Lower risk of urinary tract infection with low-dose trimethoprim/sulfamethoxazole compared to dapsone prophylaxis in older renal transplant patients on a rapid steroid-withdrawal immunosuppression regimen.
BACKGROUND
Urinary tract infections (UTI) are common in renal transplant recipients. Trimethoprim/sulfamethoxazole (TMP/SMZ) in moderate to high daily doses prevents Pneumocystis jiroveci (PCP) and reduces the risk of UTI in renal transplant patients. Low-dose TMP/SMZ also reduces the risk of PCP, although its ability to reduce the risk of UTI is uncertain.


METHODS
Retrospective review of 158 patients who received a renal transplant without corticosteroids for maintenance immunosuppression.


RESULTS
Forty percent of patients initially prescribed TMP/SMZ ultimately stopped this medication early because of an adverse reaction. Urinary infection occurred in 16% without a significant difference in the risk of UTI between those treated with dapsone vs. those treated with TMP/SMZ (HR [95%CI]: 1.7 [0.75, 3.9], p = 0.2). In the subset of patients who were older than age 47 yr (mean age for this cohort, SD ± 6.2 yr), those treated with dapsone originally or who switched from TMP/SMZ to dapsone had a greater risk of UTI compared to patients who remained on TMP/SMZ (HR [95%CI]: 4.3 [1.2, 15.5], p = 0.024).


CONCLUSIONS
For renal transplant recipients over the age of 47 yr, treated without long-term glucocorticoids, our retrospective data suggest that low-dose TMP/SMZ is associated with a lower risk of UTI compared to dapsone prophylaxis.
Giullian
Jeffrey Allen
JA
South Denver Nephrology Associates, Denver, CO, USA. jeffgiullian@yahoo.com
Cavanaugh
Kerri
K
Schaefer
Heidi
H
D000328:Adult; D000892:Anti-Infective Agents, Urinary / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D015331:Cohort Studies; D003622:Dapsone / Q000627:therapeutic use*; D005260:Female; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016720:Pneumocystis Infections / Q000517:prevention & control; D045363:Pneumocystis carinii / Q000302:isolation & purification; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*; D014552:Urinary Tract Infections / Q000209:etiology / Q000517:prevention & control*
D000892:Anti-Infective Agents, Urinary; D007166:Immunosuppressive Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D003622:Dapsone