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Antimicrobial Prophylaxis of Recurrent Urinary Tract Infections: A Double-Blind, Placebo-Controlled Trial

WALTER E. STAMM, M.D.; GEORGE W. COUNTS, M.D.; KENNETH F. WAGNER, D.O.; DAVID MARTIN, M.D.; DAVID GREGORY, M.D.; MARY McKEVITT, R.N.; MARVIN TURCK, M.D.; and KING K. HOLMES, M.D., Ph.D.
[+] Article and Author Information

Grant support: in part by Program Project Grant AI-12192 and Training Grant AI-07044 from the National Institutes of Health and by a grant from Burroughs-Wellcome Company.

Presented in part at the 19th Interscience Conference on Antimicrobial Agents and Chemotherapy, 2 October 1979, Boston, Massachusetts.

▸Reprints are not available.


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© 1980 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1980;92(6):770-775. doi:10.7326/0003-4819-92-6-770
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To study once-daily antimicrobial prophylaxis of urinary tract infections, we gave trimethoprim-sulfamethoxazole (40 mg/200 mg), trimethoprim (100 mg), nitrofurantoin macrocrystals (100 mg); or placebo to 60 women for 6 months. During prophylaxis, infections per patient year were comparable in the groups receiving trimethoprim (0.0), nitrofurantoin (0.14), or trimethoprim-sulfamethoxazole (0.15) and occurred less frequently than in patients receiving placebo (2.8; P < 0.001, placebo versus each drug regimen). The effectiveness of prophylaxis was limited to the 6 months that antimicrobials were given, and infections were more likely to develop after prophylaxis in women who had three or more infections in the year before prophylaxis (P < 0.005). Further, women whose preprophylaxis infection was positive for antibody-coated bacteria were more likely to have same-strain relapse when infections recurred (P = 0.001). Emergence of trimethoprim-resistant Escherichia coli was rare, but non-E. coli infections occurred more often after prophylaxis (P < 0.05). Prophylaxis with these drugs is effective, well tolerated, and did not produce emergence of resistant E. coli but may predispose to non-E. coli urinary tract infections after its discontinuation.

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