Randomized clinical trial of rifampin-trimethoprim and sulfamethoxazole-trimethoprim in the treatment of localized urinary tract infections.

To investigate whether 10 days of rifampin-trimethoprim (RIF-TMP) or 6 weeks of sulfamethoxazole-trimethoprim (SMX-TMP) would decrease the relapse rate in patients with acute uncomplicated upper urinary tract infections in comparison with 10 days of SMX-TMP, we randomized 189 patients to receive RIF-TMP or SMX-TMP in a ratio of 1:2. After the site of infection was established by the antibody-coated bacterium (ACB) test, patients with upper-tract infections who received SMX-TMP were again randomized and received either a total of 6 weeks or 10 days of therapy. All patients who received RIF-TMP were treated for 10 days. Clinical and microbiological evaluations were repeated at 2 and 6 weeks posttreatment. Eighty-five patients (54 ACB positive) received 10 days of RIF-TMP, 71 patients (45 ACB positive) received 10 days of SMX-TMP, and 18 patients (18 ACB positive) received 6 weeks of SMX-TMP. The overall recurrence rates in patients who received 10 days of therapy were 32% for RIF-TMP and 23% for SMX-TMP (P = 0.13). There were 12 (14%) relapses in the RIF-TMP group compared with 2 (3%) relapses in the SMX-TMP group (P = 0.01). In patients with upper-tract infections, the relapse rates were not statistically significantly different (P = 0.13). There were two (11%) recurrences (one relapse and one reinfection) in the 6-week treatment group. This 6% relapse rate was not different from the 4% relapse rate observed in patients with upper-tract infections who received 10 days of SMX-TMP. The number of patients who discontinued treatment because of an adverse effect in the 6-week SMX-TMP treatment group was significantly greater than those in the 10-day SMX-TMP treatment group (P=0.003) and the RIF-TMP treatment group (P=0.05). Ten days of SMX-TMP was as effective as 6 weeks of SMP-TMP or 10 days of RIF-TMP in the treatment of uncomplicated upper urinary tract infections and caused the fewest untoward effects.

Risk factors for urinary tract infection.

The authors carried out a case-control study in 1982-1983 to investigate the possible influence of behavioral factors on the risk of urinary tract infection. Study participants were college women attending a student health service. Cases were 43 women with culture-confirmed urinary tract infection. There were two control groups: 149 women with upper respiratory infection and 227 women visiting the gynecology clinic. Using each set of controls, the study confirmed that sexual intercourse is a risk factor and that there is a dose-response effect for increasing levels of coital frequency. The study also found that use of the diaphragm was significantly associated with urinary tract infection (odds ratios 3.0, 2.3), an association which remained significant even after controlling for possible confounding by coital frequency. The findings did not show an association with many of the factors commonly believed to be important such as type of clothing worn and volume of fluids consumed.

PIP: A case study was conducted among college women using a student health service at a university in southern Michigan to identify and evaluate behavioral factors which may be determinants of urinary tract infection. Women who presented to the student health service with symptoms suggestive of urinary tract infection and found to have pyuria on urinalysis were offered the opportunity to participate in a clinical trial comparing antibiotic regimens in the treatment of their urinary infection. Women with identified structural abnormalities of the urinary tract were not admitted to the study. On their 1st visit, women enrolled in the antibiotic study were asked to complete a questionnaire for the epidemiologic study described here. Midstream specimens were obtained during the 1st visit prior to therapy and were cultured quantitatively using standard methods. A patient with symptoms of acute urinary tract infection was included as a case if the urine culture was positive or probable. 2 different control groups were used to assess risk factors for urinary tract infection. For the 1st control group, women presenting to the student health service with coryza and/or sore throat, an oral temperature of less than 38.9 degrees Centigrade, and a clinical diagnosis of uncomplicated viral upper respiratory infection were asked to complete the same questionnaire as cases. For the 2nd control group, women attending the gynecology clinic at the same student health service for routine scheduled pelvic examinations and/or contraceptive services were asked to complete the same questionnaire. Cases were entered into the study from March through December 1982. The students used as controls participated from March 1982 through March 1983. The subjects completed a standard self-administered multiple-choice questionnaire, asking primarily about activities during the 3 weeks prior to completion of the questionnaire. 47 women with presumptive urinary tract infection participated in the clinical trial. 43 cases of confirmed urinary tract infection were identified, 38 with a positive and 5 with a probable urine culture result. In all, 149 upper respiratory infection controls and 227 gynecology controls participated. The history of previous urinary tract infection was significantly greater in cases than in either of the control groups. 4 variables were included in the final logistic model: coital frequency within 3 weeks, use of the diaphragm within 3 weeks, history of previous urinary tract infection, and age. Coital frequency during the previous 3 weeks was associated strongly with illness, with generally higher risk at higher frequencies. A significant association with the diaphragm was observed in comparison with both control groups. The findings failed to show an association with many of the factors commonly believed to be important such as type of clothing worn and volume of fluids consumed.

Single-dose tioconazole compared with 3-day clotrimazole treatment in vulvovaginal candidiasis.

A total of 80 patients were equally randomized to receive a single dose of 6.5% tioconazole ointment or a 3-day course of 100-mg clotrimazole vaginal tablets for the treatment of vulvovaginal candidiasis. Of the 32 evaluable patients treated with tioconazole, 27 (84%) remained asymptomatic 4 weeks posttreatment, compared with 28 of 33 patients (85%) treated with clotrimazole. A total of 34 patients in each group could be evaluated for mycological response based on culture results 1 and 4 weeks after treatment. Twenty patients (59%) who received tioconazole and twenty-one patients (62%) who received clotrimazole remained culture negative 4 weeks after therapy. Of 40 patients who received tioconazole, 12 (30%) experienced local irritation or itching, compared with 2 of 40 patients (5%) treated with clotrimazole (P less than 0.01). Single-dose tioconazole ointment was as effective as a 3-day course of clotrimazole tablets, but significantly more patients in the tioconazole-treated group experienced local side effects.

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

Patients with acute, uncomplicated urinary tract infections were treated with either amoxicillin-clavulanic acid (A-C) in fixed combination or cefaclor for 10 days in a prospective randomized comparison. The A-C group included 29 women and 1 man (mean age, 25.5 years), and the cefaclor group included 35 women and 1 man (mean age, 24.9 years). The cure rates were 26 (87%) of 30 with A-C and 26 (72%) of 36 with cefaclor (P greater than 0.20). There was one failure in each group, each caused by an isolate resistant to ampicillin. There were one relapse and two reinfections in the A-C group, compared with seven relapses and two reinfections in the cefaclor group. Side effects, including patients started on antibiotics but whose cultures did not confirm urinary tract infections, were diarrhea in 7 (16%) and rash in 1 (2%) of 44 A-C patients, compared with diarrhea in 1 (2%) and yeast vaginitis in 3 (6%) of 48 cefaclor patients. Although the A-C group had a greater proportion of antibody-coated bacterium-positive infections (22 versus 18 with cefaclor), there was a lower recurrence rate with fewer relapses in patients treated with A-C.

Diarrhea among infants and young children in Canada: a longitudinal study in three northern communities.

Diarrhea among neonates and their siblings was studied in 98 families living in Winnipeg, Manitoba, and in 31 native Indian families and in 15 Inuit (Eskimo) families living in isolated settlements in northern Canada. The rate of infection due to rotavirus in neonates was significantly higher and infection occurred more often in the first six months of life in the northern communities (range, 0.36 in Winnipeg to 1.07 in Eskimo Point). No protective effect of breast-feeding was discerned, since infection due to rotavirus occurred more frequently and earliest in neonatal life in Eskimo Point, the community with the highest rate of breast-feeding. In contrast, infection due to Norwalk virus was most common among the neonates of Berens River (0.15 infections per child per year), the only community with relatively unsafe water supplies. Infection due to rotavirus appears to be more frequent in the far North, whereas infection due to Norwalk virus appears to be related more to inadequate sanitation.