Single dose and conventional treatment for acute bacterial and non-bacterial dysuria and frequency in general practice

Abstract

A five day course of clavulanate-potentiated amoxicillin (Augmentin) has been compared with a single oral dose of fosfomycin trometamol in the treatment of patients complaining of symptoms suggesting urinary tract infection. The study took place in a single urban general practice of 15,000 patients in Cheshire. The microbiology was performed at a London Teaching Hospital. 141 patients entered the trial. 65 had a significant bacteriuria, 62 of which were assessable for the ability of the trial drugs to eradicate bacteriuria: 29 patients received clavulanate-potentiated amoxicillin and 33 fosfomycin trometamol. The cure rates, assessed at five to ten days and at four to six weeks post treatment, were 72% and 65%, respectively for clavulanate-potentiated amoxicillin and 85% and 81%, respectively for fosfomycin trometamol. Side effects, assessed in all 141 patients, occurred in 11.6% receiving clavulanate-potentiated amoxicillin and in 8.3% receiving fosfomycin. Statistically there is no difference between any of these findings and the effect of sample size is discussed. 69 patients were symptomatic but did not have a significant bacteriuria ("urethral syndrome"). These patients were assessed for the effect of treatment in relieving symptoms: 33 received fosfomycin trometamol and 36 clavulanate-potentiated amoxicillin. The success and speed of relieving the symptoms were very similar in the two groups. The finding that both groups responded equally well appears to refute an aetiological role for lactobacilli and diphtheroids in the "urethral syndrome", since these organisms are resistant to fosfomycin but sensitive to clavulanate-potentiated amoxicillin.

Fosfomycin trometamol in a single dose versus seven days nitrofurantoin in the treatment of acute uncomplicated urinary tract infections in women

“…General practice was chosen as setting for the trial to avoid the problem of referral bias. One of the possible disadvantages of a multicentre trial mentioned by Cooper et al [14], being varying results from different participating centres (inter-observer variation), was solved by having all the dipslides read by the study co-ordinator at the end of the study. Despite this multicentre design we did not succeed in including 156 patients per group.…”

“…The drug has a favourable pharmacokinetic pattern, it shows antibacterial activity against uropathogens like Escherichia coil (MICS0 < 2 rag/I), Proteus mirabilis (MRC50 2-8 mg/I) and Staphylococcus saprophyticus (MRC50 32-128 mg/I) [13], and it penetrates into leucocytes and shows no cross-resistance with other antibiotics because of its unique chemical structure [14].…”

Enigma of urethral pain syndrome: Why are there so many ascribed etiologies and therapeutic approaches?

“…This was challenged, as fastidious bacteria were isolated in no greater numbers from the urine of patients with UPS than from the urine of women without symptoms . Additionally, treatment of UPS with an antibiotic (co‐amoxiclav) active against lactobacilli gave the same “cure rate” as treatment with fosomycin, which is inactive against lactobacilli.…”

Fosfomycin and Its Application in the Treatment of Multidrug-Resistant Enterobacteriaceae Infections

“…55,186,187 The studies were nonblinded, single-blinded, or doubleblinded comparisons. A single 3 g dose of fosfomycin was compared with single doses of amoxicillin 3 g, 188,189 ofloxacin 200 mg, 190 norfloxacin 800 mg, 191 pefloxacin 800 mg, 192 trimethoprim 200 mg, 193 and cotrimoxazole 1920 mg. 190 A single dose of fosfomycin was also compared with amoxicillin + clavulanic acid 375 mg four times daily for five days, 194 cefalexin 500 mg four times daily for five days, 195 ciprofloxacin 500 mg twice daily for five days, 196 pipemidic acid 400 mg twice daily for 5-7 days, [197][198][199] norfloxacin 400 mg bid for 5-7 days, 197,[200][201][202][203] cotrimoxazole 480 mg twice daily for three days, 204 trimethoprim 200 mg twice daily for five days, 18 and nitrofurantoin 50 mg four times daily for seven days. 205 In these studies, the microbiological and clinical efficacies were similar, and 70%-95% microbial eradication rates were observed 5-11 days after treatment.…”