trimethoprim, sulfamethoxazole drug combination

Objective To determine whether 7 days of treatment is noninferior to 14 days when using ciprofloxacin or trimethoprim/sulfamethoxazole to treat urinary tract infection (UTI) in afebrile men.

Design, Setting, and Participants Randomized, double-blind, placebo-controlled noninferiority trial of afebrile men with presumed symptomatic UTI treated with ciprofloxacin or trimethoprim/sulfamethoxazole at 2 US Veterans Affairs medical centers (enrollment, April 2014 through December 2019; final follow-up, January 28, 2020). Of 1058 eligible men, 272 were randomized.

Interventions Participants continued the antibiotic prescribed by their treating clinician for 7 days of treatment and were randomized to receive continued antibiotic therapy (n = 136) or placebo (n = 136) for days 8 to 14 of treatment.

Main Outcomes and Measures The prespecified primary outcome was resolution of UTI symptoms by 14 days after completion of active antibiotic treatment. A noninferiority margin of 10% was selected. The as-treated population (participants who took ≥26 of 28 doses and missed no more than 2 consecutive doses) was used for the primary analysis, and a secondary analysis included all patients as randomized, regardless of treatment adherence. Secondary outcomes included recurrence of UTI symptoms and/or adverse events within 28 days of stopping study medication.

Results Among 272 patients (median [interquartile range] age, 69 [62-73] years) who were randomized, 100% completed the trial and 254 (93.4%) were included in the primary as-treated analysis. Symptom resolution occurred in 122/131 (93.1%) participants in the 7-day group vs 111/123 (90.2%) in the 14-day group (difference, 2.9% [1-sided 97.5% CI, –5.2% to ∞]), meeting the noninferiority criterion. In the secondary as-randomized analysis, symptom resolution occurred in 125/136 (91.9%) participants in the 7-day group vs 123/136 (90.4%) in the 14-day group (difference, 1.5% [1-sided 97.5% CI, –5.8% to ∞]) Recurrence of UTI symptoms occurred in 13/131 (9.9%) participants in the 7-day group vs 15/123 (12.9%) in the 14-day group (difference, –3.0% [95% CI, –10.8% to 6.2%]; P = .70). Adverse events occurred in 28/136 (20.6%) participants in the 7-day group vs 33/136 (24.3%) in the 14-day group.

Conclusions and Relevance Among afebrile men with suspected UTI, treatment with ciprofloxacin or trimethoprim/sulfamethoxazole for 7 days was noninferior to 14 days of treatment with regard to resolution of UTI symptoms by 14 days after antibiotic therapy. The findings support the use of a 7-day course of ciprofloxacin or trimethoprim/sulfamethoxazole as an alternative to a 14-day course for treatment of afebrile men with UTI.

Trial Registration ClinicalTrials.gov identifier: NCT01994538

Author/s:

Drekonja, D. M., Trautner, B., Amundson, C.

Chapter 16: Pertussis

Tracy Ashby — Fri, 07 Dec 2018 06:00:00 +0000

Date Added:

December 7, 2018

Journal/Publication:

Epidemiology and Prevention of Vaccine-Preventable Diseases, aka "Pink Book"

Publisher:

Centers for Disease Control and Prevention

Publication Date:

January 1, 2015

Pages:

261-278

URL:

Epidemiology and Prevention of Vaccine-Preventable Diseases

Type:

Meta-analyses, Reviews, and Guidelines, Meta-analyses, Reviews, and Guidelines

Keywords

MeSH

trimethoprim, sulfamethoxazole drug combination

This is a chapter on Bordetella pertussis from the Pink Book on infectious diseases. Several key points regarding pertussis in adults:

Immunization is not 100% effective but usually diminishes disease severity
In immunized adults, pertussis causes URI symptoms plus cough that can last for weeks
Antibiotics (macrolides or Bactrim) reduce contagion but have little effect on symptoms

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Pertussis, or whooping cough, is an acute infectious disease caused by the bacterium Bordetella pertussis. Outbreaks of pertussis were first described in the 16th century, and the organism was first isolated in 1906.

In the 20th century, pertussis was one of the most common childhood diseases and a major cause of childhood mortality in the United States. Before the availability of pertussis vaccine in the 1940s, more than 200,000 cases of pertussis were reported annually. Since widespread use of the vaccine began, incidence has decreased more than 80% compared with the prevaccine era.

Pertussis remains a major health problem among children in developing countries, with 195,000 deaths resulting from the disease in 2008 (World Health Organization estimate).

Author/s:

Hamborsky, Jennifer, Kroger, Andrew, Wolfe, Charles S.

Antibiotics After Incision and Drainage for Uncomplicated Skin Abscesses: A Clinical Practice Guide

Jeffrey Wilson — Thu, 23 Aug 2018 16:46:00 +0000

Date Added:

September 29, 2018

Journal/Publication:

The BMJ

Publisher:

BMJ

Publication Date:

February 6, 2018

Issue:

360

URL:

Antibiotics After Incision and Drainage for Uncomplicated Skin Abscesses: A Clinical Practice Guide

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1136/bmj.k243

Keywords

PMID (1):

29437651

MeSH

trimethoprim, sulfamethoxazole drug combination

drug resistance, bacterial

anti-bacterial agents

abscess

drainage

clindamycin

Treatment with TMP-SMX or clindamycin after incision and drainage modestly reduces pain and treatment failure and probably reduces abscess recurrence, but treatment increase the risk of adverse effects including nausea and diarrhea. Other antibiotics do not improve outcomes after I&D

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For uncomplicated skin abscesses, we suggest using trimethoprim-sulfamethoxazole (TMP-SMX) or clindamycin in addition to incision and drainage rather than incision and drainage alone, and emphasise the need for shared decision making
TMP-SMX or clindamycin modestly reduces pain and treatment failure and probably reduces abscess recurrence, but increases the risk of adverse effects including nausea and diarrhoea
We suggest TMP-SMX rather than clindamycin because TMP-SMX has a lower risk of diarrhoea
Cephalosporins in addition to incision and drainage are probably not more effective than incision and drainage alone in most settings
From a societal perspective, the modest benefits from adjuvant antibiotics may not outweigh the harms from increased antimicrobial resistance in the community, although this is speculative

Author/s:

Vermandere, Mieke, Aertgeerts, Bert, Agoritsas, Thomas, Liu, Catherine, Burgers, Jako, Merglen, Arnaud, Okwen, Patrick Mbah, Lytvyn, Lyubov, Chua, Shunjie, Vandvik, Per O., Guyatt, Gordon H., Beltran-Arroyave, Claudia, Lavergne, Valéry, Speeckaert, Reinhart, Steen, Finn E., Arteaga, Victoria, Sender, Rachelle, McLeod, Shelley, Sun, Xin, Wang, Wen, Siemieniuk, Reed A.C.