How long should catheter-acquired urinary tract infection in women be treated? A randomized controlled study

Article Abstract:

The most common infections acquired by hospitalized patients are urinary tract infections, and 80 percent of these are associated with the use of bladder catheters to collect urine. These catheters are inserted and maintained in as sterile a fashion as possible, but they predispose patients to infection. Little useful data exist on how to treat these catheter-associated infections, if at all. A group of 119 women with asymptomatic, catheter-associated urinary tract infections were randomly assigned to receive either no treatment, one dose of the antibiotic trimethoprim-sulfamethoxazole, or 10 days of that same antibiotic, and all were followed with a series of urine cultures to assess the efficacy of the various regimens. In addition, a group of 32 women with infections and symptoms that suggested that the infections were limited to the lower urinary tract (the bladder) were assigned to receive either one dose or 10 days of trimethoprim-sulfamethoxazole, and 10 patients whose infections probably involved the upper urinary tract (the kidneys) received 10 days of the antibiotic. The results of these studies suggested that 36 percent of those without symptoms who received no treatment had resolution of their infections spontaneously, while a smaller group of them developed symptoms without therapy. Among the asymptomatic patients who were treated with the antibiotic, there was no significant difference in the cure rate between those who had received a single dose and those who were treated for 10 days. Similarly, those with symptomatic lower tract infection responded equally to either one dose or 10 days of trimethoprim-sulfamethoxazole. When the patients were divided into those who were under and those over 65 years old, a clear difference in efficacy of the various regimens was observed. Older women had far less spontaneous clearance of bacteria without treatment, and did not respond as well to single-dose therapy as to 10 day courses. Even those older women treated with 10 days of antibiotic had less frequent cures than those who were under 65 (61 percent versus 88 percent) who received only a single dose. The conclusions of the study are that urinary tract infections resulting from the presence of indwelling bladder catheters should be treated, with single-dose therapy performing as well as 10-day regimens in those under 65. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Women, Antibiotics, Drug therapy, Diseases, Urinary tract infections, Urinary catheterization

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Condom use prevents genital ulcers in women working as prostitutes: influence of human immunodeficiency virus infection

Article Abstract:

Genital ulcer disease (GUD) due to infection or inflammation is known to increase the risk of transmitting human immunodeficiency virus (HIV), which causes AIDS. The problem is particularly relevant for prostitutes, who are important agents of HIV transmission. To evaluate the effectiveness of condoms for preventing genital ulcers, 423 poor Nairobi women working as prostitutes were studied. The subjects were interviewed and examined at six-month intervals between 1986 and 1988. In this population, the organism most commonly associated with GUD is Haemophilus ducreyi; subjects were tested for the presence of this bacterium and for other sexually transmitted diseases (STDs) as well. If genital ulcers were found, the subjects were treated with antibiotics. The women were counseled concerning STDs and STD prevention and were given condoms. Results showed that condom use increased during the two years of the study: in 1986-1987, 41 percent of the women used condoms, compared with 65 percent in 1987-1988. However, the prevalence of GUD did not change during that time (34 percent during the earlier period, and 32 percent during the later period). A greater proportion of women who tested positive for HIV antibodies had GUD (35 percent), compared with those who tested HIV negative (14 percent). The proportion of HIV-positive women with GUD increased as did the disease severity. When HIV status was taken into account, it was found that GUD was more prevalent in prostitutes who did not use condoms. While using condoms prevents the ulcers, HIV infection predisposes women to developing ulcers. Programs to control the spread of HIV infection should include emphasis on the use of condoms and on the control of GUD among prostitutes and their clients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Sexually transmitted diseases, Prevention, HIV infection, HIV infections, Africa, Southern

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