Amoxicillin-clavulanic acid in treatment of urinary tract infection due to gram-negative bacteria resistant to penicillin

In a double-blind randomized study, amoxicillin-clavulanic acid (AM-CL) was compared with cefaclor for the treatment of acute urinary tract infections in 107 college women. A total of 53 patients received amoxicillin (250 mg) and clavulanic acid as the potassium salt (125 mg), and 54 received cefaclor (250 mg); each drug was administered every 8 h for 10 days. The cure rates at 1 and 4 weeks after treatment were 96 and 78%, respectively, in the AM-CL group and 92 and 75%, respectively, in the cefaclor group (P > 0.10). After AM-CL treatment, the prevalence of amoxicillin-resistant Eschenichia coli significantly increased in the rectal flora. Also, the frequency of bacterial resistance to amoxicillin, AM-CL, and cefaclor increased among the urinary pathogens causing subsequent urinary tract infections (P< 0.05). There were no adverse reactions in the cefaclor group; however, six patients in the AM-CL group (12%) experienced diarrhea, nausea, or vomiting (P< 0.05). Elevated transaminase enzyme levels were observed in 23% of the patients in the AM-CL group and in 6% of the patients in the cefaclor group (P< 0.05). Symptomatic Candida vaginitis developed in 16 and 13% of the patients in the AM-CL and cefaclor groups, respectively (P > 0.10).Bacterial resistance to the P-lactam antibiotics is largely due to the production of a ,-lactamase (1,5,20). Clavulanic acid inhibits many of these enzymes (16). A combination of amoxicillin (AM) and clavulanic acid (CL) is effective against a variety of ,-lactamase-positive bacteria (2, 4, 10, 12, 15). The purposes of this study were (i) to compare the efficacy and safety of AM-CL with the efficacy and safety of cefaclor in the treatment of acute urinary tract infections (UTIs) in young women, (ii) to relate therapeutic responses to the results of the antibody-coated bacteria test (ACBT), and (iii) to assess the emergence of resistant members of the Enterobacteriaceae in the rectal and urogenital areas after treatment. MATERIALS AND METHODSPatient criteria. The study group consisted of college women who came to the Kidney Clinic of the University of Florida Student Health Services with symptoms of acute UTIs. The criteria for inclusion were as follows: (i) symptoms such as dysuria, urgency, and suprapubic or flank pain; (ii) at least one bacterium in each random high-power microscopic field of an unstained and uncentrifuged urine specimen; and (iii) 2105 CFU of a bacterium per ml in each of three consecutive urine specimens. Initially, 111 patients entered the study, but 4 had negative urine cultures and did not qualify, leaving 107 patients in the study. Excluded from the study were pregnant or lactating women and women with impaired renal or liver function, radiographically proven obstructive uropathy, or a history of allergy to penicillins or cephalosporins. Patients who had received antimicrobial agents during the preceding week were also excluded.Collection, processing, and analysis of specimens. A specially trained nurse instructed each patient to submit three * Correspond...

Section: Methodssupporting

confidence: 82%

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confidence: 99%

Amoxicillin-clavulanic acid versus cefaclor in the treatment of urinary tract infections and their effects on the urogenital and rectal flora

Iravani¹,

Richard²

1986

“…The cure rate for infections due to amoxicillin-resistant bacteria is similar to that caused by amoxicillin-susceptible organisms, and the addition of low doses of clavulanic acid to amoxicillin did not appear to increase the incidence of adverse reactions (7). In comparative studies, A-C was significantly more effective than amoxicillin alone against infections due to amoxicillin-resistant bacteria (9,14).…”

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confidence: 99%

Prospective comparison of amoxicillin-clavulanic acid and cefaclor in treatment of uncomplicated urinary tract infections

Gurwith¹,

Stein²,

Gurwith³

1983

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.

“…The combination of amoxicillin plus clavulanic acid at a 2-to-1 ratio is known as Augmentin (Beecham Laboratories, Bristol, Tenn.). The potential usefulness of this compound has been demonstrated in several preliminary clinical studies (3,7,9,12,18).…”

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confidence: 99%

In vitro evaluation of Augmentin by broth microdilution and disk diffusion susceptibility testing: regression analysis, tentative interpretive criteria, and quality control limits

Fuchs¹,

Barry²,

Thornsberry³

et al. 1983

Augmentin (Beecham Laboratories, Bristol, Tenn.), a combination drug consisting of two parts amoxicillin to one part clavulanic acid and a potent betalactamase inhibitor, was evaluated in vitro in comparison with ampicillin or amoxicillin or both for its inhibitory and bactericidal activities against selected clinical isolates. Regression analysis was performed and tentative disk diffusion susceptibility breakpoints were determined. A multicenter performance study of the disk diffusion test was conducted with three quality control organisms to determine tentative quality control limits. All methicillin-susceptible staphylococci and Haemophilus influenzae isolates were susceptible to Augmentin, although the minimal inhibitory concentrations for beta-lactamase-producing strains of both groups were, on the average, fourfold higher than those for enzyme-negative strains. Among the Enterobacteriaceae, Augmentin exhibited significantly greater activity than did ampicillin against Klebsiella pneumoniae, Citrobacter diversus, Proteus vulgaris, and about one-third of the Escherichia coli strains tested.