Treatment of Cystitis in Women with a Single Dose of Trimethoprim-Sulfamethoxazole

Counts, George W.; Stamm, Walter E.; McKevitt, Mary; Running, Kate; Holmes, King K.; Turck, Marvin

doi:10.1093/clinids/4.2.484

Cited by 57 publications

(14 citation statements)

References 15 publications

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“…The failure of cefaclor as a single dose in the Greenberg et al trial (14) versus the favorable results of cefuroxime axetil in the present trial and ceftrioxone as a single dose (21) may be attributed to pharmacokinetic factors. A variety of other antimicrobial agents have been reported to be effective as single-dose treatments in women with acute UTIs (7,25,34,38). We and others have found a single 3-g dose of amoxicillin to be as effective as a 7-to 10-day course in a similar patient population (2,20,34,41).…”

Section: Discussionmentioning

confidence: 66%

Single-dose cefuroxime axetil versus multiple-dose cefaclor in the treatment of acute urinary tract infections

Iravani

Richard

1989

Antimicrob Agents Chemother

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Eighty-nine college women with acute urinary tract infections were treated orally with either 1,000 mg of cefuroxime axetil in a single dose (n = 59) or 250 mg of cefaclor three times a day for 7 days (n = 30). At 1 week posttherapy, 88% of the patients in the cefuroxime axetil group and 97% in the cefaclor group were clinically and bacteriologically cured (P > 0.10). There was no statistically significant difference between the cure rates of the two treatment groups. However, this study has only a 50% power to detect a 10% difference. Therefore, there is a substantial possibility of a type II error, i.e., failing to find a difference that is actually present. At 4 weeks posttherapy, 78% of the patients in the cefuroxime group and 80% in the cefaclor group remained cured. By 36 weeks posttherapy, the cumulative rate of recurrence in both treatment groups was 60%. Of the patients with a positive antibody-coated bacteria test, fewer achieved a short-term cure after single-dose treatment with cefuroxime axetil than those with a negative antibody-coated bacteria test (67 versus 96%; P < 0.01).Urinary tract infections (UTIs) are a common medical problem in women (1,12,26,30). They are usually associated with symptoms of cystitis, although the kidneys may be involved (5-7, 11, 23, 41). Single-and multiple-dose regimens of a variety of antimicrobial agents have been reported to be effective in the treatment of these infections in women (15,19,21,33,35). Single-dose antibiotic therapy with simultaneous localization studies of the sites of infection has resulted in favorable responses in patients with infections confined to the bladder and poor responses in those with upper urinary tract involvement or complicated infections (2,10,34,35,38,39,41). Other advantages of single-dose therapy are lower cost, increased patient compliance, fewer adverse effects, and reduced potential for emergence of resistant bacteria in the gut. However, comparisons of long-term recurrence rates between single-dose therapy and conventional multidose therapy are not available.Cephalosporins have a broad spectrum of antimicrobial activity, but their efficacy in single-dose therapy remains controversial (5,14,32,35). The patient population studied, the types of infections, and the pharmacokinetic characteristics of the tested cephalosporin contribute in part to the conflicting results.Cefuroxime axetil was evaluated as a single dose in this clinical study. Cefuroxime is a broad-spectrum, P-lactamase-stable parenteral cephalosporin which is not well absorbed in the gastrointestinal tract, whereas cefuroxime axetil, a novel ester prodrug of cefuroxime, is de-esterified in the intestinal mucosa after oral administration into the active form of cefuroxime and subsequently absorbed to attain effective therapeutic concentrations in plasma and urine (16, 37). The purposes of this trial were (i) to compare the efficacy and safety of a single dose of cefuroxime axetil versus multiple doses of cefaclor for treatment of UTIs, (ii) to relate therapeutic resp...

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Section: Discussionmentioning

confidence: 66%

Single-dose cefuroxime axetil versus multiple-dose cefaclor in the treatment of acute urinary tract infections

Iravani

Richard

1989

Antimicrob Agents Chemother

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“…5,6 Vaginal cultures were considered positive for E coli if there was Ն1+ growth on a semiquantitative scale. The Kirby-Bauer disc method was used to determine antimicrobial susceptibility of causative strains.…”

Section: Laboratory Studiesmentioning

confidence: 99%

Amoxicillin-Clavulanate vs Ciprofloxacin for the Treatment of Uncomplicated Cystitis in Women

Hooton¹,

Scholes²,

Gupta³

et al. 2005

JAMA

162

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CUTE UNCOMPLICATED URInary tract infections (UTIs) are among the most commonly encountered bacterial infections in women. Management of these infections has been made more complicated in recent years by increasing antimicrobial resistance, especially to ␤-lactams and trimethoprim-sulfamethoxazole. The current standard for the empirical treatment of acute uncomplicated cystitis is trimethoprimsulfamethoxazole for 3 days. Because the prevalence of resistance to trimethoprimsulfamethoxazole among uropathogens is increasing, however, fluoroquinolones are increasingly being used as empirical therapy for the management of cystitis. 1,2 Increasing fluoroquinolone resistance in many pathogens causing health care-associated and communityacquired infections has raised concerns about the future usefulness of this potent and frequently prescribed class of antibiotics. 3 It is important, therefore, that fluoroquinolone-sparing antibiotics be used when appropriate. In the case of acute cystitis, nitrofurantoin and fosfomycin tromethamine have been advocated as fluoroquinolone-sparing

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“…At each follow-up visit, a genitourinary history was taken, patients were asked about adverse effects by using a checklist, and a midstream urine sample was collected for culture. At the enrollment and follow-up visits, rectal, urethral, and vaginal swabs for aerobic bacterial cultures were collected from patients by using previously described methods (4). All specimens were transported to the appropriate laboratory within 4 h of collection.…”

mentioning

confidence: 99%

Single-dose and three-day regimens of ofloxacin versus trimethoprim-sulfamethoxazole for acute cystitis in women

Hooton

Johnson

Winter

et al. 1991

Antimicrob Agents Chemother

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We compared the safety and efficacy of a single 400-mg dose of ofloxacin, ofloxacin (200 mg) once daily for 3 days, and trimethoprim-sulfamethoxazole (160:800 mg) twice daily for 7 days for the treatment of acute uncomplicated cystitis (urinary tract infection [UTI]) in women. At 5 weeks posttreatment, 35 (81%) of 43 patients treated with single-dose ofloxacin, 40 (89%) of 45 treated with 3 days of ofloxacin, and 41 (98%) of 42 treated with trimethoprim-sulfamethoxazole were cured (P = 0.03, single-dose ofloxacin group versus trimethoprim-sulfamethoxazole group). Retreatment for symptomatic recurrent UTI was given to 7 (16%) of 43 patients initially treated with single-dose ofloxacin, 3 (7%) of 45 patients treated with 3 days of ofloxacin, and 0 of 42 patients treated with trimethoprim-sulfamethoxazole (P = 0.01, single-dose ofloxacin group versus trimethoprim-sulfamethoxazole group). There was a trend in each of the three treatment groups toward an association between persistent or recurrent episodes of significant bacteriuria and a history of UTI in the past year and with diaphragm use. Ofloxacin was more effective than trimethoprim-sulfamethoxazole in eradicating Escherichia coli from rectal cultures during or soon after therapy, but there were no differences at later follow-up visits. Adverse effects were equally common among the three treatment groups. We conclude that single-dose ofloxacin was less effective than 7 days of trimethoprim-sulfamethoxazole for treatment of uncomplicated cystitis in women, while the 3-day ofloxacin regimen and the trimethoprim-sulfamethoxazole regimen were not significantly different in efficacy.The majority of cases of acute cystitis in young healthy women are effectively treated with conventional oral antimicrobial agents such as trimethoprim-sulfamethoxazole or nitrofurantoin. Ampicillin and sulfonamides have become less reliable in such cases because of the high prevalence of resistance to these agents among common uropathogens (10). The new fluoroquinolone antimicrobial agents, of which ofloxacin is one, have also been demonstrated to be effective for treatment of cystitis (24). While these agents are not considered the treatment of choice for uncomplicated cystitis, they are often used in patients who are intolerant of conventional agents, who have resistant pathogens, or in whom the presence of a complicating factor is more likely.Single-dose or 3-day regimens of antimicrobial agents are becoming increasingly popular for the treatment of uncomplicated cystitis because, compared with conventional regimens, they tend to be as effective and are associated with fewer adverse effects, better compliance, and lower cost (10). However, there are no published data on the use of the new fluoroquinolones in single-dose regimens for the treatment of uncomplicated cystitis in the United States. We therefore compared the safety and efficacy of ofloxacin in a single-dose regimen with a regimen of once-daily doses of ofloxacin for 3 days and with a conventional 7-day regimen of trimet...

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Treatment of Cystitis in Women with a Single Dose of Trimethoprim-Sulfamethoxazole

Cited by 57 publications

References 15 publications

Single-dose cefuroxime axetil versus multiple-dose cefaclor in the treatment of acute urinary tract infections

Single-dose cefuroxime axetil versus multiple-dose cefaclor in the treatment of acute urinary tract infections

Amoxicillin-Clavulanate vs Ciprofloxacin for the Treatment of Uncomplicated Cystitis in Women

Single-dose and three-day regimens of ofloxacin versus trimethoprim-sulfamethoxazole for acute cystitis in women

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