Trimethoprim-Sulphamethoxazole: Comparative Study in Urinary Infection in Hospital

Abstract

, [541][542][543][544] ummary: Trimethoprim is inhibitory for a wide range of bacteria, and when used in combination with a sulphonamide marked synergy has been reported.In order to test its value in the treatment of urinary infections 154 hospital patients with infections of varying severity and due to a wide range of organisms were treated with combinations of sulphamethoxazole and trimethoprim. Combinations of these substances in two different ratios (2 : 1 and 10: 1) were used in 113 patients, and one week after the end of treatment about threequarters were cured by both combinations. In a second study 106 patients were treated with a sulphamethoxazoletrimethoprim combination (5: 1), ampicillin, or sulphadimidine. The cure rate with the 5: 1 combination was higher than that found with ampicillin or sulphadimidine both one week after finishing treatment (sulphamethoxazole-trimethoprim 85%, ampicillin 70%, sulphadimidine 40%) and at the fourth-to fifth-week follow-up (sulphamethoxazole-trimethoprim 67%, ampicillin 52%, sulphadimidine 15%).The results obtained with the various sulphamethoxazole-trimethoprim combinations did not indicate that a particular ratio was superior for treating urinary infections in general or for those caused by any particular species of organism.Laboratory studies showed that many bacteria causing urinary infections in hospital were sensitive to trimethoprim, and the therapeutic results could have been largely predicted from a knowledge of the in-vitro sensitivity tests to trimethoprim alone. For example, sulphamethoxazole-trimethoprim in the treatment of Proteus mirabilis infections was less successful than in those due to Escherichia coli, and this finding was clearly reflected in the higher minimal inhibitory concentrations for trimethoprim of Pr. mirabilis.The sulphamethoxazole-trimethoprim combination was simple to administer, free from side-effects, and gave satisfactory results in the treatment of urinary infections that occurred in hospital patients.

A Clinical Investigation of Pivmecillinam

“…D avies et al, [1971] showed that cephalexin and ampicillin had a cure rate of about 60°/o in hospital patients with urinary tract infections. The cure rate amongst similar patients treated with co-trimoxazole was 67% [Reeves et al, 1969]. Amongst those six patients in whom treatment failed it was in teresting to note that four had pathological conditions present in their ur ogenital tract, and therefore treatment failure was not unexpected.…”

The <i>in vitro</i> Demonstration of the Efficacy of Trimethoprim as an Antibacterial Agent in a Comparative Bacteriological Study on the Effects of Trimethoprim, Sulfamethoxazole and the Combination Trimethoprim/Sulfamethoxazole

“…The degree of potentiation of the two components as determined by the agar-diffusion method (2.5 times according to an analysis of the regression lines presented by Dornbusch [9] as well as by Gallien and Schonfeld [11]) is much smaller than that obtained with the agar-dilution test (10-20 times according to various other au thors [4,5,9,11] and our own results). R eeves et al [18] have stated that the therapeutic success could usually be predicted from the result of testing the sensitivity to TMP. We believe that the agar-diffusion test with two discs containing the single components or with only one disc containing TMP alone would be a useful method of sensitivity testing.…”

“…With the combination of TMP and SMZ this requirement has not yet been ful filled. Although many papers have been published concerning the clini cal effectiveness of this combination [3,7,13,18], TMP alone has only been investigated a few times [7,14,15,16,19].…”

Cephacetrile, a New Cephalosporin, in the Treatment of Urinary Tract Infections

“…The urine levels of the drug are very variable, as is usually the case, but are adequate for the eradication of most urinary pathogens. A 75-percent cure rate at the end of a 4-to 6-week follow-up is very encouraging and compares favourably with trials of other agents in similar patients treated with oral antibiotics [3,4].…”