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Experience with antimicrobial combinations in urinary tract infections
1Department of Medicine, Ain Shams University, Cairo, Egypt.
Abstract:
Four antimicrobial combinations were tried in the management of recurrent upper urinary tract infections: (i) rifampicin + trimethoprim (50 patients); (ii) amoxycillin + clavulanic acid (50 patients); (iii) ampicillin + sulbactam (10 patients); and (iv) pivampicillin + pivmecillinam (50 patients). The initial and final microbiological success rate was excellent with all four drug combinations; all were well tolerated. Although monotherapy should be the rule in antimicrobial chemotherapy, there are certain indications that may necessitate combination therapy; for example, to cover a wider spectrum of activity with mixed infections or before the causative pathogen is isolated and its antimicrobial sensitivity defined, to delay the emergence and to avoid selection of resistant strains, to convert a bacteriostatic into a bactericidal effect and to obtain a synergistic (or at least an additive) antimicrobial effect by the combination.
Insights
Four antimicrobial combinations effectively managed recurrent upper urinary tract infections with excellent microbiological success rates. These drug combinations were well-tolerated and offer benefits like broader spectrum activity and resistance prevention.
Area of Science:
- Infectious Diseases
- Pharmacology
- Urology
Background:
- Recurrent upper urinary tract infections (UTIs) pose a significant clinical challenge.
- Antimicrobial resistance necessitates exploring effective treatment strategies.
Purpose of the Study:
- To evaluate the efficacy and tolerability of four different antimicrobial combinations in managing recurrent upper UTIs.
- To assess the microbiological success rates of combination therapies.
Main Methods:
- A study involving 160 patients with recurrent upper UTIs.
- Four antimicrobial combinations were administered: rifampicin + trimethoprim, amoxycillin + clavulanic acid, ampicillin + sulbactam, and pivampicillin + pivmecillinam.
- Microbiological success rates were assessed initially and finally.
Main Results:
- All four antimicrobial combinations demonstrated excellent initial and final microbiological success rates.
- The drug combinations were consistently well-tolerated by patients.
- No significant adverse events were reported.
Conclusions:
- Antimicrobial combination therapy is a viable and effective option for recurrent upper UTIs.
- Combination therapy can broaden spectrum of activity, prevent resistance, and enhance antimicrobial effects.
- While monotherapy is standard, specific indications justify combination approaches in UTI management.