Therapy for Women Hospitalized with Acute Pyelonephritis: A Randomized Trial of Ampicillin versus Trimethoprim-Sulfamethoxazole for 14 Days

Abstract

The efficacy of the traditionally recommended ampicillin (Amp) plus gentamicin (GM) regimen was compared with that of a trimethoprim-sulfamethoxazole (TMP/SMZ)-plus-GM regimen and the adequacy of 14 days total therapy for acute uncomplicated pyelonephritis (AUPN). Eighty-five women hospitalized for AUPN were randomly assigned to receive either Amp, 1 g intravenously (iv) every 6 h for 3 days, then 500 mg orally four times daily, or TMP/SMZ, 160/800 mg iv every 12 h for 3 days, then 160/800 mg orally twice daily. Initially, all patients also received GM every 8 h iv (mean, 606 doses). Antimicrobial resistance necessitated modifying therapy of 14 (32%) of the Amp recipients but of none of the TMP/SMZ recipients (P less than .001). Both regimens produced a satisfactory bacteriologic and clinical response in all cases. Reinfection occurred in 11% of Amp and in 8% of TMP/SMZ recipients. No patient experienced relapsing infection. The TMP/SMZ regimen was less costly and less likely to require modification due to antimicrobial resistance.

Oral vs Intravenous Ciprofloxacin in the Initial Empirical Management of Severe Pyelonephritis or Complicated Urinary Tract Infections

“…20,23,24 The rate of resistance to ampicillin was 33%, a finding consistent with previous studies, 20,23,24 whereas the rate of resistance to co-trimoxazole (12%) was higher than previously reported. 20,23,24 Resistant infections were more frequent in complicated UTIs (10 of 70 patients, 14%) and were often caused by gram-positive cocci, particularly enterococci. The isolation of enterococci (in monomicrobial or mixed infections) was also the most frequent reason for modification of treatment when culture and susceptibility testing results became available.…”

The type 1 pili regulator gene fimX and pathogenicity island PAI-X as molecular markers of uropathogenic Escherichia coli

“…Bacterial strains were routinely cultured in Luria-Bertani broth without antibiotics. Isolates were derived from four sources: (1) well-characterized, published representative pathogenic and commensal strains (n59); (2) isolates collected in previously published clinical studies in Seattle, representing various clinical syndromes of urinary tract infection (n5155) (Czaja et al, 2009;Garofalo et al, 2007;Hooton et al, 1996;Johnson et al, 1987Johnson et al, , 1988Johnson et al, , 1991 as well as control faecal-commensal isolates (n520) (Stapleton et al, 1991); (3) strains from the E. coli reference (ECOR) collection (n568) (Ochman & Selander, 1984) and (4) clinical enterohaemorrhagic E. coli (EHEC) isolates (n57).…”

“…The study population for all studies was non-pregnant, outpatient women ages 18 to 49 seen in the Hall Health Primary Care Center (student health clinic) at the University of Washington (Czaja et al, 2009;Garofalo et al, 2007;Hooton et al, 1996) or Group Health Cooperative of Puget Sound (Garofalo et al, 2007;Hooton et al, 1996), except for isolates collected from in-patients hospitalized with pyelonephritis and/or urosepsis. Pyelonephritis isolates were collected from 20 women ages 18 to 45 hospitalized in one of four hospitals in Seattle (Johnson et al, 1991) and 2 were out-patients (Garofalo et al, 2007). Urosepsis isolates were collected from women ages 18 to 45 with bacteraemia arising from a urinary tract source, hospitalized in one of four hospitals in Seattle, WA (Johnson et al, 1987(Johnson et al, , 1988(Johnson et al, , 1991.…”

“…Pyelonephritis isolates were collected from 20 women ages 18 to 45 hospitalized in one of four hospitals in Seattle (Johnson et al, 1991) and 2 were out-patients (Garofalo et al, 2007). Urosepsis isolates were collected from women ages 18 to 45 with bacteraemia arising from a urinary tract source, hospitalized in one of four hospitals in Seattle, WA (Johnson et al, 1987(Johnson et al, , 1988(Johnson et al, , 1991. Exclusion criteria for all studies of out-patients included known anatomical or functional abnormalities of the urinary tract, chronic illness requiring medical supervision, pregnancy or planned pregnancy during the next three months and, except for studies of pyelonephritis, symptoms or signs of acute pyelonephritis.…”

“…bacteria ml 21 documented twice at least 24 h apart in a subject with no typical symptoms of UTI (Garofalo et al, 2007;Hooton et al, 1996); acute uncomplicated pyelonephritis (n522) was defined as costovertebral angle pain and/or tenderness, pyuria and bacteriuria with ¢10 4 c.f.u. ml 21 (Garofalo et al, 2007;Johnson et al, 1991) and urosepsis (n520) was defined as bacteraemia arising from a urinary tract source (Johnson et al, 1987(Johnson et al, , 1988. Commensal isolates (n520) were defined as faecal isolates (prospectively collected between 1981 and 1987) from healthy, non-pregnant women with no cystitis symptoms, no history of UTI in the prior year and no antibiotic use in the previous month (Stapleton et al, 1991).…”