The Urethra and its Relationship to Urinary Tract Infection. II. The Urethral Flora of the Female with Recurrent Urinary Infection

Cox, Clair E.; Lacy, Sushil S.; Hinman, Frank

doi:10.1016/s0022-5347(17)62762-9

Cited by 99 publications

(36 citation statements)

References 13 publications

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“…However, the percentages of recurrence through the 24 weeks after therapy ended were not significantly different in the TMP treatment groups and the SZ treatment groups. This lack of correlation between the changes in the fecal flora TMP VERSUS SZ IN UTIs 849 and the patterns of recurrence may have been due to a more important role played by host factors in the pathogenesis of UTIs (8).…”

Section: Discussionmentioning

confidence: 99%

Treatment of uncomplicated urinary tract infections with trimethoprim versus sulfisoxazole, with special reference to antibody-coated bacteria and fecal flora

Iravani¹,

Richard²,

Baer³

1981

Antimicrob Agents Chemother

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A total of 331 college-age women with urinary tract infections were studied. These women were assigned randomly to the following groups: 50 patients treated with 400 mg of trimethoprim (TMP) per day for 14 days (designated the TMP400/ 14d group); 50 treated with 2.0 g of sulfisoxazole (SZ) per day for 14 days (SZ/14d group); 120 treated with 200 mg of TMP per day for 10 days (TMP200/10d group); and 111 treated with 2.0 g of SZ per day for 10 days (SZ/lOd group). By the last day of therapy, clinical and bacteriological cure rates were 100% in the TMP400/14d, SZ/14d, and TMP200/lOd groups and 97.1% in the SZ/lOd group. At 1 week after therapy ended, the initial urinary pathogens remained eradicated in 100% of the TMP400/14d group, 98.2% of the TMP200/lOd group, 95.6% of the SZ/14d group, and 98.0% of the SZ/lOd group. At 4 weeks after therapy ended, the clinical cure rates were 92.0% in the TMP400/14d group, 92.0% in the SZ/14d group, 89.0% in the TMP200/lOd group, and 90.0% in the SZ/lOd group. At 4 and 24 weeks after therapy ended, the recurrence rates in the four treatment groups did not differ significantly. The antibody-coated bacteria test localized 39.5% of the infections to kidneys and 56.8% of the infections to bladders. Neither symptoms nor responses to therapy were correlated with the antibody-coated bacteria test results. Both TMP at a dose of 200 mg/day and SZ were tolerated well. TMP at a dose of 400 mg/day was associated with a skin rash in 24% of the patients receiving this therapy. TMP suppressed fecal Escherichia coli. SZ increased the number of sulfa-resistant fecal isolates; however, this phenomenon did not affect the rate of sulfa-resistant recurrences.Trimethoprim (TMP), a 2,4-diaminopyrimidine, is an antimicrobial agent which acts against a wide variety of bacterial species by selectively inhibiting microbial folate metabolism. TMP competitively inhibits bacterial dihydrofolate reductase and consequently blocks the formation of tetrahydrofolate and deoxyribonucleic acid synthesis. The inhibitory activity of TMP is enhanced by adding a sulfonamide, which acts in a prior step to prevent the formation of dihydrofolate (5, 6). Furthermore, Darrell et al. reported that the presence of a sulfonamide could reduce the emergence of TMP resistance when bacteria were exposed in vitro to low levels of TMP, provided that they were initially sulfa sensitive (11). Consequently, TMP has been used extensively in combination with sulfamethoxazole for the treatment of a variety of infections, including urinary tract infections (UTIs) (7,9,26). Interest in the synergistic effects of TMP and the sulfonamides diverted attention from the activity of TMP as an antibacterial agent in its own right. Preliminary descriptions of TMP as the sole therapeutic agent against adult UTIs have been encouraging (4,17,21,23).In this study the efficacy and safety of TMP were compared with the efficacy and safety of sulfisoxazole (SZ)

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Section: Discussionmentioning

confidence: 99%

Treatment of uncomplicated urinary tract infections with trimethoprim versus sulfisoxazole, with special reference to antibody-coated bacteria and fecal flora

Iravani¹,

Richard²,

Baer³

1981

Antimicrob Agents Chemother

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“…As in most series [6][7][8], Escherichia coli was the most common infecting organism. In a total of 88 infections E. coli was found 60 times.…”

Section: Resultsmentioning

confidence: 98%

“…Nine of the women were sexually active. The glomerular filtration rate for the group as a whole was moderately reduced (mean 60.7 ml/min): in the 4 women with allergic intersti tial nephritis (2,4,5,8), the glomerular filtration rate measured at the time sulfonamides were discontinued averaged only 34 ml/min. Frequent infections had occurred in all: an average of 6.8 +1.4 infections/patient being documented in an observation period of 20.9 + 5.96 months or an average of 3.9 infections/patient/year.…”

mentioning

confidence: 94%

Prevention of Recurrent Urinary Tract Infections in Postmenopausal Women

Privette

Cade

Peterson

et al. 1988

Nephron

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Twelve postmenopausal women who experienced frequent urinary tract infections were found to have atrophic vaginitis. Four of them who were taking sulfonamide preparations chronically also had an interstitial nephritis manifest by decreasing glomerular filtration rate and eosinophiluria. Treatment consisted of a Betadine douche daily for 1 week, administration of an appropriate nonsulfonamide antibiotic, and institution of estrogen therapy to restore glycogen deposition in the vaginal epithelium and promote return of a normal vaginal pH and bacterial flora. Prior to estrogen therapy, the frequency of infection was four per patient per year. During a follow-up observation period ranging from 2 to 8 years, there have been only four infections in the entire group. When sulfonamides were discontinued in the 4 patients with manifestations of interstitial nephritis, the eosinophiluria cleared, and the glomerular filtration rate increased significantly.

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“…Thus Cox (1966) and Cox et al (1968) recovered Gram-negative bacilli from the urethra of 54% of women with recurrent infection and 27% of normal women. We ourselves recovered five or more enterobacteria from periurethral swabs from 230% of healthy women and 280% of women with frequency or dysuria or both in the absence of bacteriuria (O'Grady et al, 1970 (O'Grady et al, 1970).…”

Section: Discussionmentioning

confidence: 99%

“…In support of this, Stamey et al (1971) observed striking differences in enterobacterial carriage on the vestibule and in urethral urine between normal and affected women. Most other investigators (Cox, 1966;Cox et al, 1968;O'Grady et al, 1970;Marsh et al, 1972;Bailey et al, 1973) have failed to confirm these observations though O'Grady et al (1970) observed that "recurrent infection was commoner in patients who were persistent carriers of enterobacteria." Marsh et al (1972), studying patients with symptoms of recurrent infection, found little correlation between the level of introital colonization and the incidence of subsequent infections.…”

Section: Introductionmentioning

confidence: 99%

Periurethral Enterobacterial Carriage in Pathogenesis of Recurrent Urinary Infection

Cattell¹,

McSherry²,

A³

et al. 1974

BMJ

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The Urethra and its Relationship to Urinary Tract Infection. II. The Urethral Flora of the Female with Recurrent Urinary Infection

Cited by 99 publications

References 13 publications

Treatment of uncomplicated urinary tract infections with trimethoprim versus sulfisoxazole, with special reference to antibody-coated bacteria and fecal flora

Treatment of uncomplicated urinary tract infections with trimethoprim versus sulfisoxazole, with special reference to antibody-coated bacteria and fecal flora

Prevention of Recurrent Urinary Tract Infections in Postmenopausal Women

Periurethral Enterobacterial Carriage in Pathogenesis of Recurrent Urinary Infection

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