Prophylactic efficacy of nitrofurantoin macrocrystals and trimethoprim-sulfamethoxazole in urinary infections. Biologic effects on the vaginal and rectal flora.
We examined bacterial persistence and resistance in the vaginal and fecal flora of 28 women who received a total of 253 months of daily low-dosage prophylaxis with nitrofurantoin macrocystals (100 mg per day) or trimethoprim-sulfamethoxazole (40 and 200 mg respectively). During trimethoprim-sulfamehtoxazole prophylaxis, 8.5% of monthly vaginal and 27% of monthly fecal cultures grew Escherichia coli, as compared to 36 and 96%, respectively for nitrofurantoin macrocrystals. Esch. coli resistant to nitrofurantoin occurred in two of 95 fecal cultures during therapy, and Esch. coli resistant to trimethoprim-sulfamethoxazole in 16 of 182 (8.8%) fecal cultures. In the 12 months before treatment, 92 episodes of recurrent urinary infection occurred, as compared to six during treatment (none occurred on trimethoprim-sulfamethoxazole). These results confirm the value of trimethoprim-sulfamethoxazole prophylaxis for high-risk patient with recurrent urinary infections. Prophylaxis with nitrofurantoin macrocrystals seems adequate for less severe problems of reinfection.
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001437:Bacteriuria / Q000517:prevention & control; D004338:Drug Combinations; D004352:Drug Resistance, Microbial; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification; D005243:Feces / Q000382:microbiology*; D005260:Female; D006801:Humans; D007709:Klebsiella / Q000187:drug effects; D008722:Methods; D008875:Middle Aged; D009582:Nitrofurantoin / Q000008:administration & dosage / Q000627:therapeutic use*; D011513:Proteus mirabilis / Q000187:drug effects; D012008:Recurrence; D012737:Sex Factors; D013420:Sulfamethoxazole / Q000008:administration & dosage* / Q000627:therapeutic use*; D014295:Trimethoprim / Q000008:administration & dosage* / Q000627:therapeutic use; D014552:Urinary Tract Infections / Q000517:prevention & control*; D014621:Vagina / Q000382:microbiology*
D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D009582:Nitrofurantoin; D014295:Trimethoprim; D013420:Sulfamethoxazole