Treatment of the Acute Urethral Syndrome

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

doi:10.1056/nejm198104163041608

Cited by 108 publications

(27 citation statements)

References 6 publications

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“…In contrast, only 3 of 16 (19%) patients with similar symptoms and pyuria but without any evidence of bacteriuria had symptomatic relief after singledose therapy. These observations are consistent with the reports of Stamm et al (16,17) that patients with symptoms of dysuria and frequency and pyuria, but with less-thansignificant bacteriuria (the acute urethral syndrome), have infections of one of two types: infection caused by classical bacterial uropathogens present in smaller numbers than usual or infection caused by Chlamydia trachomatis. Our data suggest that single-dose amoxicillin therapy is very effective for the former type of infection but that more traditional anti-chlamydial therapy is necessary for effective treatment of the latter type of infection.…”

supporting

confidence: 92%

“…If the patient is pyuric but not bacteriuric, this is sufficient evidence to initiate treatment for C. trachomatis infection. At present, optimal therapy for C. trachomatis infection consists of a 7-to 14-day regimen of a tetracycline or a sulfonamide for the patient and her sexual partner (16). Since cultures for C. trachomatis are not widely available and the cost is usually prohibitive, therapy without cultural proof would appear to be justified.…”

Section: Whatmentioning

confidence: 99%

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Single-dose amoxicillin therapy of acute uncomplicated urinary tract infections in women

Tolkoff-Rubin¹,

Wilson²,

Zuromskis³

et al. 1984

Antimicrob Agents Chemother

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Of 210 women who were experiencing dysuria, frequent urination, pyuria, and significant bacteriuria and who were treated with a single 3-g dose of amoxicillin, 165 (79%) were cured of their original infections. Patients with infections that were negative by antibody-coated-bacteria assay were cured at a significantly higher rate than those with infections that were positive by antibody-coated-bacteria assay (90 versus 59%; P < 0.001). Similarly, those with infections caused by amoxicillin-susceptible organisms were cured at a significantly higher rate than those with infections caused by resistant organisms (85 versus 50%;o P < 0.001). Of 27 patients who had infections caused by amoxicillin-susceptible organisms and who had relapses after single-dose therapy, 14 (52%) had relapses again after a conventional 10-day course of therapy, although all responded to a 6-week course. An additional 27 patients experiencing dysuria, frequent urination, and pyuria but who had a lower number of uropathogens in the urine (102 to 104-5/ml of urine) were treated with single-dose therapy, with a 100% eradication of organisms and an 89% rate of symptomatic relief.Single-dose antimicrobial therapy of lower urinary tract infections (UTIs) in women has been shown to be effective and economical, and its use has been associated with better patient compliance and a significantly lower rate of side effects than that occurring with conventional therapy (1,2,(5)(6)(7)(8)(9)(10)(11)(12). This approach has evolved from the recognition that the anatomical site of infection has an important impact on the outcome of any antimicrobial therapy. Upper tract infection connotes deep tissue infection within the renal medulla, where normal host defenses appear to function poorly and antimicrobial delivery may be limited. Lower tract infection connotes a superficial mucosal process within the bladder, which is continually bathed in urine and in which extremely high antimicrobial concentrations can be attained. Although single-dose therapy is highly effective in the latter type of infection, it fails to effect a cure in a significant percentage of women with the former type of infection (6,7,11,12).Thus, a graded therapeutic approach based upon the anatomical site of infection appears to be reasonable. Unfortunately, however, clinical signs and symptoms and a variety of noninvasive tests are incomplete predictors of the site of infection in unselected patients. (6,7,(11)(12)(13). Instead, we and others have suggested that all women with acute, uncomplicated UTIs be treated initially with single-dose therapy and that their responses to such therapy should then guide the clinician to further management (3,6,7,12,14,20).In this study, we tested this hypothesis in a large group of women from various socioeconomic groups whose infections were further defined by the use of the antibody-coatedbacteria (ACB) assay.MATERIALS

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supporting

confidence: 92%

Section: Whatmentioning

confidence: 99%

Single-dose amoxicillin therapy of acute uncomplicated urinary tract infections in women

Tolkoff-Rubin¹,

Wilson²,

Zuromskis³

et al. 1984

Antimicrob Agents Chemother

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“…As none of our patients had a positive Chlamydia culture, the efficacy of SDT for Chlamydia cystourethritis could not be assessed. The median age in our study population was greater than the original study of Stamm et al (21) of the acute urethral syndrome, and our group was more affluent and probably less sexually active than were the women in other similar studies. This possibly accounts for the absence of Chlamydia species in our study group.…”

contrasting

confidence: 56%

Comparison of single-dose tetracycline hydrochloride to conventional therapy of urinary tract infections

Rosenstock¹,

Smith²,

Gurney³

et al. 1985

Antimicrob Agents Chemother

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Sixty-two women with signs and symptoms compatible with lower urinary tract infections were randomized to receive single-dose tetracycline (2 g), multi-dose tetracycline (500 mg four times per day for 10 days), or single-dose amoxicillin (3 g). Urine cultures were obtained upon entry into the study and on days 4, 14, and 28 after therapy. Single-dose tetracycline cured 12 of 16 (75%) of women with documented urinary tract infections, compared with 15 of 16 (94%) in the multi-dose tetracycline group and 7 of 13 (54%) receiving single-dose amoxicillin. Mild nausea in 3 of 20 patients (15%) was the only complication in the single-dose tetracycline group. Two grams of single-dose tetracycline is as effective as other reported regimens regardless of the susceptibility of the initial pathogen and has minimal toxicity.Symptomatic lower urinary tract infections (UTI) in women are a common problem in the United States. It affects approximately 20% of women during child-bearing years and generates approximately 6 million office visits annually. In recent years, numerous studies have attempted to define an effective, easily administered, nontoxic, inexpensive therapeutic regimen, deliverable in a single oral dose (2, 5-7, 9, 14-16, 18, 19, 23). Although these studies tested a variety of single-dose agents, tetracycline (TCN) has certain properties that make it particularly attractive as a singledose regimen. TCN is active against most common bacterial urinary pathogens (17) and is also one of the most effective antimicrobial agents available for treatment of Chlamydia trachomatis, the etiological agent in perhaps 20% of women with the acute urethral syndrome (22). TCN is inexpensive ($0.16 for 2 g at our pharmacy), has a low incidence of toxicity in nonpregnant adults, and is largely excreted through urine (12). TCN has been used successfully without significant toxicity in single-dose regimens for shigellosis (4, 13) and gonorrhea (3,11). We previously evaluated the efficacy of a 2.5-g single-dose TCN (SDT) in uncomplicated UTI and reported that although it was efficacious, frequent gastrointestinal toxicity limited its use (unpublished data). In this study, we compared the efficacy and adverse side effects of a 2-g SDT in the therapy of UTI to single-dose amoxicillin (SDA) (3 g) and to 10 days of TCN (500 mg mented UTI in the preceeding 2 years, or allergy to penicillin or TCN. Informed consent was obtained from all patients.At the initial visit, the following specimens were obtained: a urethral swab, two cervical swabs, and a clean-catch midstream urine (MSU) sample. The MSU was examined chemically by dipstick (N-Multistix-C; Ames Co., Elkhart, Ind.) and cultured by standard microbiological techniques. Antimicrobial susceptibility testing was determined by the Kirby-Bauer disk method. Positive MSU cultures had colony counts greater than or equal to 1,000 organisms per ml of a single isolate (20). The MSU sediment was prepared in duplicate by centrifuging 10-ml portions for 10 min at 1,500 x g. One sediment was suspende...

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“…A 10-day course of antimicrobial therapy effectively treats low-count bacteriuria caused by conventional uropathogens (E. coli, Staphylococcus saprophyticus) and C. trachomatis (51). The latter organism causes the urethral syndrome rather exclusively in young, unmarried, sexually active women who have multiple sexual partners (3).…”

Section: Acute Bacterial Cystitis In Womenmentioning

confidence: 99%

Treatment duration for urinary tract infections in adults

Gleckman¹

1987

Antimicrob Agents Chemother

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Treatment of the Acute Urethral Syndrome

Cited by 108 publications

References 6 publications

Single-dose amoxicillin therapy of acute uncomplicated urinary tract infections in women

Single-dose amoxicillin therapy of acute uncomplicated urinary tract infections in women

Comparison of single-dose tetracycline hydrochloride to conventional therapy of urinary tract infections

Treatment duration for urinary tract infections in adults

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