Long-term antimicrobial prophylaxis for recurrent urinary tract infection in women.

Thirteen women and two preadolescent girls who suffered recurrences after six months of prophylaxis with trimethoprim (TMP; 40 mg) and sulfamethoxazole (SMZ; 200 mg) taken thrice weekly at bedtime were enrolled in a 24-month study of prophylaxis with the same region. During 29.1 cumulative patient-years of prophylaxis, two infections due to Escherichia coli and one each due to Staphylococcus epidermidis and Streptococcus faecalis occurred (0.14 infection/patient-year). MICs for these isolates were less than or equal to 2 micrograms of TMP/ml and greater than 512 micrograms of SMZ/ml. During prophylaxis, 106 of 116 cultures from the periurethral area and 66 of 97 cultures from the anal and canal yielded no aerobic gram-negative bacilli. In three patients, the periurethral area was colonized with aerobic gram-negative bacilli with MICs of greater than or equal to 2 micrograms of TMP/ml. Thirteen patients were followed after the discontinuation of prophylaxis. Eight suffered recurrences, seven with organisms susceptible to TMP. After one year the remaining five had experienced no recurrences. It is concluded that long-term prophylaxis with 40 mg of TMP and 200 mg of SMZ thrice weekly is an effective, well-tolerated regimen that can maintain an infection-free state in women with histories of frequent urinary reinfections.

[1]  K. Holmes,et al.  Is antimicrobial prophylaxis of urinary tract infections cost effective? , 1981, Annals of internal medicine.

[2]  K. Holmes,et al.  Antimicrobial prophylaxis of recurrent urinary tract infections: a double-blind, placebo-controlled trial. , 1980, Annals of internal medicine.

[3]  K. Towner,et al.  EMERGENCE OF TRIMETHOPRIM-RESISTANT ENTEROBACTERIA IN PATIENTS RECEIVING LONG-TERM CO-TRIMOXAZOLE FOR THE CONTROL OF INTRACTABLE URINARY-TRACT INFECTION , 1979, The Lancet.

[4]  G. Harding,et al.  Prophylaxis of recurrent urinary tract infection in female patients. Efficacy of low-dose, thrice-weekly therapy with trimethoprim-sulfamethoxazole. , 1979, JAMA.

[5]  G. Harding,et al.  Biotyping of Escherichia coli by a simple multiple-inoculation agar plate technique. , 1979, Journal of clinical microbiology.

[6]  G. Harding,et al.  Urinary tract infection localization in women. , 1978, JAMA.

[7]  T. Stamey,et al.  Prophylactic efficacy of nitrofurantoin macrocrystals and trimethoprim-sulfamethoxazole in urinary infections. Biologic effects on the vaginal and rectal flora. , 1977, The New England journal of medicine.

[8]  C. Wong,et al.  Prophylaxis of recurring urinary tract infection in females: a comparison of nitrofurantoin with trimethoprim-sulfamethoxazole. , 1975, Canadian Medical Association journal.

[9]  G. Harding,et al.  A controlled study of antimicrobial prophylaxis of recurrent urinary infection in women. , 1974, The New England journal of medicine.

[10]  A. Shelokov,et al.  Antibody-coated bacteria in the urine and the site of urinary-tract infection. , 1974, The New England journal of medicine.

[11]  P. Gower,et al.  Prevention of urinary-tract infection with low-dose nitrofurantoin. , 1971, Lancet.

[12]  J. Mcgeachie.  Recurrent Infection of the Urinary Tract: Reinfection or Recrudescence? , 1966, British medical journal.

[13]  E. Steers,et al.  An inocula replicating apparatus for routine testing of bacterial susceptibility to antibiotics. , 1959, Antibiotics & chemotherapy.

[14]  Kraft Jk,et al.  The natural history of symptomatic recurrent bacteriuria in women. , 1977 .

[15]  E. Kaarsalo,et al.  Trimethoprim in the treatment and long-term control of urinary tract infection. , 1974, Scandinavian journal of infectious diseases.