Trimethoprim alone for UTI
                        ==========================

Trimethoprim alone is equally effective in urinary tract infections(1).

The combination of sulphonamide and trimethoprim(cotrimoxazole/Bactrim) has
been associated with significant adverse side effects in up to 32% of
cases(2).

The current recommendation here is trimethoprim 300mg daily for 3 days in
uncomplicated acute cystitis in non-pregnant females.

(1) ARTICLE TITLE:  Limitations of and indications for the use of
co-trimoxazole.
ARTICLE SOURCE:  J Chemother  (Italy), Feb 1994, 6(1) p3-11
AUTHOR(S):  Brumfitt W; Hamilton-Miller JM
AUTHOR'S ADDRESS:  Department of Medical Microbiology, Royal Free Hospital,
London, UK.
MAJOR SUBJECT HEADING(S):  Trimethoprim-Sulfamethoxazole Combination
[therapeutic use]
MINOR SUBJECT HEADING(S):  Clinical Trials; Microbial Sensitivity Tests;
Trimethoprim-Sulfamethoxazole Combination [adverse effects]
INDEXING CHECK TAG(S):  Human
PUBLICATION TYPE:  JOURNAL ARTICLE; REVIEW (48 references); REVIEW, TUTORIAL
ABSTRACT:  Co-trimoxazole is still widely used for indications where
trimethoprim alone is equally effective. Microbiological and
pharmacokinetic considerations reveal that trimethoprim alone provides
adequate anti-microbial activity for treatment of conditions for which
co-trimoxazole is often given. Synergy may be shown in vitro, but in
clinical practice is an unusual occurrence. There is no evidence from
clinical studies that the sulphonamide moiety fo co-trimoxazole prevents
the development of resistance to trimethoprim. The adverse event profile of
co-trimoxazole is a summation of that of sulphonamide and of trimethoprim.
Thus, using trimethoprim alone should reduce both the incidence and
potential severity of adverse events seen when co-trimoxazole is used.
Clinical trials have shown trimethoprim to be as effective as
co-trimoxazole in many of the common bacterial infections of the urinary
and respiratory tracts. However, there are a few specific varieties of
infection for which co-trimoxazole can be shown to be superior to
trimethoprim: these include toxoplasmosis, brucellosis, nocardiosis,
chancroid and pneumonia caused by Pneumocystis carinii. For many common
infections, scientific, rational, economic and clinical reasons dictate
that trimethoprim is preferable to co-trimoxazole.
MEDLINE INDEXING DATE:  9412
ISSN:  1120-009X
LANGUAGE:  English
UNIQUE NLM IDENTIFIER:  94351348
CAS REGISTRY/EC NUMBER(S):   8064-90-2 (Trimethoprim-Sulfamethoxazole


(2) ARTICLE TITLE:  Ciprofloxacin versus trimethoprim-sulfamethoxazole:
treatment of community-acquired urinary tract infections in a prospective,
controlled, double-blind comparison.
ARTICLE SOURCE:  Mayo Clin Proc  (United States), Dec 1992, 67(12) p1163-8
AUTHOR(S):  Grubbs NC; Schultz HJ; Henry NK; Ilstrup DM; Muller SM; Wilson WR
AUTHOR'S ADDRESS:  Division of Community Internal Medicine, Mayo Clinic,
Rochester, MN 55905.
MAJOR SUBJECT HEADING(S):  Ciprofloxacin [therapeutic use];
Trimethoprim-Sulfamethoxazole Combination [therapeutic use]; Urinary Tract
Infections [drug therapy]
MINOR SUBJECT HEADING(S):  Adult; Aged; Double-Blind Method; Middle Age;
Prospective Studies; Urinary Tract Infections [microbiology]
INDEXING CHECK TAG(S):  Comparative Study; Female; Human; Male
PUBLICATION TYPE:  CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED
TRIAL
ABSTRACT:  In this study, we determined the safety and efficacy of the
treatment of adults with urinary tract infection with ciprofloxacin
hydrochloride (250 mg twice daily for 10 days) in comparison with
trimethoprim-sulfamethoxazole (160 mg of trimethoprim and 800 mg of
sulfamethoxazole twice daily for 10 days). Patients with signs and symptoms
of urinary tract infection were randomized to receive ciprofloxacin (98
women and 5 men) or trimethoprim-sulfamethoxazole (92 women and 8 men). The
success rate of therapy was 91% for both treatment arms of the study. Among
seven failures after ciprofloxacin therapy, three were due to relapse of
infection and two to side effects that necessitated a change in medication;
in addition, two patients had persistent symptoms and required
hospitalization. Among the six failures associated with
trimethoprim-sulfamethoxazole therapy, four were due to relapse, one to
persistence of infection, and one to a side effect that necessitated a
change in medication. Among the patients treated with
trimethoprim-sulfamethoxazole, 32% had mild or moderate adverse reactions;
in comparison, 17% of the ciprofloxacin-treated patients had adverse
reactions (P = 0.026). For the treatment of urinary tract infection in
adult patients in this study, ciprofloxacin and
trimethoprim-sulfamethoxazole were equally effective, but ciprofloxacin was
associated with fewer adverse reactions.
MEDLINE INDEXING DATE:  9303
ISSN:  0025-6196
LANGUAGE:  English
UNIQUE NLM IDENTIFIER:  93108796
CAS REGISTRY/EC NUMBER(S):   8064-90-2 (Trimethoprim-Sulfamethoxazole

Michael Hession M.B.,B.S.,MBIOMEDE
Emergency Registrar
Westmead Hospital, Sydney, Australia