Comparative efficacy and safety of nalidixic acid versus trimethoprim/sulfamethoxazole in treatment of acute urinary tract infections in college-age women

Abstract

One hundred and thirty-five college-age women with acute urinary tract infections caused by gram-negative Enterobacteriaceae were treated by random allocation with either nalidixic acid (NA), 1 g every 6 h for 7 days, or trimethoprim/sulfamethoxazole (TMP/SMZ), 160/800 mg every 12 h for 10 (5,10,22). Nalidixic acid (NA) has a broad spectrum of activity against gram-negative Enterobacteriaceae. Pseudomonas species and gram-positive cocci are resistant to this agent (6,23,24). Oral doses of both drugs produce bactericidal urinary levels well in excess of the miniimal inhibitory concentration for most urinary pathogens (20). TMP/SMZ is considered an effective drug for the treatment of urinary tract infections (UTIs) (5,9,13,21,28,35). However, because of conflicting reports and controversy over the emergence of bacterial resistance, NA has been used less frequently (8,25,28).In this study, the efficacy of NA was compared with that of TMP/SMZ for treatment of acute UTIs in young women. The antibody-coated bacteria test (ACBT) was used to localize the site of the infections (32, 33). Criteria were established to allow recurrences to be subdivided into reinfections and relapses. The effects of these drugs on the ecology of the fecal flora, as well as the emergence of resistant urinary pathogens, were assessed. MATERIALS AND METHODSThe patient population was comprised of college women who entered the University of Florida Outpatient Clinic with symptoms of acute UTI. The criterion for inclusion in the study was the presence of more than 105 colonies of the same gram-negative Enterobacteriaceae per ml in each of three consecutive urine samples obtained within 24 h of initiating therapy. Lower urinary tract symptoms were monitored by the use of a patient diary. The time of each voiding and the degree of severity of each symptom were recorded in the diary during the first 3 days of therapy. Women with asymptomatic infections were included in the study. They were identified from a group of students who were having monthly urine cultures done as follow-up for previous UTIs. Patients

Treatment of urinary tract infections with a combination of amoxicillin and clavulanic acid

“…Patients with a positive or a negative test had similar responses to therapy. Patients with a positive test did not show a propensity for recurrence rates higher than those of patients with a negative test (13,14,23). We feel that further studies are required to clarify the clinical significance of this test.…”

“…The major criterion for inclusion was the presence of 2105 colony-forming units (CFU) of the same bacterium per ml in each of three consecutive clean-catch midstream urine specimens. Excluded (13,14,25).…”

“…Vaginal, periurethral, and rectal specimens were collected on Culturette rayon-tipped swabs (Scientific Products, McGaw Park, Ill.) for culture and susceptibility testing before therapy and at 1 week after the end of treatment (14). Vaginal specimens obtained at the above times with a rayon-tipped swab were tested for candida with KOH smear and Nickerson culture (GIBCO Diagnostics, Madison, Wis.).…”

“…Urine specimens were processed and bacterial isolates were identified according to methods described previously (3,9,15 (26). Rectal, vaginal, and periurethral specimens were processed for culture and susceptibility testing as previously described (14).…”

Effects of changes in pH, medium, and inoculum size on the in vitro activity of amifloxacin against urinary isolates of Staphylococcus saprophyticus and Escherichia coli

“…AGENTS CHEMOTHER. 6.25 ,ug/ml). S. saprophyticus was resistant to 7.0, 7.5, and 8.0 with NaOH or HCl.…”