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

Abstract

A 10-day course of amoxicillin (250 mg)-potassium clavulanate (125 mg) was administered three times daily to 116 female college students with urinary tract infections. All of the bacterial isolates from these patients were susceptible to amoxicillin-potassium clavulanate in vitro; only 81.0%0 were susceptible to amoxicillin alone. Evaluations at 1 week after completion of this course showed that clinical and bacteriological cures had been achieved in 96.9%0 of those who completed therapy. Cures were sustained in 85.6% of the patients examined at 4 weeks after the end of therapy. Therapeutic responses were comparable, irrespective of the results of antibody-coated bacteria tests. All strains of Enterobacteriaceae isolated from the rectal and urogenital sites at 1 week after therapy were susceptible to amoxicillin-potassium clavulanate. The proportion of fecal Escherichia coli resistant to amoxicillin alone increased from 13.3% before therapy to 35.6% at 1 week after therapy. Adverse drug reactions consisted of gastrointestinal symptoms (9.8%) and rashes (4.1%). Sixteen patients (14.2%) developed symptomatic candida vaginitis by 1 week after therapy.Ampicillin and its analog amoxicillin have been extensively used for the treatment of urinary tract infections (5, 6). The widespread use of these P-lactam antibiotics has been associated with the emergence of resistant strains of various pathogens, resulting in an increased number of therapeutic failures (12, 17, 22). Resistance to these agents is usually mediated by the production of P-lactamases which inactivate these antibiotics (1). Clavulanic acid, a naturally occurring 3-lactamase inhibitor, may prevent the inactivation of these P-lactams (8,21). Combinations of clavulanic acid and amoxicillin are significantly more active both in vitro and in vivo against certain ,B-lactamase-producing bacteria than is amoxicillin alone (11,18).The purposes of this study were: (i) to determine the efficacy and safety of the combination of amoxicillin and potassium clavulanate in the treatment of urinary tract infections; (ii) to attempt to relate therapeutic responses to the results of antibody-coated bacteria tests (25)

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

“…Both AM-CL and cefaclor were efficacious in eliminating urinary pathogens regardless of the in vitro resistance of the organisms. The therapeutic results were in agreement with previous results (2,4,10,12,14,15 15:443,1981).…”

“…Cefaclor was tolerated well by all the patients, and the adverse reactions occurring with AM-CL (12%) were comparable to the reactions described in previous reports (4,12,14). The frequency of elevated transaminase levels (serum (20) 4 (9) glutamic oxalacetic transaminase and serum glutamic pyruvic transaminase) was significantly higher in the AM-CL group (23%) than in the cefaclor group (6.%) and was higher than our previous report of 4% in patients treated with AM-CL (12).…”

“…In a previous trial we found an incidence of symptomatic vaginal candidiasis of 14% following the use of AM-CL (12).…”

“…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.…”

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

“…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).…”