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 language | English |
|---|---|
| Pages (from-to) | 41-45 |
| Number of pages | 5 |
| Journal | Journal of the American Medical Association |
| Volume | 273 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 4 1995 |
| Externally published | Yes |
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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 journal › Article
}
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.
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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 -