Trimethoprim-Sulfamethoxazole for Acute Dysuria in Women: A Single-Dose or 10-Day Course

Fihn, Stephan D.; Johnson, Carolyn; Roberts, Pacita L.; Running, Katherine; Stamm, Walter E.

doi:10.7326/0003-4819-108-3-350

Cited by 93 publications

(22 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Persistence of coliforms in the vagina after treatment has been found to be associated with frequent early recurrences of cystitis (5). We found in the current study, as we found in our previous study (9), that ofloxacin was initially more effective than trimethoprim-sulfamethoxazole in eradicating E. coli from the rectum, but colonization was high in all treatment groups several weeks after treatment.…”

Section: Resultssupporting

confidence: 76%

“…Previous studies of short-course treatment for uncomplicated cystitis in women have demonstrated an association between posttreatment recurrence of UTI and a previous history of UTI (5,18), high-quantity bacteriuria (5), and diaphragm use (5). Likewise, in our study, a history of UTI in the previous year and diaphragm use were associated with persistent or recurrent significant bacteriuria in each study group.…”

Section: Resultssupporting

confidence: 61%

“…In another study with an unstated follow-up interval, the cure rate in women treated with a 100-mg single-dose regimen of ofloxacin was significantly lower (73%) than that in the comparison group treated with a longer regimen of trimethoprim-sulfamethoxazole (93%) (16). While these observed cure rates are similar to those in our single-dose ofloxacin group, they are inferior to cure rates we have observed with short or conventional regimens of trimethoprim-sulfamethoxazole for uncomplicated cystitis (5,9). Our data show that a single 400-mg dose of ofloxacin was highly effective in the initial eradication of bacteriuria but was more likely to be followed by a recurrent symptomatic UTI requiring retreatment, compared with a conventional regimen of trimethoprim-sulfamethoxazole.…”

Section: Resultscontrasting

confidence: 53%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

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...

show abstract

Section: Resultssupporting

confidence: 76%

Section: Resultssupporting

confidence: 61%

Section: Resultscontrasting

confidence: 53%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

show abstract

“…The high in vitro resistance to ampicillin and sulfonamide and the high cost of amoxicillin/clavulanate and the cephalocrystalline sporins limit their usefulness in the setting of acute uncomplicated cystitis. More than 90% of females report the absence of acute urinary symptoms within 72 hours after commencement of antimicrobial therapy (Fihn et al 1988). Phenazopyridine or Uristat can be prescribed in females with severe persistent dysuria.…”

Section: Managementmentioning

confidence: 99%

Current Management Strategies for Uncomplicated and Complicated Cystitis

Davis¹,

Flood²

2011

Urinary Tract Infections

View full text Add to dashboard Cite

“…More recently, trimethoprim was found to act as an inhibitor of bacterial dihydrofolate reductase (5). The combined application of trimethoprim and a sulfonamide is an important protocol for the treatment of bacterial infections (5)(6)(7)(8).…”

mentioning

confidence: 99%

Biosynthesis of Pteridines in Escherichia coli

Haussmann

Rohdich

Schmidt

et al. 1998

Journal of Biological Chemistry

View full text Add to dashboard Cite

An open reading frame located at 69.0 kilobases on the Escherichia coli chromosome was shown to code for dihydroneopterin aldolase, catalyzing the conversion of 7,8-dihydroneopterin to 6-hydroxymethyl-7,8-dihydropterin in the biosynthetic pathway of tetrahydrofolate. The gene was subsequently designated folB. The FolB protein shows 30% identity to the paralogous dihydroneopterin-triphosphate epimerase, which is specified by the folX gene located at 2427 kilobases on the E. coli chromosome. The folX and folB gene products were both expressed to high yield in recombinant E. coli strains, and the recombinant proteins were purified to homogeneity. Both enzymes form homo-octamers. Aldolase can use L-threo-dihydroneopterin and D-erythro-dihydroneopterin as substrates for the formation of 6-hydroxymethyldihydropterin, but it can also catalyze the epimerization of carbon 2 of dihydroneopterin and dihydromonapterin at appreciable velocity. Epimerase catalyzes the epimerization of carbon 2 in the triphosphates of dihydroneopterin and dihydromonapterin. However, the enzyme can also catalyze the cleavage of the position 6 side chain of several pteridine derivatives at a slow rate. Steady-state kinetic parameters are reported for the various enzyme-catalyzed reactions. We propose that the polarization of the 2-hydroxy group of the substrate could serve as the initial reaction step for the aldolase as well as for the epimerase activity. A deletion mutant obtained by targeting the folX gene of E. coli has normal growth properties on complete medium as well as on minimal medium. Thus, the physiological role of the E. coli epimerase remains unknown. The open reading frame ygiG of Hemophilus influenzae specifies a protein with the catalytic properties of an aldolase. However, the genome of H. influenzae does not specify a dihydroneopterin-triphosphate epimerase.

show abstract

Trimethoprim-Sulfamethoxazole for Acute Dysuria in Women: A Single-Dose or 10-Day Course

Cited by 93 publications

References 19 publications

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

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

Current Management Strategies for Uncomplicated and Complicated Cystitis

Biosynthesis of Pteridines in Escherichia coli

Contact Info

Product

Resources

About