Long-Term Prophylaxis of Urinary Infections in Women: Comparative Trial of Trimethoprim, Methenamine Hippurate and Topical Povidone-Iodine

Abstract

We randomized 64 patients with a history of recurrent urinary tract infections among 3 regimens of long-term (1 year) prophylactic treatment: 20 were given 100 mg. trimethoprim at night, 25 received 1,000 mg. methenamine hippurate every 12 hours and 19 were asked to cleanse the perineum (especially the periurethral area) twice daily with povidone-iodine solution. The progress of patients in terms of urinary symptoms and/or bacteriuria, changes in periurethral flora, side effects, and hematological and biochemical profiles was followed at regular intervals. All treatments were effective in reducing the incidence of symptomatic attacks when compared to the 12 months immediately before therapy and there was little to choose between the individual regimens on this account. However, trimethoprim was tolerated better than were the other 2 treatment regimens. In the group given trimethoprim most of the breakthrough infections (71.4 per cent) that occurred were caused by trimethoprim-resistant organisms (usually Escherichia coli), while in the other 2 groups the incidence of trimethoprim-resistant organisms causing infection was low (2.7 per cent). Treatment with trimethoprim reduced significantly the periurethral colonization of Escherichia coli.

Effect of amoxicillin-clavulanate and cephradine on the fecal flora of healthy volunteers not exposed to a hospital environment

“…This finding is probably associated with the ability of these two antibiotics to select for resistant bowel flora. Amoxicillin does this after a course of therapy as short as only 7 days, whereas trimethoprim may take longer to select for resistant coliforms (4). In a recent clinical trial in which cephradine was given prophylactically for 12 months (unpublished data), we observed neither emergence of resistant species nor selection for intrinsically resistant species.…”

Potential Uses of Probiotics in Clinical Practice

“…This compares favorably with two studies that used daily antibiotic therapy to prevent urinary tract infection. The first was a randomized study of 64 patients with a history of recurrent urinary tract infections given trimethoprim (100 mg) at night for 1 year or methenamine hippurate (1,000 mg) every 12 h or asked to cleanse the perineum (especially the periurethral area) twice daily with povidone-iodine solution (15). In this study, the urinary tract infection recurrence rates fell from 6 in the previous year to 2.1, 2.0, and 2.2, respectively, for the three groups.…”

Urogenital infections in women: can probiotics help?

“…Daily, low dose, long term antibiotic treatment with nitrofurantoin (50 mg at night) or other agents, is quite effective and widely used. But breakthrough infections still occur with antibiotic and antiseptic therapy, 30 due to particularly virulent pathogens, the influence of sexual practices, or other reasons. In some patients, self administration of a three day antibiotic course upon the start of symptoms and signs of UTI offers a good alternative to daily prophylaxis, leading to fewer side effects and lower risk of the development of pathogen drug resistance.…”