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Single dose trimethoprim for urinary tract infection
T Nolan1, L Lubitz, F Oberklaid
1Melboune University Department of Paediatrics, Parkville, Victoria, Australia.
Insights
Single-dose trimethoprim effectively clears urinary tract infections in children. However, a higher rate of recurrent infections, including asymptomatic cases, was observed compared to a seven-day co-trimoxazole course.
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.
Abstract:
A randomised clinical trial of single dose trimethoprim against a seven day course of co-trimoxazole (trimethoprim/sulphamethoxazole) for the treatment of uncomplicated urinary tract infection was carried out in 106 children aged between 2 and 16 years. Of the 50 children with confirmed urinary tract infections who were followed up 48 hours after treatment with a single dose of trimethoprim all were free of infection, whereas two of the 56 who received the course of co-trimoxazole (4%) had persisting infections. At follow up after 10 days, however, significantly more of the group treated with trimethoprim had evidence of recurrent urinary tract infection compared with those who had received co-trimoxazole (10 of 44, 23%, compared with one of 46, 2%). Of the recurrences in the trimethoprim group, six were asymptomatic. We conclude that single dose trimethoprim is effective in clearing the urine of bacteria, but the risk of asymptomatic bacteriuria soon after treatment is high.