Recurrent urinary tract infections in women

OB/GYN News,  Sept 15, 2002  by Mitchel Zoler,  Sharon Worcester

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Drug                   Dosage            Cost/Day

cephalexin             500 mg b.i.d.     $2.50 *
                       for 7 days









ciprofloxacin (Cipro)  250 mg b.i.d.     $7.72 *
                       for 3 days











topical estradiol      0.5-2 g/day       $1.14 (1 g) **
 (Estrace)












nitrofurantoin         100 mg b.i.d.     $3.40 *
 (Macrobid)            for 7 days



















trimethoprim-          160 mg            $0.70 *
 sulfamethoxazole      trimethoprim and
                       800 mg
                       sulfamethoxazole
                       once a day for
                       3 days


















trimethoprim           100 mg b.i.d.     $0.42
                       for 3 days







Drug                   Comment +

cephalexin             Escherichia coli resistance rates
                       are high in some areas, but
                       resistance is generally
                       intermediate and good clinical
                       cure rates have been reported
                       nonetheless. This dosage is for
                       acute treatment. For prophylaxis,
                       use 250 mg once postcoitally or
                       250 mg three times a week for
                       ongoing prophylaxis.

ciprofloxacin (Cipro)  Exceptionally good coverage for
                       uropathogens. Good option when
                       other antibiotics fail for acute
                       treatment, if prescribed by phone
                       and no culture was done, or as
                       empiric treatment until culture
                       results are obtained. Biggest
                       drawback is relatively higher
                       cost, which makes it less useful
                       for prophylaxis. Avoid in pregnant
                       women if possible, and do not use
                       in women who are breast-feeding.

topical estradiol      Prophylaxis only. Results from at
 (Estrace)             least one study showed marked
                       decreases in recurrence rates in
                       postmenopausal women using topical
                       estrogen daily. Thought to
                       normalize vaginal flora, reducing
                       the risk that E. coli and other
                       pathogens will travel into the
                       bladder and cause infections. Do
                       not use in pregnant or breast-
                       feeding women. This dosage is for
                       amount of cream used. Estradiol
                       dose is 100 mg/g of cream.

nitrofurantoin         Good coverage for E. coli and
 (Macrobid)            Staphylococcus saprophyticus.
                       Proteus species are intrinsically
                       resistant, but only a small
                       fraction of infections are caused
                       by these pathogens. May cause
                       gastrointestinal side effects, but
                       generally safe, even during
                       pregnancy. Preferred treatment
                       during pregnancy, but best to
                       avoid in women who are breast-
                       feeding infants younger than 1
                       month. Some physicians avoid for
                       prophylaxis due to rare risk of
                       adverse pulmonary reactions. This
                       dosage is for acute treatment. For
                       postcoital prophylaxis, use a
                       single 50-mg dose; for ongoing
                       prophylaxis, use 50 mg three times
                       a week.

trimethoprim-          Inexpensive and generally
 sulfamethoxazole      effective. First-line treatment
                       according to guidelines of the
                       Infectious Diseases Society of
                       America. E. coli is usually
                       susceptible, but avoid if
                       resistance in area is greater than
                       20%. Often used off label during
                       pregnancy, but don't use in late
                       third trimester because of adverse
                       effects on bilirubin levels. Don't
                       use in breast-feeding women
                       because sulfonamides are excreted
                       in breast milk and can cause
                       kernicterus. In Patients on
                       warfarin or those who are allergic
                       to sulfa drugs, use trimethoprim
                       alone. This dosage is for acute
                       treatment and is a double-strength
                       tablet. For prophylaxis, use
                       regular-strength formulation
                       (80 mg trimethoprim and 400 mg
                       sulfamethoxazole).

trimethoprim           Good alternative to trimethoprim-
                       sulfamethoxazole for patients who
                       can't take that drug. This dosage
                       is for acute treatment; also
                       effective for prophylaxis. Don't
                       use in late third trimester of
                       pregnancy or in breast-feeding
                       women.

* Cost/day is based on the average wholesale price for a 100-unit
container of the generic formulation, unless otherwise specified, in the
2001 Red Book.

** Cost/day is based on the average wholesale price for a 42.5-g tube in
the 2001 Red Book.

+ Comments reflect the opinions and expertise of the following sources:

Dr. Kal Gupta, acting assistant professor of medicine, division of
infectious diseases, University of Washington, Seattle.

Dr. Elbert Huang, instructor of medicine, division of internal medicine,
University of Chicago.

Dr. Steven Schaefer, head of telephone management of urinary tract
infections for Kaiser Permanente, Southern California.

COPYRIGHT 2002 International Medical News Group
COPYRIGHT 2008 Gale, Cengage Learning