Low-dose trimethoprim (TMP), trimethoprim-sulfamethoxazole (TMP-SMZ), and nitrofurantoin macrocrystals were found to be safe and effective as prophylaxis against recurrent urinary tract infections. Women given placebo had 2.8 infections per patient-year during the six-month study period, while women given TMP, TMP-SMZ, or nitrofurantoin had significantly lower infection rates (0.015 per patient-year). The effect of prophylaxis appeared to be limited to the period when the agents were taken. Only one patient had a TMP-resistant coliform isolated from cultures obtained during prophylaxis and six months afterwards. The sole factor associated with the recurrence of infection after prophylaxis was a history of three or more infections in the year preceding prophylaxis. Thirty-one of the 60 women in the trial were monitored for a mean of 6.1 years before and 3.2 years after they entered the study. Analysis of infection rates indicated that about half these women were experiencing an infection cluster when they entered the study and that the prestudy baseline infection rate correlated with the poststudy rate. Thus, prophylaxis did not appear to exert a long-term effect on the baseline infection rate. Urinary prophylaxis generally appears to become cost-effective when the baseline infection rate exceeds two per patient-year.

Bacteriuria↗

PubMedDate not supplied

Treatment of cystitis in women with a single dose of trimethoprim-sulfamethoxazole.

The efficacy of a single dose (four tablets) and of 10-day courses of trimethoprim-sulfamethoxazole (TMP-SMZ) was studied in 77 women with symptomatic cystitis and negative tests for antibody-coated bacteria. Cure rates after six weeks were 76% for single-dose therapy and 87% for 10 days of treatment. For Escherichia coli infections, cure rates after six weeks were 80% and 86%, respectively. However, 10-day treatment eliminated enteric bacilli from urethral and vaginal sites more often than did single-dose therapy. Two weeks after completion of treatment, perineal colonization was observed more often in the women who developed recurrent infections than in those who did not (P = 0.01). During these two weeks, recurrent infections were found somewhat more often in the women who had received single-dose therapy than in those who had undergone 10-day treatment (5 of 38 vs. 2 of 39; P = 0.07). With conventional courses of antibiotics, retreatment of all recurrent infections was less successful in women previously given single-dose therapy. Recurrent infections were also more frequent in women infected with bacteria other than E. coli. Both drug regimens were well tolerated. However, serious adverse reactions were fewer in patients treated with a single dose (8.5%) than in patients treated for 10 days (15%). Single-dose therapy with TMP-SMZ appears as effective as 10-day therapy in acute uncomplicated cystitis caused by E. coli.

Adolescent↗

PubMedDate not supplied

Cephalosporins and related antibiotics: an overview.

With the release of cefotaxime and, more recently, moxalactam, there are now 13 cephalosporin drugs available in the United States, and close to another half dozen are under investigation. Commercial competition is steep, and every new product is being praised as superior to its predecessor. In general, it is necessary to become familiar with one formulation that can be given parenterally and one that is available for oral use. For certain patients, primarily those with nosocomial infections, one of the extended-spectrum cephalosporins must be considered, but these drugs should be employed only when specifically indicated. Certainly, cefotaxime has good stability to many beta-lactamases and possesses a wider spectrum of activity against gram-negative bacilli than any other clinically available cephalosporin. Clinical trials have demonstrated the efficacy of cefotaxime in diverse infections, including those associated with E. coli, indole-positive and indole-negative species of Proteus, and species of Klebsiella and Serratia. Strains of Enterobacter species, P. aeruginosa, and B. fragilis are only moderately susceptible to cefotaxime, and enterococci are frequently resistant. Although the antibacterial activity and wide spectrum of cefotaxime, coupled with its apparent safety and tolerability, make it a useful antibiotic for the treatment of serious nosocomial infections, it will frequently have to be employed with another agent--i.e., an aminoglycoside--until the precise identification and in vitro susceptibility of the infecting organism is known.

Anti-Bacterial Agents↗

PubMedDate not supplied

Nephrotoxicity due to cephaloridine: a light- and electron-microscopic study in rabbits.

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Acute Kidney Injury↗