title: The comeback of trimethoprim in France.
abstract: Already used in various countries, trimethoprim (TMP) was withdrawn from the French market in 1990, but should be soon available again. This article reviews the experience of TMP use around the world and its current use in Europe. Label use and guidelines only recommend the use of TMP for the treatment of urinary tract infections (UTI). Compared with co-trimoxazole (Co-T), a combination of TMP and sulfamethoxazole (SMX), TMP has (a) a similar resistance rate among Escherichia coli strains (estimated between 10 and 20% in uncomplicated cystitis), (b) a similar clinical efficacy for cystitis prevention and treatment, (c) a lower toxicity (as severe toxicity adverse effects of Co-T come from its sulfonamide component), (d) limited data for the treatment of pyelonephritis and male UTIs, and (e) an important impact on the microbiota. TMP should thus be indicated in the third-line empirical treatment of acute uncomplicated cystitis (sparing fluoroquinolones and nitrofurantoin), in the prevention of recurrent acute cystitis when an antibiotic prophylaxis is required (possibly in first line), and in the treatment of documented acute cystitis at risk of complications. Updated data on the epidemiology of resistance to TMP per clinical pictures is now required. The bactericidal effect of TMP should also be confirmed on recent strains (although limited recent data suggests a bactericidia similar to that of Co-T) and its clinical efficacy should be evaluated in pyelonephritis and male UTI.
authors.affiliation: Maladies infectieuses et tropicales, hôpital C.-Nicolle, centre hospitalier universitaire de Rouen, 1, rue de Germont, 76000 Rouen, France; Groupe de recherche sur l'adaptation microbienne (GRAM-EA2656 IRIB), université de Rouen, 22, boulevard Gambetta, 76000 Rouen, France.
authors.forename: F
authors.initials: F
authors.lastname: Caron
authors.affiliation: Département de microbiologie, hôpital C.-Nicolle, centre hospitalier universitaire de Rouen, 1, rue de Germont, 76000 Rouen, France.
authors.forename: V
authors.initials: V
authors.lastname: Wehrle
authors.affiliation: Maladies infectieuses et tropicales, hôpital C.-Nicolle, centre hospitalier universitaire de Rouen, 1, rue de Germont, 76000 Rouen, France; Groupe de recherche sur l'adaptation microbienne (GRAM-EA2656 IRIB), université de Rouen, 22, boulevard Gambetta, 76000 Rouen, France. Electronic address: manuel.etienne@chu-rouen.fr.
authors.forename: M
authors.initials: M
authors.lastname: Etienne
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D003556:Cystitis / Q000188:drug therapy / Q000453:epidemiology; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization; D004926:Escherichia coli / Q000187:drug effects; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology; D005578:Fosfomycin / Q000627:therapeutic use; D005602:France / Q000453:epidemiology; D006801:Humans; D017410:Practice Guidelines as Topic; D057051:Product Recalls and Withdrawals; D014295:Trimethoprim / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects / Q000627:therapeutic use; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D005578:Fosfomycin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D014295:Trimethoprim
keywords: Co-trimoxazole; Cystite; Cystitis; Infections urinaires; Trimethoprim; Trimethoprim-sulfamethoxazole; Triméthoprime; Triméthoprime-sulfaméthoxazole; Urinary tract infection