Single dose trimethoprim for urinary tract infection

Area of Science:

• Pediatric infectious diseases
• Pharmacology and therapeutics
• Urology

Background:

• Uncomplicated urinary tract infections (UTIs) are common in children.
• Antibiotic resistance necessitates evaluating optimal treatment regimens.
• Short-course therapies are desirable for improved adherence and reduced side effects.

Purpose of the Study:

• To compare the efficacy and recurrence rates of single-dose trimethoprim versus a seven-day course of co-trimoxazole (trimethoprim/sulphamethoxazole) for treating uncomplicated UTIs in children.
• To assess the incidence of recurrent UTIs, including asymptomatic bacteriuria, following each treatment regimen.

Main Methods:

• A randomized clinical trial involving 106 children aged 2-16 years with confirmed UTIs.
• Participants were assigned to receive either a single dose of trimethoprim or a seven-day course of co-trimoxazole.
• Follow-up assessments were conducted at 48 hours and 10 days post-treatment to evaluate infection status and recurrence.

Main Results:

• At 48 hours, single-dose trimethoprim achieved a 100% cure rate, compared to 96% for co-trimoxazole.
• At 10 days, the recurrence rate of UTIs was significantly higher in the trimethoprim group (23%) than in the co-trimoxazole group (2%).
• Asymptomatic bacteriuria accounted for six of the recurrences in the trimethoprim group.

Conclusions:

• Single-dose trimethoprim is effective for initial bacterial clearance in pediatric UTIs.
• The higher risk of early recurrence, particularly asymptomatic bacteriuria, necessitates careful consideration of this regimen.
• A seven-day course of co-trimoxazole demonstrated a lower rate of recurrent UTIs in this pediatric cohort.