Randomized comparative trial and cost analysis of 3-day antimicrobial regimens for treatment of acute cystitis in women

Thomas Hooton, Carol Winter, Felice Tiu, Walter E. Stamm

Research output: Contribution to journalArticle

135 Citations (Scopus)

Abstract

Objective. - To determine the efficacy, safety, and costs associated with four different 3-day regimens for the treatment of acute uncomplicated cystitis in women. Design. - A prospective randomized trial with a cost analysis. Study Population. - Women with acute cystitis attending a student health center. Interventions. - Treatment with 3-day oral regimens of trimethoprim-sulfamethoxazole, 160 mg/800 mg twice daily, macrocrystalline nitrofurantoin, 100 mg four times daily, cefadroxil, 500 mg twice daily, or amoxicillin, 500 mg three times daily. Results. - Six weeks after treatment, 32 (82%) of 39 women treated with trimethoprim-sulfamethoxazole were cured compared with 22 (61%) of 36 treated with nitrofurantoin (P=.04 vs trimethoprim-sulfamethoxazole), 21 (66%) of 32 treated with cefadroxil (P=.11 vs trimethoprim-sulfamethoxazole), and 28 (67%) of 42 treated with amoxicillin (P=.11 vs trimethoprim-sulfamethoxazole). Persistence of significant bacteriuria was less common with trimethoprim-sulfamethoxazole (3%) and cefadroxil (0%) compared with nitrofurantoin (16%; P=.05 vs trimethoprim-sulfamethoxazole) and amoxicillin (14%; P=.11 vs trimethoprim- sulfamethoxazole). Persistence of bacteriuria was associated with amoxicillin-resistant strains in the amoxicillin group but nitrofurantoin- susceptible strains in the nitrofurantoin group. Trimethoprim- sulfamethoxazole was more successful in eradicating Escherichia coli from rectal cultures soon after therapy and from urethral and vaginal cultures at all follow-up visits compared with the other treatment regimens. Adverse effects were reported by 16 (35%) of 46 patients receiving trimethoprim- sulfamethoxazole, 18 (43%) of 42 receiving nitrofurantoin, 12 (30%) of 40 receiving cefadroxil, and 13 (25%) of 52 receiving amoxicillin. The mean costs per patient were less with trimethoprim-sulfamethoxazole ($114) and amoxicillin ($131) compared with nitrofurantoin ($155) and cefadroxil ($155). Conclusions. - A 3-day regimen of trimethoprim-sulfamethoxazole is more effective and less expensive than 3-day regimens of nitrofurantoin, cefadroxil, or amoxicillin for treatment of uncomplicated cystitis in women. The increased efficacy of trimethoprim-sulfamethoxazole is likely related to its antimicrobial effects against E coli the rectum, urethra, and vagina.

Original languageEnglish
Pages (from-to)41-45
Number of pages5
JournalJournal of the American Medical Association
Volume273
Issue number1
DOIs
StatePublished - Jan 4 1995
Externally publishedYes

Fingerprint

Cystitis
Sulfamethoxazole Drug Combination Trimethoprim
Nitrofurantoin
Cefadroxil
Amoxicillin
Costs and Cost Analysis
Therapeutics
Bacteriuria
Escherichia coli
Vagina
Urethra
Rectum

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Randomized comparative trial and cost analysis of 3-day antimicrobial regimens for treatment of acute cystitis in women. / Hooton, Thomas; Winter, Carol; Tiu, Felice; Stamm, Walter E.

In: Journal of the American Medical Association, Vol. 273, No. 1, 04.01.1995, p. 41-45.

Research output: Contribution to journalArticle

@article{6ff9d04f0c004a30a5b785459c747a13,
title = "Randomized comparative trial and cost analysis of 3-day antimicrobial regimens for treatment of acute cystitis in women",
abstract = "Objective. - To determine the efficacy, safety, and costs associated with four different 3-day regimens for the treatment of acute uncomplicated cystitis in women. Design. - A prospective randomized trial with a cost analysis. Study Population. - Women with acute cystitis attending a student health center. Interventions. - Treatment with 3-day oral regimens of trimethoprim-sulfamethoxazole, 160 mg/800 mg twice daily, macrocrystalline nitrofurantoin, 100 mg four times daily, cefadroxil, 500 mg twice daily, or amoxicillin, 500 mg three times daily. Results. - Six weeks after treatment, 32 (82{\%}) of 39 women treated with trimethoprim-sulfamethoxazole were cured compared with 22 (61{\%}) of 36 treated with nitrofurantoin (P=.04 vs trimethoprim-sulfamethoxazole), 21 (66{\%}) of 32 treated with cefadroxil (P=.11 vs trimethoprim-sulfamethoxazole), and 28 (67{\%}) of 42 treated with amoxicillin (P=.11 vs trimethoprim-sulfamethoxazole). Persistence of significant bacteriuria was less common with trimethoprim-sulfamethoxazole (3{\%}) and cefadroxil (0{\%}) compared with nitrofurantoin (16{\%}; P=.05 vs trimethoprim-sulfamethoxazole) and amoxicillin (14{\%}; P=.11 vs trimethoprim- sulfamethoxazole). Persistence of bacteriuria was associated with amoxicillin-resistant strains in the amoxicillin group but nitrofurantoin- susceptible strains in the nitrofurantoin group. Trimethoprim- sulfamethoxazole was more successful in eradicating Escherichia coli from rectal cultures soon after therapy and from urethral and vaginal cultures at all follow-up visits compared with the other treatment regimens. Adverse effects were reported by 16 (35{\%}) of 46 patients receiving trimethoprim- sulfamethoxazole, 18 (43{\%}) of 42 receiving nitrofurantoin, 12 (30{\%}) of 40 receiving cefadroxil, and 13 (25{\%}) of 52 receiving amoxicillin. The mean costs per patient were less with trimethoprim-sulfamethoxazole ($114) and amoxicillin ($131) compared with nitrofurantoin ($155) and cefadroxil ($155). Conclusions. - A 3-day regimen of trimethoprim-sulfamethoxazole is more effective and less expensive than 3-day regimens of nitrofurantoin, cefadroxil, or amoxicillin for treatment of uncomplicated cystitis in women. The increased efficacy of trimethoprim-sulfamethoxazole is likely related to its antimicrobial effects against E coli the rectum, urethra, and vagina.",
author = "Thomas Hooton and Carol Winter and Felice Tiu and Stamm, {Walter E.}",
year = "1995",
month = "1",
day = "4",
doi = "10.1001/jama.273.1.41",
language = "English",
volume = "273",
pages = "41--45",
journal = "JAMA - Journal of the American Medical Association",
issn = "0002-9955",
publisher = "American Medical Association",
number = "1",

}

TY - JOUR

T1 - Randomized comparative trial and cost analysis of 3-day antimicrobial regimens for treatment of acute cystitis in women

AU - Hooton, Thomas

AU - Winter, Carol

AU - Tiu, Felice

AU - Stamm, Walter E.

PY - 1995/1/4

Y1 - 1995/1/4

N2 - Objective. - To determine the efficacy, safety, and costs associated with four different 3-day regimens for the treatment of acute uncomplicated cystitis in women. Design. - A prospective randomized trial with a cost analysis. Study Population. - Women with acute cystitis attending a student health center. Interventions. - Treatment with 3-day oral regimens of trimethoprim-sulfamethoxazole, 160 mg/800 mg twice daily, macrocrystalline nitrofurantoin, 100 mg four times daily, cefadroxil, 500 mg twice daily, or amoxicillin, 500 mg three times daily. Results. - Six weeks after treatment, 32 (82%) of 39 women treated with trimethoprim-sulfamethoxazole were cured compared with 22 (61%) of 36 treated with nitrofurantoin (P=.04 vs trimethoprim-sulfamethoxazole), 21 (66%) of 32 treated with cefadroxil (P=.11 vs trimethoprim-sulfamethoxazole), and 28 (67%) of 42 treated with amoxicillin (P=.11 vs trimethoprim-sulfamethoxazole). Persistence of significant bacteriuria was less common with trimethoprim-sulfamethoxazole (3%) and cefadroxil (0%) compared with nitrofurantoin (16%; P=.05 vs trimethoprim-sulfamethoxazole) and amoxicillin (14%; P=.11 vs trimethoprim- sulfamethoxazole). Persistence of bacteriuria was associated with amoxicillin-resistant strains in the amoxicillin group but nitrofurantoin- susceptible strains in the nitrofurantoin group. Trimethoprim- sulfamethoxazole was more successful in eradicating Escherichia coli from rectal cultures soon after therapy and from urethral and vaginal cultures at all follow-up visits compared with the other treatment regimens. Adverse effects were reported by 16 (35%) of 46 patients receiving trimethoprim- sulfamethoxazole, 18 (43%) of 42 receiving nitrofurantoin, 12 (30%) of 40 receiving cefadroxil, and 13 (25%) of 52 receiving amoxicillin. The mean costs per patient were less with trimethoprim-sulfamethoxazole ($114) and amoxicillin ($131) compared with nitrofurantoin ($155) and cefadroxil ($155). Conclusions. - A 3-day regimen of trimethoprim-sulfamethoxazole is more effective and less expensive than 3-day regimens of nitrofurantoin, cefadroxil, or amoxicillin for treatment of uncomplicated cystitis in women. The increased efficacy of trimethoprim-sulfamethoxazole is likely related to its antimicrobial effects against E coli the rectum, urethra, and vagina.

AB - Objective. - To determine the efficacy, safety, and costs associated with four different 3-day regimens for the treatment of acute uncomplicated cystitis in women. Design. - A prospective randomized trial with a cost analysis. Study Population. - Women with acute cystitis attending a student health center. Interventions. - Treatment with 3-day oral regimens of trimethoprim-sulfamethoxazole, 160 mg/800 mg twice daily, macrocrystalline nitrofurantoin, 100 mg four times daily, cefadroxil, 500 mg twice daily, or amoxicillin, 500 mg three times daily. Results. - Six weeks after treatment, 32 (82%) of 39 women treated with trimethoprim-sulfamethoxazole were cured compared with 22 (61%) of 36 treated with nitrofurantoin (P=.04 vs trimethoprim-sulfamethoxazole), 21 (66%) of 32 treated with cefadroxil (P=.11 vs trimethoprim-sulfamethoxazole), and 28 (67%) of 42 treated with amoxicillin (P=.11 vs trimethoprim-sulfamethoxazole). Persistence of significant bacteriuria was less common with trimethoprim-sulfamethoxazole (3%) and cefadroxil (0%) compared with nitrofurantoin (16%; P=.05 vs trimethoprim-sulfamethoxazole) and amoxicillin (14%; P=.11 vs trimethoprim- sulfamethoxazole). Persistence of bacteriuria was associated with amoxicillin-resistant strains in the amoxicillin group but nitrofurantoin- susceptible strains in the nitrofurantoin group. Trimethoprim- sulfamethoxazole was more successful in eradicating Escherichia coli from rectal cultures soon after therapy and from urethral and vaginal cultures at all follow-up visits compared with the other treatment regimens. Adverse effects were reported by 16 (35%) of 46 patients receiving trimethoprim- sulfamethoxazole, 18 (43%) of 42 receiving nitrofurantoin, 12 (30%) of 40 receiving cefadroxil, and 13 (25%) of 52 receiving amoxicillin. The mean costs per patient were less with trimethoprim-sulfamethoxazole ($114) and amoxicillin ($131) compared with nitrofurantoin ($155) and cefadroxil ($155). Conclusions. - A 3-day regimen of trimethoprim-sulfamethoxazole is more effective and less expensive than 3-day regimens of nitrofurantoin, cefadroxil, or amoxicillin for treatment of uncomplicated cystitis in women. The increased efficacy of trimethoprim-sulfamethoxazole is likely related to its antimicrobial effects against E coli the rectum, urethra, and vagina.

UR - http://www.scopus.com/inward/record.url?scp=0028831904&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028831904&partnerID=8YFLogxK

U2 - 10.1001/jama.273.1.41

DO - 10.1001/jama.273.1.41

M3 - Article

C2 - 7654268

AN - SCOPUS:0028831904

VL - 273

SP - 41

EP - 45

JO - JAMA - Journal of the American Medical Association

JF - JAMA - Journal of the American Medical Association

SN - 0002-9955

IS - 1

ER -