, but should be performed in those women who are suffering from RUTIs or a complicated UTI.…”

Prospective, randomized, placebo-controlled trial of norfloxacin for the prophylaxis of recurrent urinary tract infection in women

“…The patient subsequently treated herself, with resolution of symptoms, and completed the 5 remaining study months without further episodes. In retrospect, this was considered in the analysis as symptomatic urinary tract infection with low bacterial counts (16). An additional patient in the placebo group who completed 12 months of therapy took two self-medicated single doses during the year of therapy because of perceived symptoms.…”