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Long-term low-dose co-trimoxazole in prophylaxis of childhood urinary tract infection: bacteriological aspects
Insights
Long-term low-dose co-trimoxazole effectively prevents urinary tract infections in children. Bacterial resistance did not increase during treatment, and sensitivity returned after stopping the antibiotic.
Area of Science:
- Pediatric infectious diseases
- Bacteriology
- Antimicrobial stewardship
Background:
- Recurrent urinary tract infections (UTIs) are common in children.
- Preventive antibiotic therapy is a strategy to reduce UTI recurrence.
- Understanding the impact of prophylactic antibiotics on bacterial resistance is crucial.
Purpose of the Study:
- To investigate the bacteriological effects of long-term, low-dose co-trimoxazole prophylaxis in children with recurrent UTIs.
- To assess the development of bacterial resistance during prophylaxis.
- To evaluate the recovery of normal flora and sensitivity patterns after prophylaxis cessation.
Main Methods:
- Longitudinal study of children receiving co-trimoxazole for UTI prevention.
- Monitoring of UTI "break-through" infections.
- Quantification and antimicrobial sensitivity testing of rectal coliform bacilli.
- Assessment of bacterial populations and sensitivities before, during, and after prophylaxis.
Main Results:
- Low incidence of breakthrough UTIs (6 per 2637 child-months) during co-trimoxazole prophylaxis.
- Significant reduction in rectal coliform bacilli during treatment.
- High sensitivity (≥70%) of surviving coliforms to co-trimoxazole components.
- No increase in resistance to sulphonamide or trimethoprim over time.
- Rapid return of rectal flora and sensitivity patterns to baseline after stopping prophylaxis.
Conclusions:
- Low-dose co-trimoxazole is effective in preventing recurrent UTIs in children.
- Prophylaxis does not lead to a significant increase in antimicrobial resistance in rectal flora.
- Bacterial sensitivity is restored upon discontinuation of co-trimoxazole.
- Subsequent UTIs after prophylaxis are caused by sensitive organisms, suggesting continued treatment options.
Abstract:
The bacteriological consequences of giving long-term low-dose co-trimoxazole to children to prevent reinfection of the urinary tract were studied. Only six "break-through" infections occurred during 2637 child-months of prophylaxis. The children complied well with treatment. During prophylaxis the number of rectal coliform bacilli recovered was greatly and rapidly reduced, but at least 70% of the surviving coliform organisms remained sensitive to the two components of co-trimoxazole. Changes in sensitivity pattern were evident within a month of starting treatment and the proportion of rectal organisms resistant to sulphonamide or trimethoprim did not increase with time. After stopping co-trimoxazole prophylaxis the number of rectal organisms recoverable returned rapidly to normal, as did their sensitivities to trimethoprim and sulphonamide. Further episodes of urinary tract infection developing after prophylaxis was stopped were caused by organisms sensitive to a wide range of antimicrobial agents, including trimethoprim.