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Trimethoprim alone for treatment of urinary tract infection
Abstract:
Studies of the use of trimethoprim (TMP) alone compared with the use of trimethoprim and sulfamethoxazole in combination (TMP-SMZ) have shown that TMP alone is as effective as TMP-SMZ in the treatment of urinary tract infections. With the exception of one study in which use of TMP singly for 28 days for treatment of recurrent urinary tract infections selected resistant nonfermenting bacteria, the use of TMP singly for treatment of urinary tract infections has not resulted in selection of resistant Enterobacteriaceae. However, use of both TMP and TMP-SMZ for prevention of traveler's diarrhea has resulted in plasmid mediated resistance in Escherichia coli.
Insights
Trimethoprim (TMP) alone is effective for urinary tract infections, similar to trimethoprim-sulfamethoxazole (TMP-SMZ). TMP monotherapy generally does not select for resistant Enterobacteriaceae, unlike some uses for traveler's diarrhea prevention.
Area of Science:
- Microbiology
- Pharmacology
- Infectious Diseases
Background:
- Urinary tract infections (UTIs) are common bacterial infections.
- Antibiotic resistance is a growing public health concern.
- Trimethoprim (TMP) and trimethoprim-sulfamethoxazole (TMP-SMZ) are commonly used antibiotics.
Purpose of the Study:
- To compare the efficacy of TMP alone versus TMP-SMZ for UTIs.
- To evaluate the potential for TMP monotherapy to select for resistant bacteria.
- To assess the impact of TMP and TMP-SMZ on bacterial resistance, particularly in the context of traveler's diarrhea prevention.
Main Methods:
- Comparative analysis of studies evaluating TMP monotherapy and TMP-SMZ combination therapy.
- Review of data on bacterial resistance patterns, specifically Enterobacteriaceae and nonfermenting bacteria.
- Examination of resistance selection associated with different treatment durations and indications (UTIs vs. traveler's diarrhea prevention).
Main Results:
- TMP alone demonstrated comparable efficacy to TMP-SMZ in treating UTIs.
- TMP monotherapy for UTIs did not typically lead to the selection of resistant Enterobacteriaceae.
- An exception was noted in one study where prolonged TMP use (28 days) for recurrent UTIs selected for resistant nonfermenting bacteria.
- Both TMP and TMP-SMZ use for traveler's diarrhea prevention resulted in plasmid-mediated resistance in Escherichia coli.
Conclusions:
- Trimethoprim monotherapy is a viable and effective treatment option for urinary tract infections.
- The risk of selecting for resistant Enterobacteriaceae with TMP monotherapy for UTIs appears low, with specific exceptions for prolonged use.
- Antibiotic resistance, including plasmid-mediated resistance in E. coli, is a significant concern with the use of both TMP and TMP-SMZ for traveler's diarrhea prevention.