title: Empiric use of trimethoprim-sulfamethoxazole (TMP-SMX) in the treatment of women with uncomplicated urinary tract infections, in a geographical area with a high prevalence of TMP-SMX-resistant uropathogens.
abstract: This study evaluated whether trimethoprim-sulfamethoxazole (TMP-SMX) is effective for treatment of uncomplicated urinary tract infections (UTIs) due to TMP-SMX-resistant (TMP-SMX-R) pathogens. Healthy nonpregnant premenopausal women with symptomatic lower UTI were assessed for the presence of pyuria and bacteriuria; if either was present, a urine sample was cultured and TMP-SMX was prescribed. Clinical and microbiologic cure was assessed at days 5-9 and 28-42 after cessation of therapy. For 71%, of patients, cultures grew TMP-SMX-susceptible (TMP-SMX-S) microorganisms, and for 29%, cultures grew TMP-SMX-R organisms. Escherichia coli remained the predominant bacteria in both groups of cultures. At visit 2, microbiological cure had been achieved in 86% of the patients in the TMP-SMX-S group and 42% of those in the TMP-SMX-R group. Similar differences were found at visit 3 by clinical evaluation. Treatment with TMP-SMX of uncomplicated UTI caused by TMP-SMX-R microorganisms results in microbiologic and clinical failure. In high-resistance areas, TMP-SMX should not be the empiric drug of choice for uncomplicated UTI.
authors.affiliation: Infectious Diseases Unit, Haemek Medical Center, Afula; and Technion, Institute of Technology, Haifa, Israel. raz_r@clalit.org.il
authors.forename: R
authors.initials: R
authors.lastname: Raz
authors.forename: B
authors.initials: B
authors.lastname: Chazan
authors.forename: Y
authors.initials: Y
authors.lastname: Kennes
authors.forename: R
authors.initials: R
authors.lastname: Colodner
authors.forename: E
authors.initials: E
authors.lastname: Rottensterich
authors.forename: M
authors.initials: M
authors.lastname: Dan
authors.forename: I
authors.initials: I
authors.lastname: Lavi
authors.forename: W
authors.initials: W
authors.lastname: Stamm
mesh_terms: D000328:Adult; D000892:Anti-Infective Agents, Urinary / Q000627:therapeutic use*; D003556:Cystitis / Q000188:drug therapy; D024881:Drug Resistance, Bacterial / Q000235:genetics; D005260:Female; D005787:Gene Frequency; D006801:Humans; D008875:Middle Aged; D017697:Premenopause; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*; D014552:Urinary Tract Infections / Q000188:drug therapy*; D014930:Women
chemical_list: D000892:Anti-Infective Agents, Urinary; D015662:Trimethoprim, Sulfamethoxazole Drug Combination