trimethoprim for uti prophylaxis

Placebo or antibiotics were allowed as comparators. Effective Prevention of Recurrent UTIs With Vaginal Estrogen: Pearls for a Urological Approach to Genitourinary Syndrome of Menopause. Out of 227 patients with recurrent UTI only 7 patients (3.1%) were prescribed topical estrogen. Descriptive and inferential statistics have been performed for the socio-demographic and clinical variables. Even including the latter approach, there was no significant difference in efficacy between the continuous and intermittent prophylaxis approaches. What else should I know about Primsol (trimethoprim)? The site is secure. The Copas selection method (Supplementary Figure6) produced an estimate slightly closer to that from the original model (P=.21; .13.32), suggesting that 1 additional study would be required to achieve symmetry. Federal government websites often end in .gov or .mil. FOIA Al-Rubeaan KA, Moharram O, Al-Naqeb D, Hassan A, Rafiullah MR. Tablets should be stored at room temperature, 15 C - 30 C (59 F - 86 Table1 summarizes the effect of interventions in the meta-analysis, divided by type of comparison. All Escherichia coli strains causing post-prophylactic UTI were TMP sensitive. For prophylaxis, 5 mg/kg/dose of trimethoprim component IV/PO every 48 to 72 hours. 2008;2:Cd005131. Overall, study quality was low. Neurourol Urodyn. High rates of resistance development under prophylactic antibiotics have been described for trimethoprim-sulfamethoxazole in particular (eg, [47]). the contents by NLM or the National Institutes of Health. Wong ES, McKevitt M, Running K, Counts GW, Turck M, Stamm WE. <> Zhong YH, Fang Y, Zhou JZ, Tang Y, Gong SM, Ding XQ. Please enable it to take advantage of the complete set of features! A variety of prophylactic options, including but not limited to antibiotics, have been examined in either head-to-head or placebo-controlled trials. Recurrent urinary tract infections in male are more likely related to prostatic hypertrophy and diabetes both of which lead to high post-void residuals [32, 33] The mean age of our male patients with recurrent UTI was (64.622.5) years. Would you like email updates of new search results? The children received the antibiotics for 6 months. Risk factors for recurrent UTI included diabetes mellitus, chronic renal disease, and use of immunosuppressive drugs, renal transplant, any form of urinary tract catheterization, immobilization and neurogenic bladder. PubMed Our patients population are from a tertiary care hospital outpatient clinic compared to a community set up in the previous reference and a much smaller number in our study, all of which may explain the prevalence difference in male patients. However, increased resistance of urinary bacteria is a concern that requires surveillance if prophylaxis is started. Primsol may increase in the body and lead to side effects. This study had no external funding source; article access fees were covered by the department. Urology and gynecological referral were infrequently requested as part of the evaluation process for patients with recurrent UTI. Perrotta C, Aznar M, Mejia R, Albert , Ng CW. Written informed consent from the participants legal guardian/next of kin was not required to participate in this study in accordance with the national legislation and the institutional requirements. Prevalence of urinary tract infection increase in male above age of 85 and 15% of those with UTI will have recurrent infection. 2010 Jul;36(4):846-51. doi: 10.1093/schbul/sbn191. Guglietta A. Recurrent urinary tract infections in women: risk factors, etiology, pathogenesis and prophylaxis. We excluded patients who are pregnant at the time of UTI diagnosis. Adult neurogenic lower urinary tract dysfunction and intermittent catheterisation in a community setting: risk factors model for urinary tract infections. females, may be at greater risk for developing anemia with Primsol. when a combination of trimethoprim and sulfamethoxazole was given with, Trimethoprim also may increase blood levels of. Nicolle LE, Harding GK, Thomson M, Kennedy J, Urias B, Ronald AR. Gentamicin 1 mg/kg (80 mg) IV 8H for 1-2 weeks when used only for synergy. Chang et al. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement, Cochrane Handbook for Systematic Reviews of Interventions, Users guides to the medical literature. The prophylactic effect seems, though, to be limited to the period of antibiotic intake, and the effectiveness of antibiotic prophylaxis should be weighed against concerns for resistance selection. proposed that Methenamine Hippurate is not inferior to antibiotic prophylaxis in terms of UTI prevention as it showed comparable efficacy, as well as it negates the risk of antimicrobial resistance [40]. Customize your JAMA Network experience by selecting one or more topics from the list below. (GI) tract, such as: Rarely, the Article Where appropriate, the absolute risk reduction (ARR) was used to calculate the number needed to treat (NNT). Clipboard, Search History, and several other advanced features are temporarily unavailable. Women who are pregnant. A total of 477 patients with at least one symptomatic with a positive urine culture were seen in outpatient department (OPD) in the period between January 2016 and December 2018 (Fig. Correspondence to The identified risk factors for recurrent UTI in our study were similar to previous studies nationally and internationally [15, 22,23,24,25]. potential benefits to the mother when considering trimethoprim therapy for This study reported an absolute UTI risk reduction of 68% (NNT, 1.5) [32]. 4 0 obj Because of the frequent development of resistance to Primsol is a synthetic (man-made) https://doi.org/10.1136/bmj.c346, Article A statistical analysis of UTI events after discontinuation of prophylaxis was not possible due to inconsistent reporting of the number of patients at risk in 2 of 3 studies that scrutinized the postprophylaxis period: One of these 2 studies [24] drew the conclusion that recurrences were infrequent even after discontinuation of prophylaxis, whereas the other reported no difference in recurrences after discontinuation of prophylaxis as compared with placebo [13]. Price JR, Guran LA, Gregory WT, McDonagh MS. Am J Obstet Gynecol. The mean duration of antibiotics prophylaxis was (12858) days for Bactrim, (9346) days for Nitrofurantoin and (5842) days for Amoxicillin/clavulanic acid. effects of trimethoprim on the fetus, animal studies have shown adverse effects. Salim Baharoon. Accessibility Statement, Our website uses cookies to enhance your experience. Google Scholar. This site needs JavaScript to work properly. Only outpatient visits were included. PubMed Jung C, Brubaker L. The etiology and management of recurrent urinary tract infections in postmenopausal women. 1.1 Preventing recurrent urinary tract infections 1.2 Self-care 1.3 Choice of antibiotic prophylaxis 1.1 Preventing recurrent urinary tract infections 1.1.1 Manage an acute UTI as outlined in the NICE guidelines on urinary tract infection (lower): antimicrobial prescribing or pyelonephritis (acute): antimicrobial prescribing. Over all Trimethoprim-Sulfamethoxazole was the most frequently used prophylaxis antibiotic in both men and women although Nitrofurantoin is still used more frequently in our patients compared to other studies specially in male (18% vs 31%) [31]. Funding UK National Institute for Health Research. Two other women received trimethoprim for suppression of infection complicating stag-horn calculi. Trimethorpim was approved as a stand-alone drug in 1980. With studies dating back as far as the 1970s, this may reflect a lower reporting standard by todays expectations rather than low study quality. The search syntax is reported in Supplementary Table1. LL revised and edited the final manuscript, review and updated the reference.SB Developed the idea and designed the methods, presented the discussion, wrote the manuscript, revised the content and finalization. Adv Data. Despite being effective in reducing recurrent urinary tract infection rate, emergency room visits and hospital admissions due to UTI, continuous antibiotic prophylaxis was only used in 55% of patients with recurrent infections. This population sitting may explain the higher percentage of male patients with recurrent urinary tract infections in our study compared to other studies conducted in the primary care setting [22, 25,26,27]. Unauthorized use of these marks is strictly prohibited. Head-to-head antibiotic comparisons were mainly published for nitrofurantoin vs comparators and showed no significant difference in recurrences, making nitrofurantoin, norfloxacin, and trimethoprim-sulfamethoxazole essentially interchangeable options. Schappert SM, Rechtsteiner EA. Of note, the systematically assessed study quality of the included RCTs was low, indicating that the results of the meta-analysis should be interpreted with caution. Risk factors for recurrent urinary tract infection included diabetes, indwelling urinary catheterization, immobilization, neurogenic bladder and renal transplantation and are all consistent with what is previously reported [22, 23, 25, 34]. Nitrofurantoin proved to be the most efficient prophylactic drug in patients with abnormal urography and/or reflux (n = 60) as evaluated by actuarial percentage recurrence-free analysis (p = 0.0025). The economic burden of urinary tract infections in women visiting general practices in France: a cross-sectional survey. Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland. Studies comparing intermittent (postcoital) with continuous strategies revealed intermittent application to be equally effective. Side effects include diarrhea, abdominal pain, abnormal taste, swelling of the tongue. Fisher H, et al. Urinary tract is a leading site of infections in all ages and genders. Melekos MD, Asbach HW, Gerharz E, Zarakovitis IE, Weingaertner K, Naber KG. 1988 Jan;2(1):12-7. doi: 10.1007/BF00870372. The post-prophylactic rate returned to the pre-prophylaxis rate: 23 recurrences/100 months. 8600 Rockville Pike Are the results of the study valid? Ali SB, Perdawood D, Abdulrahman R, Al Farraj DA, Alkubaisi NA. The Bucherer-Bergs Multicomponent Synthesis of Hydantoins-Excellence in Simplicity. https://doi.org/10.1007/s00467-010-1625-8. 8 mg TMP/kg/day PO divided q12hr for 7-14 days if serious infection ; 8-10 mg TMP/kg/day IV divided q6-12hr for 14 days if serious infection; Prophylaxis: 2 mg TMP/kg/dose PO qDay or 5 mg TMP/kg/dose twice weekly; Skin/soft Tissue Infection Due to Community Acquired MRSA (Off-label) Urology. Light RB, Ronald AR, Harding GKM, Dikkema J, Thompson L, Buckwold FJ. 2022;41(4):100211. The https:// ensures that you are connecting to the Ten Doesschate,T et al. MeSH A. Google Scholar. 1980 Jun;92(6):770-5. doi: 10.7326/0003-4819-92-6-770. Publication bias was investigated using funnel plots [16, 17] and the arcsine test [18]. Correspondence: Philipp Jent, MD, Department of Infectious Diseases, Inselspital Bern University Hospital, Freiburgstrasse 16p, CH-3010 Bern, Switzerland (. The .gov means its official. The only study [37] that quantified events after discontinuation of the prophylaxis and reported both the number of events and the number of patients at risk found no difference in recurrences (59% in cinoxacin group, 39% in the placebo group, during a follow-up of6 months after ending prophylaxis). CAS The Cochrane sensitivity-maximizing filter to identify randomized trials was applied [11]. trimethoprim by the kidneys and may reduce the effectiveness of trimethoprim. Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA. First urinary tract infection occurred at pre-menopausal in 136 patients (42.9%) and in the post-menopause in 131 patients (41.3%). Ther Clin Risk Manag. [3840], UTI recurrences were defined as the presence of clinical symptoms without microbiological confirmation, and clinical recurrences were 5 times more common than microbiological ones, suggesting that most patients did not have UTIs by current definitions. Trimethoprim is an antibiotic used to treat a variety of bacterial infections, but most commonly in the treatment or prophylaxis of urinary tract infections. Vital Health Stat. 3 0 obj Urinary Tract Infections in the First 6 Months after Renal Transplantation. Low dose trimethoprim prophylaxis in long term control of chronic recurrent urinary tract infection Authors R Svensson , P Larsson , K Lincoln PMID: 7100825 DOI: 10.3109/inf.1982.14.issue-2.13 Abstract government site. The only comprehensive synthesis on antibiotic prophylaxis in the last 15 years has been a guideline-embedded meta-analysis. Harding C, et al. To further explore the discrepancy between the funnel plot and Arcsine test, an additional sensitivity analysis using a simple trim-and-fill method and a Copas selection model was performed. Cystitis refers to irritative voiding symptoms (dysuria or pain after micturition), frequency, urgency, cloudy or offensive urine and discomfort or pain in the bladder, urethra or vagina. Google Scholar. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government. Ronald AR, Harding CK, Mathias R, Wong CK, Muir P. Can Med Assoc J. Smith AL, Brown J, Wyman JF, Berry A, Newman DK, Stapleton AE. 2005; 23(Suppl 4):38. Reported adverse events (AEs) varied considerably in included trials and were not reported at all in 1 study [24]. The site is secure. In the 11 placebo-controlled trials, the risk for developing UTI was 85% lower with prophylaxis in comparison with placebo (risk ratio [RR], 0.15; 95% CI, 0.080.29). Potential host-related risk factors for recurrent urinary tract infection in Saudi women of childbearing age. Nitzan O, Elias M, Chazan B, Saliba W. Urinary tract infections in patients with type 2 diabetes mellitus: review of prevalence, diagnosis, and management. Abbreviations: SMZ, sulfamethoxazole; TMP, trimethoprim. kidneys may not eliminate Primsol adequately from the body, and levels of Caterino JM, Weed SG, Espinola JA, Camargo Jr CA. xZ[o~GyQ+SZ9hf7tGqV%?3.e"-5s#^q6rwv[ A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. Since 2004 (last Cochrane meta-analysis on this subject [36]), a single RCT comparing fosfomycin with placebo among 158 patients was published in 2005. Primsol (trimethoprim) is a drug prescribed for the treatment of uncomplicated urinary tract infections. In the post-renal transplant group, 17 patients (31%) were given prophylactic antibiotic after a single episode of UTI and 39 patients (71%) were given continuous prophylaxis after multiple UTI episodes. J Pediatric Infect Dis Soc. People with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galacactose malabsorption. Primsol inhibits the bacterial enzyme more than the human enzyme. Disclaimer. Those with recurrent UTIs were significantly older with a mean age of 60.621.54 vs 53.619.1 (p<0.001) (Table 1). We included any type of prophylaxis schedule (daily, weekly, monthly, or postcoital). Bethesda, MD 20894, Web Policies Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Age Ageing. This finding is in line with what was reported in the last 2 comprehensive compilations of studies on this subject by Albert et al. The primary outcome was the number of UTI episodes during the observed period of prophylaxis intake. In patients with recurrent urinary tract infections, first episode of infections more frequently occurred at post-menopause (P<0.001) (Table 1). pregnant women. A large number of children must be given prophylaxis to prevent one infection and antibiotic resistance is a major concern when treating community-acquired urinary tract infections. 2022. The categorical variables were compared using a chi-square test or Fishers exact test, as appropriate. HHS Vulnerability Disclosure, Help doi: 10.1002/14651858.CD001534. The overall prevalence of uncomplicated urinary tract infection in USA is between 8 and 11% [7, 8, 10] while that of women over age of 65 is 20%. An official website of the United States government. For the time being, this meta-analysis confirms that antibiotic prophylaxis is an effective prevention strategy for RUTIs and that a number of antimicrobial substances can be used with similar likelihood of success. Bethesda, MD 20894, Web Policies Nicolle LE, Harding GK, Thompson M, Kennedy J, Urias B, Ronald AR. Patients for the studies were mainly recruited in outpatient clinics (20/23 studies), in 1 study in private practices [22], and in another study from university students [14], whereas 1 study did not describe the study setting [23]. 2018 Apr;34(2):62-81. doi: 10.1177/8755122518755402. We conducted a systematic review and meta-analysis of randomized controlled trials published up to October 13, (Tables 5, 6). Nitrofurantoin was the single most common comparator (to norfloxacin in 3 studies, to cefaclor in 1 study, and to trimethoprim [ sulfamethoxazole] in 3 studies); the pooled relative risk between nitrofurantoin and other comparator antibiotics indicated no significant difference (RR, 1.01; 95% CI, 0.741.37) (Supplementary Figure7). Further research in the form of well-planned randomized controlled trials and long-term cohort studies is needed to clarify the role of antibiotic prophylaxis in relation to nonantibiotic preventive options for RUTI and to define the optimal and safe duration of antibiotic prophylaxis, taking into account the risk of resistance selection. Urinary Tract Infection. Supplementary Table4 gives an overview of described AEs. Long-term low-dose co-trimoxazole in prophylaxis of childhood urinary tract infection: bacteriological aspects. Some patients have prioritized topical estrogen as a first line treatment for postmenopausal women with recurrent UTI [39]. 2019 Apr 1;4(4):CD001534. z"=n>|utbc:DC V=)xL Bmj. 2019;48(2):22834. The anemia usually is mild and resolves when the The meta-analysis of the PC studies was based on a comparison of pooled risk ratios (RRs) in the 2 arms. . HG collected data and performed Critical revision of the manuscript for important intellectual content. Unable to load your collection due to an error, Unable to load your delegates due to an error. In the small number of controlled trials comparing intermittent UTI prophylaxis after an activity that could precipitate UTI (such as sexual intercourse) vs continuous prophylaxis, both strategies appeared to be equally effective. The prophylaxis period was 6 months in 13/23 studies, 12 months in 9/23 studies, and 3 months in 1 study [25]. per dose 200 mg), alternatively 25 mg twice daily. We used the search terms recurrent AND urinary tract infection OR UTI OR cystitis, AND prophylaxis OR antibiotic, among others. The efficiency of nitrofurantoin and trimethoprim prophylaxis in preventing recurrent urinary tract infections (UTI) was compared by means of actuarial percentage recurrence-free curves in a randomized, double blind study in 130 children (126 girls, 4 boys) aged 1 to 14 years (mean 7.5). https://doi.org/10.1097/spv.0000000000000989. The recurrence rate before prophylaxis was 26/100 months, compared to a significantly lower frequency (3.3 recurrences/100 months, p less than 0.001) during prophylaxis. Bactrim was more prescribed in younger patients (P<0.001), in post-renal transplantation (P<0.001) and after urological procedures (P<0.001), while Nitrofurantoin was more prescribed in immobilized patients (P=0.002) and in patients with neurogenic bladder (P<0.001). The concept of using antibiotic prophylaxis in preventing recurrent UTI without urological and gynecological review in our study is an indicator for the urgent need to develop a multi-disciplinary care for patients with recurrent UTI especially in the era of increasing bacterial resistance in tertiary care centers. Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland. 2019;11:1756287219832172. https://doi.org/10.1177/1756287219832172. Patients were then grouped into those with single urinary tract infection during the follow-up of one year from initial episode and those with recurrent infections. Financial support. Thus, the sensitivity analysis indicated consistent estimates of the treatment effect with the original model. We described the risk factors and the use of antibiotic prophylaxis in patients with recurrent UTI in Saudi Arabia. gastrointestinal 2018;10(10):28393. doi: 10.1002/14651858.CD001209.pub2. https://doi.org/10.1016/s1473-3099(18)30279-2. Pediatr Nephrol. Harding et al. Premature infants or children aged under 4 months. Categorical data (e.g., gender, and comorbidities) was presented by frequencies and percentages. AS collected data and revised the final manuscript. government site. Cochrane Database Syst Rev. 2014;33(1):95100. This analysis was limited by the small number of included patients (n=17 in the cinoxacin arm, 13 in the placebo arm). Abstract Prophylactic antibiotics for urinary tract infections are no longer routinely recommended. These infections can be empirically treated without the need for urine cultures. The prescription patterns of continuous antimicrobial prophylaxis in children and adults are not well described in Saudi patients. Received 2022 May 2; Accepted 2022 Jul 1. 2019;22(3):2429. https://doi.org/10.1016/j.idc.2013.09.003. The most frequently used antibiotic prophylaxis for those prescribed a prophylaxis antibiotic was oral trimethoprim/sulfamethoxazole (TMP-SMX), prescribed for 65 patients (52%) followed by oral Nitrofurantoin, prescribed for 52 patients (41.6%). Both TMP-SMX and Nitrofurantoin were used effectively to prevent recurrent UTI in our study. HHS Vulnerability Disclosure, Help Trimethoprim alone is effective for the treatment and prophylaxis of urinary tract infections, but may cause a high incidence of adverse reactions in patients known to be sensitive to sulfonamides. About one third of patients with recurrent UTI are male. Aydin A, Ahmed K, Zaman I, Khan MS, Dasgupta P. Recurrent urinary tract infections in women, Diagnosis and management of recurrent urinary tract infections in non-pregnant women. Trimethoprim/sulfamethoxazole, also known as co-trimoxazole and can be abbreviated in the following ways: SXT, TMP-SMX, TMP-SMZ, or TMP-sulfa. F). Supplementary materials Supplementary materials are available at Open Forum Infectious Diseases online. Oestrogens for preventing recurrent urinary tract infection in postmenopausal women. Abbreviation: RR, risk ratio. Clin Infect Dis. RUTIs are a common problem, causing morbidity and health care costs. For analysis, included studies were classified into 3 main groups: placebo-controlled studies (PC), head-to-head studies (HH), and continuous vs intermittent approaches (CI). Comorbidities significantly associated with risk of recurrent urinary tract infections included, Diabetes, Hypertensions, Chronic renal disease, Use of immunosuppressive medications including steroids and biological drugs, heart failure and mental health illness (Table 1). Trimpex and Proloprim are brand names that have been discontinued in the US. exposed to the sun. We conducted a systematic review and meta-analysis of randomized controlled trials published up to October 13, 2020, evaluating patients age12 years with either 2 episodes of lower urinary tract infection (UTI) within 6 months or3 in the past year. It is not clear whether the practice of choosing one antibiotic over the other was based on patient characteristics, pathogen resistance pattern or physician versus patient preference. Conclusions Findings from three small trials with relatively short follow-up periods suggest long-term antibiotic therapy reduces the risk of recurrence in postmenopausal women with recurrent UTI. trimethoprim in combination with: Rifampin can increase the elimination of However, preferable antibiotic choices are poorly characterized, and the scientific literature on RUTI prophylaxis randomized trials has only been screened systematically in the last 15 years in a guideline-embedded meta-analysis [4], 2 meta-analyses focusing on nitrofurantoin [5, 6], and 3 descriptive literature reviews without meta-analysis [79]. We showed that old age, female gender and comorbidities (diabetes, indwelling urinary catheterization, immobilization, neurogenic bladder and renal transplantation) were associated with recurrent urinary tract infection. Excluding the studies with cinoxacin, an obsolete antibiotic, the heterogeneity of the treatment effect between the studies was reduced (I2=22.9%; 0%64.5%). In conclusion, nitrofurantoin is recommended as the first choice prophylactic treatment of children with recurrent UTI and urinary tract abnormalities. During treatment, the incidence of infection was 0.56 per patient-year compared with 4.25 infections in the year preceding study. The date of last search for all sources was October 13, 2020. PubMed Central E. coli infections was the most prevalent organism in both patients who have single episode and recurrent UTI episodes. Efficacy of five years of continuous, low-dose trimethoprim-sulfamethoxazole prophylaxis for urinary tract infection. Double-blind randomized study using cinoxacin and placebo. Bacterial Infections 101: Types, Symptoms, and Treatments. Urinary tract infection and recurrent UTI are common problems in outpatients visits especially in postmenopausal women. PMC Primsol is the brand name for trimethoprim available in the US. Management of recurrent urinary tract infections with patient-administered single-dose therapy, https://creativecommons.org/licenses/by-nc-nd/4.0/, A1. The mean age of all patients with urinary tract infections was 5720.5 and with a mean body mass index (BMI) of 29.610.3. Cost effectiveness of management strategies for urinary tract infections: results from randomised controlled trial. Disclaimer. 1 In a 6-month study of college-aged women, 27% of these UTIs were found to recur once . Prophylactic co-trimoxazole and trimethoprim in the management of urinary tract infection in children. (Gentamicin monitoring is generally not required with low dose in this setting) Artificial valve, post-surgery or suspected MRSA 4. The benefit continuous prophylaxis antibiotics in elderly patients was studied previously with conflicting results. %PDF-1.4 (Azo-Gantanol), and is rarely used alone. 1976 Jul 24;2(6029):206-8. doi: 10.1136/bmj.2.6029.206. Trimethoprim was used alone to treat urinary tract infections in 20 women who were unable to tolerate sulfonamides. Antimicrobial Pharmacotherapy Management of Urinary Tract Infections in Pediatric Patients. https://doi.org/10.1157/13091442. Kennelly M et al. The efficiency of nitrofurantoin and trimethoprim prophylaxis in preventing recurrent urinary tract infections (UTI) was compared by means of actuarial percentage recurrence-free curves in a randomized, double blind study in 130 children (126 girls, 4 boys) aged 1 to 14 years (mean 7.5). The efficacy of antibiotic prophylaxis in patients with recurrent UTI is conflicting in various studies while some studies showed more harm than benefit is noted in view of development of resistant pathogens and Clostridium Difficile associated diarrhea, other studies showed efficacy in preventing recurrent urinary tract infections in patients with intermittent catheterization [28,29,30]. Confidence intervals for I2 were based on the Higgins and Thomson calculation [15]. Therefore, the physician must weigh the potential risks to the fetus against the Also, the end points shifted from microbiological to clinical criteria, with the latter now being considered more relevant. By continuing to use our site, or clicking "Continue," you are agreeing to our. <>/OutputIntents[<>] /Metadata 1222 0 R>> 1992;24(1):3-10. doi: 10.1007/BF02552109. All patients should have a minimum 12months of follow-up after the first diagnosis of UT. J Infect Dis. We aim to describe the pattern of continuous antibiotic prophylaxis prescription for recurrent urinary tract infections, in what group of adult patients they are prescribed and their efficacy. Medically reviewed by John P. Cunha, DO, FACOEP; Board Certified Emergency Medicine. The most common uropathogens isolated in urinary culture were E. coli, 233 patients (49%), Klebsiella pneumoniae, 102 patients (21%), and Enterococcus faecalis, 44 patients (9.2%) (Table 1). Post-intercourse versus daily ciprofloxacin prophylaxis for recurrent urinary tract infections in premenopausal women. All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare the following: Dr. Trautners work is supported in part by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413). AS performed Critical revision of discussion part of the manuscript for important intellectual content. Similar results were found by Philipp Jent et al. Cochrane Database Syst Rev. 2 months: Contraindicated >2 months. COMMON BRAND NAMES Primsol, Proloprim, TRIMPEX HOW SUPPLIED Primsol/TRIMPEX Oral Sol: 5mL, 50mg 2007;386:132. It acts as a selective inhibitor of dihydrofolate reductase to prevent folic acid synthesis, thereby inhibiting DNA replication. Healthcare professionals should not prescribe antibiotics to treat asymptomatic bacteriuria in adults with Consisting of data provided by the authors to benefit the reader, the posted materials are not copyedited and are the sole responsibility of the authors, so questions or comments should be addressed to the corresponding author. This collateral effect has also to be taken into consideration. Comorbidities like history of urolithiasis, mild renal impairment, diabetes mellitus, mild urinary incontinence, minor urogenital abnormalities on pyelogram, cystoscopy, or radiography, single kidney, and temporary indwelling catheters were not reasons for exclusion. MeSH Recurrences that followed the period of antibiotic intake were captured as a secondary outcome, as well as adverse effects (AEs) of antibiotic administration, stratified by severity: AEs leading to discontinuation of the treatment were considered severe AEs; all others were considered nonsevere. photosensitivity This site needs JavaScript to work properly. 2019 May 11;8(2):152-159. doi: 10.1093/jpids/piy065. Trimethoprim as adjuvant treatment in schizophrenia: a double-blind, randomized, placebo-controlled clinical trial. Epidemiology and etiology of urinary tract infections in the community. Brumfitt W, Smith GW, Hamilton-Miller JM, Gargan RA. Recurrent urinary tract infection (UTI) occurs in sizable percentages of patients after a single episode and is a frequent cause of primary healthcare visits and hospital admissions, accounting for up to one quarter of emergency department visits. What are the side effects of Primsol (trimethoprim)? In the 3 head-to-head trials by Brumfitt et al. Commonly used for UTI, prophylaxis of UTI, traveler's diarrhea, and in combination with sulfamethoxazole or dapsone for prophylaxis and treatment of Pneumocystis infections. EM performed the analysis, and interpretation of data. Primsol may cause anemia due to a deficiency of folic acid. In addition, the lack of antibiotic susceptibility patterns of bacterial isolates of UTI is a major limitation of our study. These patients were transplant recipients, with neurogenic bladder and intermittent catheterization. The quality of the included trials was assessed in terms of the randomization process, internal validity, and external validity, based on the criteria described by Guyatt et al. Neither renal insufficiency nor C. difficile enterocolitis was mentioned as a possible AE in the included studies, also suggesting underreporting of AEs. Welk B, Lenherr S, Santiago-Lastra Y, Norman HS, Keiser MG, Elliott CS. Foxman B, Barlow R, DArcy H, Gillespie B, Sobel JD. Three investigators (J.M., J.B., A.A.) independently rated the risk of bias using a modification of the Cochrane handbook quality assessment recommendations [11]. Smellie JM, Grneberg RN, Bantock HM, Prescod N. Pediatr Nephrol. It was effective in reducing recurrence rate, ER visits and hospital admissions due to recurrent UTI. Bailey RR, Roberts AP, Gower PE, De Wardener HE. In the 9 head-to-head trials, the efficacy of the antibiotic agents appeared similar: The pooled RR indicated no difference between nitrofurantoin and comparators (RR, 1.01; 95% CI, 0.741.37), nor trimethoprim (+/- sulfamethoxazole; RR, 1.34; 95% CI, 0.892.03) or norfloxacin and comparators (RR, 1.17; 95% CI, 0.431.70). Oestrogens for preventing recurrent urinary tract infection in postmenopausal women, Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women: multicentre, open label, randomised, non-inferiority trial, Efficacy and safety of self-start therapy in women with recurrent urinary tract infections. What are the uses for Primsol (trimethoprim)? Trimethoprim dosing information. Langford BJ, et al. 1 Urinary tract infection is associated with long-term morbidity, with . <> Pediatric urinary tract infections: an analysis of hospitalizations, charges, and costs in the USA. Sutton AJ, Duval SJ, Tweedie RL, Abrams KR, Jones DR. Empirical assessment of effect of publication bias on meta-analyses, Meta-analysis, funnel plots and sensitivity analysis, A sensitivity analysis for publication bias in systematic reviews, Antibioprevention of recurrent cystitis. The number of rectal enterobacteria were markedly reduced during prophylaxis (p less than 0.05). Recurrences could be measured on the one hand using microbiological criteria (microbiological recurrences), with confirmation by a positive urine culture of >100000 bacteria/mL, or using symptoms consistent with UTI, pyuria and positive urine culture with >10000 bacteria/mL. Before A retrospective chart review of all adult patients diagnosed with single and recurrent symptomatic urinary tract infection in the period of January 2016 to December 2018. 2016 Nov;215(5):548-560. doi: 10.1016/j.ajog.2016.07.040. Probiotics (lactobacillus) Lactobacillus did not significantly reduce the risk of recurrent infection in premenopausal women with a history of previous urinary tract infection (UTI; 1 or more episode in the past 12 months) compared with placebo (low quality evidence). For example, a recent RCT of UTI prophylaxis in adults using clean intermittent self-catheterization, published after the Cochrane review, confirmed a benefit of prophylaxis in preventing UTIs (incidence rate ratio, .52; 95% CI, .44-.61), but detected an increase in nitrofurantoin resistance and trimethoprim-sulfamethoxazole resistance among . Whether 1 antibiotic class is preferable to others in terms of risk of inducing resistance cannot be determined from this review; this should be clarified in future studies. The .gov means its official. In this study, there were 42 patients above age of 65years who received continuous prophylaxis. This study explores a very complex and common problem in medical practice in Saudi Arabia, which is recurrent urinary tract infection. Recurrent Urinary Tract Infection in Adult Patients, Risk Factors, and Efficacy of Low Dose Prophylactic Antibiotics Therapy, Journal of Epidemiology and Global Health, https://doi.org/10.1007/s44197-023-00105-4, https://doi.org/10.1007/s00467-010-1625-8, https://doi.org/10.1186/s12913-016-1620-2, https://doi.org/10.1111/j.1553-2712.2009.00353.x, https://doi.org/10.1016/j.idc.2013.09.003, https://doi.org/10.1016/j.jinf.2006.05.015, https://doi.org/10.1007/s00345-012-0934-x, https://doi.org/10.1007/s00192-016-2965-0, https://doi.org/10.1002/14651858.CD001209.pub2, https://doi.org/10.1056/nejm199309093291102, https://doi.org/10.1002/14651858.CD005131.pub2, https://doi.org/10.1016/j.ajog.2017.12.231, https://doi.org/10.1016/s1473-3099(18)30279-2, https://doi.org/10.1016/j.urology.2020.05.058, https://doi.org/10.1097/spv.0000000000000989, http://creativecommons.org/licenses/by/4.0/. The NNT should be interpreted with caution though, as event rates varied between studies. Price JR, Guran LA, Gregory WT, McDonagh MS. Nitrofurantoin vs other prophylactic agents in reducing recurrent urinary tract infections in adult women: a systematic review and meta-analysis. per dose 200 mg). Diagnosis and treatment of urinary tract infections across age groups. Patient confidentiality was ensured, and the collected patients' data used by the research team only. Of ten acute symptomatic urinary tract infections, four were cured, three were not, and three cases could not be evaluated. Vasudeva P, Madersbacher H. Factors implicated in pathogenesis of urinary tract infections in neurogenic bladders: some revered, few forgotten, others ignored. Patients who received continuous prophylactic antibiotics experienced significantly less symptomatic episodes of urinary tract infections (P<0.001), Emergency room visits and hospital admissions due to urinary tract infections (P<0.001) for both Nitrofurantoin and TMX-SMX. 2022;9(7):ofac327. Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips, Not logged in 26 patients with chronic urinary tract infections (UTI) were treated with 1 tablet of 100 mg trimethoprim (TMP) once daily for up to 6 months as long term prophylaxis. The most common antibiotic prophylactic agents used were nitrofurantoin (n=1401; 44.0%), trimethoprim/sulfamethoxazole (n=542; 17.0%), ciprofloxacin (n=500; 15.7%), cephalexin (5.9%), and trimethoprim (4.8%). As with all antibiotics, it is important to complete the 2021;27(3):e48792. Future Microbiol. PubMed Central Prolonged therapy can result in low platelet counts, low white blood cell counts, and other toxic effects on the blood cells. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 19 0 R 20 0 R 26 0 R] /MediaBox[ 0 0 595.32 842.04] /Contents 4 0 R/StructParents 0>> and transmitted securely. A sensitivity analysis was added to investigate the potential effects of publication bias based on the trim and fill method [19] and the Copas selection model [20, 21] and using the metasens package in R. We retrieved 2105 studies from the search strategy. Primsol is used for the treatment of aOr trimethoprimsulfamethoxazole. Unable to load your collection due to an error, Unable to load your delegates due to an error. Spencer JD, Schwaderer A, McHugh K, Hains DS. . ~-#QXFL ~`W- \+a0 +3>Eq\@4r.LbK>&$a/1i7=\vz7Dp Journal of Epidemiology and Global Health Bethesda, MD 20894, Web Policies The percentage of Staphylococcus epidermidis UTI was significantly higher during trimethoprim prophylaxis (27%) than before (2%, p less than 0.0003). https://doi.org/10.1002/14651858.CD001209.pub2. 2016;16(a):365. https://doi.org/10.1186/s12913-016-1620-2, Article Nitrofurantoin prophylaxis altered neither the pattern of resistance nor the bacteriological constellation, while patients receiving trimethoprim prophylaxis had 76% trimethoprim resistant bacteria during prophylaxis, compared with 8% before (p less than 0.0001) and 17% after (p less than 0.0001) prophylaxis. Of note, some studies suspended the prophylaxis as soon as there was a recurrence. For PC studies, the funnel plot indicated potential publication bias (Supplementary Figure3), although this finding was not supported by a formal test of asymmetry (Arcsine test: P=.49). The most commonly reported AEs with antibiotic prophylaxis were gastrointestinal complaints (including nausea) and oral or vaginal candidiasis. Prophylactic antibiotics were prescribed more in renal transplant patients (P<0.001), neurogenic bladder patients (P<0.001) and those with urological pathology (P<0.001). TMP-SMX is also the most prescribed antibiotic prophylaxis in post-renal transplant adult patients compared to Nitrofurantoin (P=0.019). Stapleton A, Latham RH, Johnson C, Stamm WE. [13], who found trimethoprim alone (TMP) and its co-formulation with sulfamethoxazole (TMP-SMZ) to be equally efficacious for UTI prevention, and similar findings in therapeutic and pediatric studies, the single compound and its combinations with sulfamethoxazole were analyzed as 1 antibiotic group. Clipboard, Search History, and several other advanced features are temporarily unavailable. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (, GUID:1676BF8B-4984-42CD-BCF0-F012A8D78503. Julia Berger, ), antibiotic prophylaxis used (Nitrofurantoin, Augmentin, First-generation cephalosporin, Ampicillin, Amoxicillin, Fosfomycin, Trimethoprim, and Bactrim), antibiotic prophylaxis start and completion dates, a number of visits while on antibiotic prophylaxis, number of UTI while on antibiotic prophylaxis and in the follow-up period, and antibiotic prophylaxis compliance documentation. Background Recurrent urinary tract infection (UTI) occurs in sizable percentages of patients after a single episode and is a frequent cause of primary healthcare visits and hospital admissions, accounting for up to one quarter of emergency department visits. 1996-2023 MedicineNet, Inc. An Internet Brands company. PubMedGoogle Scholar. Earlier studies considered asymptomatic bacteriuria to be the equivalent of a UTI. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. A 10% recovery of TMP resistant enterobacteria from rectal swabs was noted early (less than or equal to 1 month) during prophylaxis, but no significant further accumulation occurred. Therefore, Primsol has less effect on the production of tetrahydrofolic Careers. 2023 Springer Nature Switzerland AG. In case of disagreement, 1 of the coauthors was consulted. Diab Metab Syndr Obes Targets Ther. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Resistance in uropathogens complicates future UTI treatment for the individual Referral for Gynecological evaluation was requested for 44 female patients (20%) with recurrent UTI, of whom 11 (25%) and 27 (61%) were pre-menopausal and postmenopausal, respectively. Over the years, the definition of RUTI has changed from requiring 2 UTIs in the past 12 months (in earlier studies) to 3 or more UTIs within 1 year (in later studies). and transmitted securely. Annette Kuhn, Urinary-tract infections (UTIs) are common infections that can affect any part of the urinary tract. 2014;28(1):113. Recurrent Urinary Tract Infection in Adult Patients, Risk Factors, and Efficacy of Low Dose Prophylactic Antibiotics Therapy. Continuous low-dose antibiotic prophylaxis for adults with repeated urinary tract infections (AnTIC): a randomised, open-label trial. Methods We present a non-blinded randomized trial comparing methenamine . Alsubaie SS, Barry MA. Child 6 months-5 years 4 mg/kg twice daily (max. Urology referral was requested in 80 female patients with recurrent UTI (35.2%); 19 patients (23.7%) and 20 patients (25%) were pre-menopausal and postmenopausal, respectively. Department of Gynecology, Bern University Hospital, University of Bern, Bern, Switzerland. Reducing risk of Clostridium difficile infection and overall use of antibiotic in the outpatient treatment of urinary tract infection. The .gov means its official. The overall process of caring of patients with recurrent UTI lacks adequate documentations and focus on individuals preference rather than an organized systematic approach. Adults1 tablet (DS tablet) of 800 milligrams (mg) of sulfamethoxazole and 160 mg of trimethoprim, 2 tablets of 400 mg of sulfamethoxazole and 80 mg of trimethoprim, or 4 teaspoonfuls or 20 milliliters (mL) of oral liquid every 12 hours for 14 days. Federal government websites often end in .gov or .mil. Urinary Tract Infection Usual Pediatric Dose for: Urinary Tract Infection Otitis Media Additional dosage information: Renal Dose Adjustments Liver Dose Adjustments Precautions Dialysis Other Comments Usual Adult Dose for Urinary Tract Infection 100 mg orally every 12 hours or 200 mg orally every 24 hours Duration of therapy: 10 days Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland; antibiotic prophylaxis, recurrent urinary tract infection, meta-analysis, UTI, cystitis. The Benefits and Harms of Antibiotic Prophylaxis for Urinary Tract Infection in Older Adults. antibiotic that interferes with the production of tetrahydrofolic acid, a PubMed Ther Adv Urology. it work? Patients taking nitrofurantoin showed a higher number of dropouts, even though the number of reported side effects in the analyzed patients was comparable to that seen with other antibiotics. We mainly choose between nitrofurantoin and trimethoprim-sulfamethoxazole, if appropriate. We seek to describe the pattern of antibiotic prescription, type, duration, prescribers and in what group of patients, in adults Saudi patients with recurrent urinary tract infection and to assess how effective the treatment were compared to those who were not given continuous prophylaxis. MedicineNet does not provide medical advice, diagnosis or treatment. Recurrent uncomplicated urinary tract infection (UTI) is a common presentation to urologists and family doctors. Medina M, Castillo-Pino E. An introduction to the epidemiology and burden of urinary tract infections. The objective of this systematic review and meta-analysis was to systematically assess the efficacy and safety of antibiotic prophylaxis for the prevention of RUTI in adults. hours for 10 days. Epub 2016 Jul 22. 2021;73(3):e78291. aOr trimethoprimsulfamethoxazole. Similarly, there was no difference between norfloxacin and its comparators (3 studies; RR, 1.17; 95% CI, 0.431.70). {uP1c)"6I:;=bYs&+7'%%Oy,6C2 cpaU%) TuZ/c&0+| n|r.+;:2|rhD ,1^Y4 nlf7@d53Jfm z EW|P5)!3'vVly`MUk}alA,g`XwT`3G nUo`*;k%S?R>=j g_DLN]x2/fjpVmE/zQX5>u1!yVEW1/7,_&,9HJ>3/&nuNyX7EZnZj9ceTn[ [F1O\BpdJ1x?s+eM#c5Y-:VM__)Csr=s;w., kK Kb;copei}Vm7;BfBWF6.#0quiTB#f`?RXn}jSX/NYgKln}\.97-"##@.Jh6~j3L/UM=Qn5cVNC_R8\M^G^};&vxXv \XCibdP2lJSUuUUu]`&fRv .qr+[q*S 6pv8^~|:]T=_/o~^>tS!wN ,8y3jAcI80hmAv%us9~ @x[petz|!Z\xe^5 F@9JM/u^9 Criteria for randomized controlled trials were participants (men or women) aged12 years with either 2 episodes of lower UTI within the last 6 months or 3 in the course of the past year. Some studies showed increased risk of harm due to resistant organisms and Clostridioides difficile infection [37] while antibiotic prophylaxis was associated with an average of 50% reduction in UTI in men and women above age of 65 in others [31]. Interpretation Continuous antibiotic prophylaxis is effective in reducing UTI frequency in CISC users with recurrent UTIs, and it is well tolerated in these individuals. 2023 American Medical Association. Abbreviations: RCT, randomized controlled trial; RUTI,recurrent urinary tract infection. Clin Microbiol Infect. In non-pregnant women, consider a trial of antibacterial prophylaxis if behavioural and personal hygiene measures, and vaginal oestrogen (in . Nitrofurantoin 100 mg versus 50 mg prophylaxis for urinary tract infections, a cohort study. TMP-SMX was more prescribed in younger patients, (4918.8 vs 63.421.5), P<0.001), in post- renal transplantation (P<0.001) and after urological procedures (P<0.001), while Nitrofurantoin was more prescribed in immobilized patients (P=0.002) and in patients with neurogenic bladder (P<0.001) (Table 4). Amoxicillin/clavulanic acid was prescribed in eight patients only (6.4%). Our results show a low prescription of topical estrogen as a preventative measure for recurrent UTI in postmenopausal women. After a first episode of an uncomplicated urinary tract infection, at least one second episode will occur in 27% of women in the next 612months [5]. Drug Healthc Patient Saf. Allergic reactions or skin rashes were reported in 7 RCTs, mostly in patients receiving antibiotics; however, skin rashes were also reported in patients receiving placebo. https://doi.org/10.1016/j.ajog.2017.12.231. From the Departments of Medical Microbiology (Drs Light, Ronald, Harding, and Buckwold and Mss Dikkema and Thompson) and Medicine (Drs Light, Ronald, Harding, and Buckwold), University of Manitoba, Winnipeg. Clin Infect Dis. Recurrent urinary tract infections are a common health problem. National trends in emergency department antibiotic prescribing for elders with urinary tract infection 19962005. official website and that any information you provide is encrypted https://doi.org/10.1007/s00345-012-0934-x. Treatment and prevention of recurrent lower urinary tract infections in women: a rapid review with practice recommendations. The children received the antibiotics for 6 months. Lancet Infect Dis. J Infect. How to use an article about therapy or prevention. the FDA in combination with sulfamethoxazole (for example. The only comprehensive synthesis on antibiotic prophylaxis in the last 15 years has been a guideline-embedded meta-analysis. 0984/21), approved the study. and transmitted securely. who conducted a systematic review and meta-analysis of published randomized controlled trials and concluded that continuous prophylactic antibiotics are effective in reducing recurrent infections irrespective of the antibiotics used [35]. 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