Trimethoprim-rifampin, a new combination agent: efficacy in localized urinary infection and influence on microflora

Bourgault, Anne–Marie; Forward, Kevin R.; Ronald, Allan R.; Harding, G. K. M.; Thomson, Marian; Grey, G

doi:10.1128/aac.19.4.513

Cited by 5 publications

(3 citation statements)

References 16 publications

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“…This combination has also been shown to be effective in women who have had recurrent upper UTI (6). In this study, we found that the overall relapse rate was significantly higher in patients who received 10 days of RIF-TMP than in patients who received 10 days of SMX-TMP, although this difference was not observed in patients with upper UTI.…”

Section: Discussioncontrasting

confidence: 45%

“…The most common side effect was yeast vaginitis. Nausea was also common with RIF-TMP, but it was considerably less prevalent than that observed by Bourgault et al (6), who treated patients with 1,200 mg of rifampin in one dose. Rifampin is known to cause menstrual disorders in women who take oral contraceptives and may cause increased metabolism of exogenous estrogens (30).…”

Section: Discussionmentioning

confidence: 70%

“…RIF-TMP does not predispose to selection of rifampin-or trimethoprim-resistant strains and is effective in eradicating the urinary tract strains that colonize the periurethra and anal canal (6). Small comparative trials of RIF-TMP and SMX-TMP have suggested superior longterm cure rates with RIF-TMP (2,21).…”

mentioning

confidence: 99%

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Randomized clinical trial of rifampin-trimethoprim and sulfamethoxazole-trimethoprim in the treatment of localized urinary tract infections

Stein

Gurwith

1988

Antimicrob Agents Chemother

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To investigate whether 10 days of rifampin-trimethoprim (RIF-TMP) or 6 weeks of sulfamethoxazoletrimethoprim (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 SMX-TMP or 10 days of RIF-TMP in the treatment of uncomplicated upper urinary tract infections and caused the fewest untoward effects.Rifampin has antimicrobial activity against most urinary pathogens (10, 15, 20) and demonstrates good tissue and intracellular penetration. Even though the main excretory route for rifampin is through the bile, concentrations in urine well above the MIC for most urinary pathogens are found after single doses (18). The drawback to using rifampin alone to treat urinary tract infections (UTI) is rapid emergence of rifampin-resistant strains (27). Trimethoprim is particularly active against aerobic gram-negative bacteria, and the combination rifampin-trimethoprim (RIF-TMP) is synergistic against most urinary pathogens (10, 16, 20). This combination protects against emergence of resistance seen in bacterial populations exposed to either drug alone (3,14,15). In addition, the pattern of absorption and excretion of rifampin and trimethoprim given alone does not differ significantly from that when they are given concurrently (1, 18).The combination RIF-TMP has been reported to be effective in the treatment of acute (21, 27) and chronic (2, 6) UTI and is a potential alternative to sulfamethoxazole plus trimethoprim (SMX-TMP...

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Section: Discussioncontrasting

confidence: 45%

Section: Discussionmentioning

confidence: 70%

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Randomized clinical trial of rifampin-trimethoprim and sulfamethoxazole-trimethoprim in the treatment of localized urinary tract infections

Stein

Gurwith

1988

Antimicrob Agents Chemother

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Trimethoprim: Mechanisms of Action, Antimicrobial Activity, Bacterial Resistance, Pharmacokinetics, Adverse Reactions, and Therapeutic Indications

1981

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Trimethoprim has recently been marketed as a single-entity product for the treatment of initial episodes of uncomplicated symptomatic urinary tract infections; it was previously available only in combination with sulfamethoxazole. Trimethoprim exerts antimicrobial activity by blocking the reduction of dihydrofolate to tetrahydrofolate, the active form of folic acid, by susceptible organisms. It has inhibitory activity for most gram-positive aerobic cocci and some gram-negative aerobic bacilli. Resistance to trimethoprim may be either intrinsic or acquired. Acquired resistance most commonly stems from a chromosomal mutation that results in the production of a dihydrofolate reductase enzyme which is less vulnerable to trimethoprim inhibition. Gastrointestinal intolerance and skin eruptions are the most common untoward reactions resulting from the administration of trimethoprim. Trimethoprim constitutes very effective therapy for women with acute symptomatic urinary tract infections caused by E. coli, and the compound compares favorably with alternative standard agents, such as ampicillin and cephalexin. The safety of trimethoprim in the pregnant woman has not been established. Since indiscriminate use of trimethoprim could foster the emergence of trimethoprim resistance, thereby negating the value of both trimethoprim and trimethoprim-sulfamethoxazole, trimethoprim should only be prescribed for well defined indications. Trimethoprim is currently being investigated as definitive therapy for a wide range of infections, including bacterial exacerbations of chronic bronchitis, bacterial pneumonia, and typhoid fever. Initial reports are encouraging.

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Rifampin, a Useful Drug for Nonmycobacterial Infections

Vesely,

Pien,

Pien

1998

Pharmacotherapy

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Rifampin has clinical efficacy against a wide variety of organisms, including Staphylococcus aureus, Legionella pneumophila, group A Streptococcus, Brucella sp, Haemophilus influenzae, and Neisseria meningitidis, as well as in vitro activity against penicillin‐resistant Streptococcus pneumoniae, Neisseria gonorrhoeae, Chlamydia trachomatis, Haemophilus ducreyi, and many gram‐negative rods. Rifampin is a useful drug for several types of bacterial infections because of its broad spectrum of activity, excellent tissue penetration, and low side effect profile. In combination with other antibiotics, it may be effective when conventional therapies are not.

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Trimethoprim-rifampin, a new combination agent: efficacy in localized urinary infection and influence on microflora

Cited by 5 publications

References 16 publications

Randomized clinical trial of rifampin-trimethoprim and sulfamethoxazole-trimethoprim in the treatment of localized urinary tract infections

Randomized clinical trial of rifampin-trimethoprim and sulfamethoxazole-trimethoprim in the treatment of localized urinary tract infections

Trimethoprim: Mechanisms of Action, Antimicrobial Activity, Bacterial Resistance, Pharmacokinetics, Adverse Reactions, and Therapeutic Indications

Rifampin, a Useful Drug for Nonmycobacterial Infections

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