Postcoital antimicrobial prophylaxis for recurrent urinary tract infection: a randomized, double-blind, placebo-controlled trial

Article Abstract:

Many healthy, young women are prone to irritating recurrent urinary tract infections (UTIs). These infections are often successfully treated with combination antibiotics, especially trimethoprim-sulfamethoxazole. There is concern that continuous antibiotic therapy is not only costly and inconvenient, but that it may be associated with the emergence of antibiotic-resistant organisms in the urinary tract. These recurrent UTIs are often associated with sexual intercourse. Consequently, a postcoital (after intercourse) antibiotic protocol has been suggested to prevent the occurrence of these infections. To explore the effectiveness of postcoital antibiotic prophylaxis, three study groups were formed: patients who received daily placebo and postcoital antibiotics; daily placebo and postcoital placebo; and daily antibiotics and postcoital placebo. The daily medications were taken every morning, and the postcoital tablets were taken within two hours of intercourse. Two of the 16 women taking postcoital antibiotics developed infections during the 6-month study period, compared with 9 of 11 women taking postcoital placebo. The intercourse rate in these two groups was similar, and the infection rate increased with the frequency of intercourse for the infected placebo group, but not for the treated group. None of the four patients taking daily antibiotics and postcoital placebo developed infections, and were not included in this comparison. All of the infections which occurred were caused by Escherichia coli alone or with another organism. Postcoital antibiotics had little effect on the E. coli colonization of the vagina and urethra. These findings demonstrate that postcoital prophylactic trimethoprim-sulfamethoxazole is effective in preventing recurrent UTIs in susceptible women. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention

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Randomized comparative trial and cost analysis of 3-day antimicrobial regimens for treatment of acute cystitis in women

Article Abstract:

A three-day regimen of trimethoprim-sulfamethoxazole may be a more cost-effective treatment for cystitis in young women than nitrofurantoin, cefadroxil, or amoxicillin. Researchers examined and took urine samples and rectal, urethral, and vaginal cultures from 158 women with cystitis before and after a three-day drug treatment regimen. Forty patients were treated with trimethoprim-sulfamethoxazole, 38 were treated with nitrofurantoin, 37 were treated with cefadroxil, and 43 were treated with amoxicillin. At the six-week follow-up, trimethoprim-sulfamethoxazole-treated women had the highest cure rate and had a low rate of persistent infection. This drug was the most effective agent in reducing rectal colonization with the Escherichia coli (E. coli) bacterium at the early follow-up visit and in reducing vaginal and urethral colonization during all follow-ups. In addition, treatment costs were lowest for trimethoprim-sulfamethoxazole-treated patients.

Cystitis, Amoxicillin, Cefadroxil monohydrate, Cefadroxil, Nitrofurantoin

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Lack of circumcision increases the risk of urinary tract infection in young men

Article Abstract:

Adult men who were not circumcised as infants may have a higher incidence of urinary tract infections (UTI) than men who were circumcised. Twenty-six men being treated at a sexually transmitted diseases clinic were found to have bacteria in their urine, a sign that they had a UTI; they were compared to 52 men who had no bacteria in their urine (the control group). Thirty-one percent of the men with bacteria in their urine were uncircumcised, compared to 12% of the controls. In more than half of the men with bacteria in their urine, the bacterium isolated was Escherichia coli (E. coli), an organism that normally occurs in the large intestine. Three-quarters of the E. coli strains isolated from these men were found to be potentially dangerous.

Health aspects, Escherichia coli, Circumcision

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