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Rifaprim in urinary tract infection: a comparison with co-trimoxazole
Abstract:
Two regimes of rifaprim (RPM), a 3.75 to 1 combination of rifampicin (RIF) and trimethoprim (TMP), were compared with co-trimoxazole (CO-T) for the treatment of urinary tract infection in 60 patients. Dosages were: A, 450 mg RIF + 120 mg TMP twice daily; B, 600 mg RIF + 160 mg TMP at bedtime and C, 800 mg sulphamethoxazole (SMZ) + 160 mg TMP twice daily. Clinical results were similar but CO-T treatment was accompanied by a greater number of late bacteriological failures. In none of 40 patients receiving RPM did resistance to any of the components develop, while in three of 20 patients receiving CO-T resistance to TMP or SMZ emerged during treatment. There were no side effects in the patients receiving RPM, but three patients developed transient laboratory abnormalities. One patient receiving CO-T had a rash and one further transient laboratory abnormalities. Satisfactory concentrations of RIF and TMP were measured in urine up to 24 h after a dose of 600 mg RIF + 160 mg TMP. RIF may be a better companion to TMP than the sulphonamides for the treatment of urinary tract infection.
Insights
Rifaprim (RIF + TMP) demonstrated superior outcomes compared to co-trimoxazole (SMZ + TMP) for urinary tract infections, showing no resistance development and fewer failures.
Area of Science:
- Pharmacology
- Infectious Diseases
- Urology
Background:
- Urinary tract infections (UTIs) are common, necessitating effective antimicrobial treatments.
- Co-trimoxazole (SMZ + TMP) is a standard UTI treatment, but resistance and side effects can occur.
- Rifaprim (RIF + TMP) offers an alternative combination therapy for UTIs.
Purpose of the Study:
- To compare the efficacy and safety of two rifaprim (RIF + TMP) regimens against co-trimoxazole (SMZ + TMP) for UTI treatment.
- To assess the development of antimicrobial resistance during treatment.
- To evaluate drug concentrations in urine.
Main Methods:
- A comparative study involving 60 patients with UTIs.
- Three treatment arms: Rifaprim regimen A (RIF + TMP), Rifaprim regimen B (RIF + TMP), and Co-trimoxazole (SMZ + TMP).
- Clinical and bacteriological outcomes, resistance development, side effects, and urine drug concentrations were monitored.
Main Results:
- Clinical outcomes were similar across all groups.
- Co-trimoxazole treatment resulted in more late bacteriological failures.
- No resistance to RIF or TMP developed in patients receiving Rifaprim, unlike three patients on Co-trimoxazole.
- Rifaprim showed no side effects, while Co-trimoxazole had a rash in one patient.
- Sustained RIF and TMP urine concentrations were observed with Rifaprim regimen B.
Conclusions:
- Rifaprim (RIF + TMP) is a safe and effective alternative for UTI treatment, with a lower incidence of resistance and bacteriological failures compared to co-trimoxazole.
- Rifampicin may be a more suitable companion to trimethoprim than sulphamethoxazole for UTIs.
- Further research into Rifaprim for UTI treatment is warranted.