The authors carried out a case-control study in 1982-1983 to investigate the possible influence of behavioral factors on the risk of urinary tract infection. Study participants were college women attending a student health service. Cases were 43 women with culture-confirmed urinary tract infection. There were two control groups: 149 women with upper respiratory infection and 227 women visiting the gynecology clinic. Using each set of controls, the study confirmed that sexual intercourse is a risk factor and that there is a dose-response effect for increasing levels of coital frequency. The study also found that use of the diaphragm was significantly associated with urinary tract infection (odds ratios 3.0, 2.3), an association which remained significant even after controlling for possible confounding by coital frequency. The findings did not show an association with many of the factors commonly believed to be important such as type of clothing worn and volume of fluids consumed.

Patients with acute, uncomplicated urinary tract infections were treated with either amoxicillin-clavulanic acid (A-C) in fixed combination or cefaclor for 10 days in a prospective randomized comparison. The A-C group included 29 women and 1 man (mean age, 25.5 years), and the cefaclor group included 35 women and 1 man (mean age, 24.9 years). The cure rates were 26 (87%) of 30 with A-C and 26 (72%) of 36 with cefaclor (P > 0.20). There was one failure in each group, each caused by an isolate resistant to ampicillin. There were one relapse and two reinfections in the A-C group, compared with seven relapses and two reinfections in the cefaclor group. Side effects, including patients started on antibiotics but whose cultures did not confirm urinary tract infections, were diarrhea in 7 (16%) and rash in 1 (2%) of 44 A-C patients, compared with diarrhea in 1 (2%) and yeast vaginitis in 3 (6%) of 48 cefaclor patients. Although the A-C group had a greater proportion of antibody-coated bacterium-positive infections (22 versus 18 with cefaclor), there was a lower recurrence rate with fewer relapses in patients treated with A-C.

A total of 80 patients were equally randomized to receive a single dose of 6.5% tioconazole ointment or a 3-day course of 100-mg clotrimazole vaginal tablets for the treatment of vulvovaginal candidiasis. Of the 32 evaluable patients treated with tioconazole, 27 (84%) remained asymptomatic 4 weeks posttreatment, compared with 28 of 33 patients (85%) treated with clotrimazole. A total of 34 patients in each group could be evaluated for mycological response based on culture results 1 and 4 weeks after treatment. Twenty patients (59%) who received tioconazole and twenty-one patients (62%) who received clotrimazole remained culture negative 4 weeks after therapy. Of 40 patients who received tioconazole, 12 (30%) experienced local irritation or itching, compared with 2 of 40 patients (5%) treated with clotrimazole (P < 0.01). Single-dose tioconazole ointment was as effective as a 3-day course of clotrimazole tablets, but significantly more patients in the tioconazole-treated group experienced local side effects.The duration of treatment for Candida vaginitis has changed dramatically over the past several years. New high-dose imidazole derivatives have produced excellent short-term cure rates with treatment durations as short as 1 to 3 days (1,3,4,13,16,21). In addition, 4-week follow-up cultures of patients undergoing short-term treatment have not shown a higher incidence of recolonization by Candida organisms compared with cultures from patients undergoing longer periods of treatment (3,13,16,20,21). Shorter courses of therapy also encourage compliance and decrease expense and inconvenience (1,3,12,16).Tioconazole is a new imidazole antifungal agent similar to miconazole and clotrimazole. It has a broad spectrum of activity and is more active than other imidazoles against Candida albicans in vitro (10,11,18). In a randomized study of 109 women with vaginal candidiasis, a 3-day course of treatment with 2% tioconazole vaginal cream produced higher cure rates 7 to 10 days (P = 0.01) and 4 weeks (P < 0.05) after therapy than did clotrimazole vaginal tablets (6).Houang and Lawrence reported a mean vaginal concentration of 21.4 ,ug/ml 24 h after insertion of a single 300-mg ovule of tioconazole in 10 patients with vaginal candidiasis (8). This concentration is significantly higher than the MIC (1.6 to 12.5 ,ug/ml) of tioconazole for C. albicans (10). These studies suggest that a single application of the agent could be clinically effective in the treatment of Candida vaginitis.The study reported here was designed to compare the efficacy and acceptability of a single intravaginal application of 6.5% tioconazole ointment (325 mg) with a 3-day regimen of clotrimazole vaginal tablets in women with vulvovaginal candidiasis.(The study was presented in part at the 23rd Interscience Conference on Antimicrobial Agents and Chemotherapy, Las Vegas, Nev., 24 Before admission to the study, written informed consent was obtained from each patient. A medical history was taken, and a physical and gynecological examination, including a Pa...

To investigate whether 10 days of rifampin-trimethoprim (RIF-TMP) or 6 weeks of sulfamethoxazoletrimethoprim (SMX-TMP) would decrease the relapse rate in patients with acute uncomplicated upper urinary tract infections in comparison with 10 days of SMX-TMP, we randomized 189 patients to receive RIF-TMP or SMX-TMP in a ratio of 1:2. After the site of infection was established by the antibody-coated bacterium (ACB) test, patients with upper-tract infections who received SMX-TMP were again randomized and received either a total of 6 weeks or 10 days of therapy. All patients who received RIF-TMP were treated for 10 days. Clinical and microbiological evaluations were repeated at 2 and 6 weeks posttreatment. Eighty-five patients (54 ACB positive) received 10 days of RIF-TMP, 71 patients (45 ACB positive) received 10 days of SMX-TMP, and 18 patients (18 ACB positive) received 6 weeks of SMX-TMP. The overall recurrence rates in patients who received 10 days of therapy were 32% for RIF-TMP and 23% for SMX-TMP (P = 0.13). There were 12 (14%) relapses in the RIF-TMP group compared with 2 (3%) relapses in the SMX-TMP group (P = 0.01). In patients with upper-tract infections, the relapse rates were not statistically significantly different (P 0.13). There were two (11%) recurrences (one relapse and one reinfection) in the 6-week treatment group. This 6% relapse rate was not different from the 4% relapse rate observed in patients with upper-tract infections who received 10 days of SMX-TMP. The number of patients who discontinued treatment because. of an adverse effect in the 6-week SMX-TMP treatment group was significantly greater than those in the 10-day SMX-TMP treatment group (P = 0.003) and the RIF-TMP treatment group (P = 0.05). Ten days of SMX-TMP was as effective as 6 weeks of SMX-TMP or 10 days of RIF-TMP in the treatment of uncomplicated upper urinary tract infections and caused the fewest untoward effects.Rifampin has antimicrobial activity against most urinary pathogens (10, 15, 20) and demonstrates good tissue and intracellular penetration. Even though the main excretory route for rifampin is through the bile, concentrations in urine well above the MIC for most urinary pathogens are found after single doses (18). The drawback to using rifampin alone to treat urinary tract infections (UTI) is rapid emergence of rifampin-resistant strains (27). Trimethoprim is particularly active against aerobic gram-negative bacteria, and the combination rifampin-trimethoprim (RIF-TMP) is synergistic against most urinary pathogens (10, 16, 20). This combination protects against emergence of resistance seen in bacterial populations exposed to either drug alone (3,14,15). In addition, the pattern of absorption and excretion of rifampin and trimethoprim given alone does not differ significantly from that when they are given concurrently (1, 18).The combination RIF-TMP has been reported to be effective in the treatment of acute (21, 27) and chronic (2, 6) UTI and is a potential alternative to sulfamethoxazole plus trimethoprim (SMX-TMP...