Skip to main content
NCBI home page
Antimicrobial Agents and Chemotherapy logoLink to Antimicrobial Agents and Chemotherapy
. 1981 Apr;19(4):598–604. doi: 10.1128/aac.19.4.598

Comparative efficacy and safety of nalidixic acid versus trimethoprim/sulfamethoxazole in treatment of acute urinary tract infections in college-age women.

A Iravani, G A Richard, H Baer, R Fennell
PMCID: PMC181485  PMID: 6972732

Abstract

One hundred and thirty-five college-age women with acute urinary tract infections caused by gram-negative Enterobacteriaceae were treated by random allocation with either nalidixic acid (NA), 1 g every 6 h for 7 days, or trimethoprim/sulfamethoxazole (TMP/SMZ), 160/800 mg every 12 h for 10 days. The clinical and bacteriological cure rates were 98.0% in each group on the last day of therapy. At 1 and 4 week posttherapy, both the clinical and bacteriological cure rates for NA declined to 90.0 and 74.0% respectively; for TMP/SMZ, they declined to 93.0 and 72.0% respectively. By 4 weeks posttherapy, 96.0% of the TMP/SMZ group and 93.0% of the NA group had remained free of the initial urinary pathogens. Neither drug was associated with emergence of resistant bacterial mutants in urine. The antibody-coated bacteria tested (ACBT) localized 31.5% of the infections of the kidney and 67.7% to the bladder. Upper tract symptoms did not correlate with the presence of a positive ACBT. The response to therapy was similar for the two regimens regardless of ACBT results. After treatment, the emergence of resistant Enterobacteriaceae in fecal flora was 1.1% in the NA group and 2.3% in the TMP/SMZ group. The incidences of drug reactions were 7.0% with NA and 6.3% and TMP/SMZ.

Full text

PDF
598

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bauer A. W., Kirby W. M., Sherris J. C., Turck M. Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol. 1966 Apr;45(4):493–496. [PubMed] [Google Scholar]
  2. Bognár S., Binder L., Szalka A. Post-therapeutic levels of antimicrobial drugs in faeces. Acta Microbiol Acad Sci Hung. 1975;22(3):271–274. [PubMed] [Google Scholar]
  3. Brown P. C., Donaghy M. C., Dootson P. H., Titcombe D. H., MacLaren D. M. Sulphadimidine and nalidixic acid therapy in urinary-tract infections in general practice. Practitioner. 1971 Dec;207(242):819–826. [PubMed] [Google Scholar]
  4. Brumfitt W., Pursell R. Double-blind trial to compare ampicillin, cephalexin, co-trimoxazole, and trimethoprim in treatment of urinary infection. Br Med J. 1972 Jun 17;2(5815):673–676. doi: 10.1136/bmj.2.5815.673. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bruun J. N., Mulholland S. G. Antibiotic sensitivity of isolates from nosocomial and community-acquired urinary tract infections. Urology. 1973 May;1(5):409–413. doi: 10.1016/0090-4295(73)90369-5. [DOI] [PubMed] [Google Scholar]
  6. CUTLER S. J., EDERER F. Maximum utilization of the life table method in analyzing survival. J Chronic Dis. 1958 Dec;8(6):699–712. doi: 10.1016/0021-9681(58)90126-7. [DOI] [PubMed] [Google Scholar]
  7. Cederberg A., Denneberg T., Ekberg M., Juhlin I. Nalidixic acid in urinary tract infections with particular reference to the emergence of resistance. Scand J Infect Dis. 1974;6(3):259–264. doi: 10.3109/inf.1974.6.issue-3.09. [DOI] [PubMed] [Google Scholar]
  8. Cosgrove M. D., Morrow J. W. Ampicillin versus trimethoprim sulfamethoxazole in chronic urinary tract infection. J Urol. 1974 May;111(5):670–672. doi: 10.1016/s0022-5347(17)60042-9. [DOI] [PubMed] [Google Scholar]
  9. Datta N., Faiers M. C., Reeves D. S., Brumfitt W., Orskov F., Orskov I. R Factors in Escherichia coli in faeces after oral chemotherapy in general practice. Lancet. 1971 Feb 13;1(7694):312–315. doi: 10.1016/s0140-6736(71)91042-7. [DOI] [PubMed] [Google Scholar]
  10. Fennell R. S., Luengnaruemitchai M., Iravani A., Garin E. H., Walker R. D., Richard G. A. Urinary tract infections in children: effect of short course antibiotic therapy on recurrence rate in children with previous infections. Clin Pediatr (Phila) 1980 Feb;19(2):121–124. doi: 10.1177/000992288001900206. [DOI] [PubMed] [Google Scholar]
  11. Gillespie W. A., Sellin M. A., Gill P., Stephens M., Tuckwell L. A., Hilton A. L. Urinary tract infection in young women, with special reference to Staphylococcus saprophyticus. J Clin Pathol. 1978 Apr;31(4):348–350. doi: 10.1136/jcp.31.4.348. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Harding G. K., Marrie T. J., Ronald A. R., Hoban S., Muir P. Urinary tract infection localization in women. JAMA. 1978 Sep 8;240(11):1147–1151. [PubMed] [Google Scholar]
  13. Harrison L. H., Cox C. E. Bacteriologic and pharmacodynamic aspects of nalidixic acid. J Urol. 1970 Dec;104(6):903–913. [PubMed] [Google Scholar]
  14. JAMESON R. M. TISSUE CONCENTRATION OF NALIDIXIC ACID IN CHRONIC PYELONEPHRITIS. Br Med J. 1965 Sep 11;2(5462):621–622. doi: 10.1136/bmj.2.5462.621. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Jones S. R., Smith J. W., Sanford J. P. Localization of urinary-tract infections by detection of antibody-coated bacteria in urine sediment. N Engl J Med. 1974 Mar 14;290(11):591–593. doi: 10.1056/NEJM197403142901103. [DOI] [PubMed] [Google Scholar]
  16. Jordan P. A., Iravani A., Richard G. A., Baer H. Urinary tract infection caused by Staphylococcus saprophyticus. J Infect Dis. 1980 Oct;142(4):510–515. doi: 10.1093/infdis/142.4.510. [DOI] [PubMed] [Google Scholar]
  17. Keys T. F. Antimicrobials commonly used for urinary tract infection: sulfonamides, trimethoprim-sulfamethoxazole, nitrofurantoin, nalidixic acid. Mayo Clin Proc. 1977 Nov;52(11):680–682. [PubMed] [Google Scholar]
  18. Koch U. J., Schumann K. P., Küchler R., Kewitz H. Efficacy of trimethoprim, sulfamethoxazole and the combination of both in acute urinary tract infection. Clinical and pharmacokinetical studies. Chemotherapy. 1973;19(5):314–321. doi: 10.1159/000221470. [DOI] [PubMed] [Google Scholar]
  19. Madsen S. T. Trimethoprim + sulphamethoxazole in urinary tract infections. A double blind trial. Scand J Urol Nephrol. 1973;7(2):184–186. doi: 10.3109/00365597309133700. [DOI] [PubMed] [Google Scholar]
  20. McAllister T. A., Alexander J. G., Dulake C., Percival A., Boyce J. M., Wormald P. J. Multicentric study of sensitivities of urinary tract pathogens. Postgrad Med J. 1971 Sep;47(Suppl):7–14. [PubMed] [Google Scholar]
  21. Ronald A. R., Turck M., Petersdorf R. G. A critical evaluation of nalidixic acid in urinary-tract infections. N Engl J Med. 1966 Nov 17;275(20):1081–1089. doi: 10.1056/NEJM196611172752001. [DOI] [PubMed] [Google Scholar]
  22. SLEET R. A., GRAY W., CALDER M., MURDOCH J. M. TREATMENT OF URINARY TRACT INFECTIONS WITH NALIDIXIC ACID. A CLINICAL TRIAL. Chemotherapy. 1964;27:137–141. doi: 10.1159/000220304. [DOI] [PubMed] [Google Scholar]
  23. Smith J. W., Jones S. R., Kaijser B. Significance of antibody-coated bacteria in urinary sediment in experimental pyelonephritis. J Infect Dis. 1977 Apr;135(4):577–581. doi: 10.1093/infdis/135.4.577. [DOI] [PubMed] [Google Scholar]
  24. Stamey T. A., Bragonje J. Resistance to nalidixic acid. A misconception due to underdosage. JAMA. 1976 Oct 18;236(16):1857–1860. [PubMed] [Google Scholar]
  25. Stamey T. A., Nemoy N. J., Higgins M. The clinical use of nalidixic acid. A review and some observations. Invest Urol. 1969 May;6(6):582–592. [PubMed] [Google Scholar]
  26. Stamey T. A., Timothy M., Millar M., Mihara G. Recurrent urinary infections in adult women. The role of introital enterobacteria. Calif Med. 1971 Jul;115(1):1–19. [PMC free article] [PubMed] [Google Scholar]
  27. TURCK M., PETERSDORF R. G. The epidemiology of nonenteric Escherichia coli infections: prevalence of serological groups. J Clin Invest. 1962 Sep;41:1760–1765. doi: 10.1172/JCI104635. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Thomas V., Shelokov A., Forland M. Antibody-coated bacteria in the urine and the site of urinary-tract infection. N Engl J Med. 1974 Mar 14;290(11):588–590. doi: 10.1056/NEJM197403142901102. [DOI] [PubMed] [Google Scholar]
  29. Toivonen S., Pentikäinen P., Leirisalo M., Pyörälä K. Comparison of ampicillin and nalidixic acid in the treatment of urinary tract infections caused by E. coli. Acta Med Scand. 1974 Mar;195(3):181–184. doi: 10.1111/j.0954-6820.1974.tb08120.x. [DOI] [PubMed] [Google Scholar]

Articles from Antimicrobial Agents and Chemotherapy are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES