Randomized comparative trial and cost analysis of 3-day antimicrobial regimens for treatment of acute cystitis in women.
OBJECTIVE
To determine the efficacy, safety, and costs associated with four different 3-day regimens for the treatment of acute uncomplicated cystitis in women.


METHODS
A prospective randomized trial with a cost analysis.


METHODS
Women with acute cystitis attending a student health center.


METHODS
Treatment with 3-day oral regimens of trimethoprim-sulfamethoxazole, 160 mg/800 mg twice daily, macrocrystalline nitrofurantoin, 100 mg four times daily, cefadroxil, 500 mg twice daily, or amoxicillin, 500 mg three times daily.


RESULTS
Six weeks after treatment, 32 (82%) of 39 women treated with trimethoprim-sulfamethoxazole were cured compared with 22 (61%) of 36 treated with nitrofurantoin (P = .04 vs trimethoprim-sulfamethoxazole), 21 (66%) of 32 treated with cefadroxil (P = .11 vs trimethoprim-sulfamethoxazole), and 28 (67%) of 42 treated with amoxicillin (P = .11 vs trimethoprim-sulfamethoxazole). Persistence of significant bacteriuria was less common with trimethoprim-sulfamethoxazole (3%) and cefadroxil (0%) compared with nitrofurantoin (16%; P = .05 vs trimethoprim-sulfamethoxazole) and amoxicillin (14%; P = .11 vs trimethoprim-sulfamethoxazole). Persistence of bacteriuria was associated with amoxicillin-resistant strains in the amoxicillin group but nitrofurantoin-susceptible strains in the nitrofurantoin group. Trimethoprim-sulfamethoxazole was more successful in eradicating Escherichia coli from rectal cultures soon after therapy and from urethral and vaginal cultures at all follow-up visits compared with the other treatment regimens. Adverse effects were reported by 16 (35%) of 46 patients receiving trimethoprim-sulfamethoxazole, 18 (43%) of 42 receiving nitrofurantoin, 12 (30%) of 40 receiving cefadroxil, and 13 (25%) of 52 receiving amoxicillin. The mean costs per patient were less with trimethoprim-sulfamethoxazole ($114) and amoxicillin ($131) compared with nitrofurantoin ($155) and cefadroxil ($155).


CONCLUSIONS
A 3-day regimen of trimethoprim-sulfamethoxazole is more effective and less expensive than 3-day regimens of nitrofurantoin, cefadroxil, or amoxicillin for treatment of uncomplicated cystitis in women. The increased efficacy of trimethoprim-sulfamethoxazole is likely related to its antimicrobial effects against E coli in the rectum, urethra, and vagina.
Hooton
T M
TM
Department of Medicine, University of Washington School of Medicine, Harborview Medical Center, Seattle.
Winter
C
C
Tiu
F
F
Stamm
W E
WE
D000208:Acute Disease; D000328:Adult; D000658:Amoxicillin / Q000191:economics / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D002434:Cefadroxil / Q000191:economics / Q000627:therapeutic use; D016001:Confidence Intervals; D003365:Costs and Cost Analysis; D003556:Cystitis / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D009582:Nitrofurantoin / Q000191:economics / Q000627:therapeutic use; D015242:Ofloxacin / Q000191:economics / Q000627:therapeutic use; D011446:Prospective Studies; D012007:Rectum / Q000382:microbiology; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000191:economics / Q000627:therapeutic use; D014521:Urethra / Q000382:microbiology; D014621:Vagina / Q000382:microbiology
D000890:Anti-Infective Agents; D002434:Cefadroxil; D000658:Amoxicillin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D009582:Nitrofurantoin; D015242:Ofloxacin