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Trimethoprim in the treatment of urinary infections in hospital
Abstract:
Success in the cure of urinary infections of hospital patients was compared for five-day courses of sulphamethoxazole alone, sulphamethoxazole plus one-tenth its weight of trimethoprim, and sulphamethoxazole plus one-fifth its weight of trimethoprim (Septrin). The cure rates were 65%, 84%, and 92% respectively. Fifty-four per cent. of 111 patients had urinary tract abnormalities. Forty-three per cent. of the causative organisms were sulphonamide-resistant in vitro. There were no major side-effects, though two patients had pruritus or a rash.The degree of potentiation of sulphamethoxazole activity by one-fifth the weight of trimethoprim was so great that its cure rate of infections due to sulphonamide-resistant organisms exceeded that of sulphamethoxazole alone used in infections due to sulphonamide-sensitive organisms. The degree of synergism between trimethoprim and sulphamethoxazole demonstrated in vitro against urinary organisms was directly related to the cure rate of the combination.
Insights
This study compared treatments for urinary infections, finding that combining sulphamethoxazole with trimethoprim significantly improved cure rates, especially for resistant bacteria.
Area of Science:
- Infectious Diseases
- Pharmacology
- Urology
Background:
- Urinary tract infections (UTIs) are common hospital-acquired infections.
- Sulphonamide resistance in causative organisms poses a treatment challenge.
- Assessing combination therapies is crucial for optimizing UTI treatment outcomes.
Purpose of the Study:
- To compare the efficacy of sulphamethoxazole alone versus combination therapy with trimethoprim for hospital-acquired urinary infections.
- To evaluate the impact of different trimethoprim-to-sulphamethoxazole ratios on cure rates.
- To investigate the relationship between in vitro synergism and clinical outcomes.
Main Methods:
- A comparative study involving hospital patients with urinary infections.
- Three treatment groups received five-day courses of: sulphamethoxazole alone, sulphamethoxazole with 1/10th weight trimethoprim, or sulphamethoxazole with 1/5th weight trimethoprim (Septrin).
- Cure rates were assessed, and causative organisms were tested for sulphonamide resistance in vitro.
Main Results:
- Cure rates were 65% for sulphamethoxazole alone, 84% for the 1/10th trimethoprim combination, and 92% for the 1/5th trimethoprim combination.
- The combination therapy, particularly with a higher ratio of trimethoprim, demonstrated superior efficacy, even against sulphonamide-resistant organisms.
- No major side-effects were reported, with only minor instances of pruritus or rash.
Conclusions:
- Combination therapy of sulphamethoxazole and trimethoprim significantly enhances treatment success for urinary infections.
- The degree of trimethoprim potentiation is directly related to improved cure rates, including those caused by resistant bacteria.
- Synergistic effects observed in vitro correlate with superior clinical outcomes in UTI treatment.