Chronic bacteriuria due to Escherichia coli. I. Assessment of the value of combined short- and long-term treatment with cycloserine, nitrofurantoin, and sulphadimidine

Selective use of excretory urography in women with acute pyelonephritis

The outcome of excretory urography was analyzed in 103 nonpregnant women followed prospectively after community acquired acute pyelonephritis. Radiological abnormality was found in 40 per cent of the patients (17 per cent had major abnormalities, including renal scarring, calculi and obstruction). All 5 women with surgically correctable lesions had rapid bacteriological relapse or recurrent acute pyelonephritis. Neither a history of urinary tract infection, the acute inflammatory response nor infection due to Escherichia coli with or without adhesins specific for Gal alpha 1----4Gal beta-containing receptors was efficient in predicting major radiographic lesions or the outcome of treatment. Bacteremia was detected in 27 per cent of the patients but in the absence of obstruction. These results suggest that excretory urography is dispensable in most women with acute pyelonephritis, and that those needing such investigation may be identified by failure to respond to antibiotic treatment or by the recurrence pattern.

Recurrent urinary infections in women: clinical trial of cephradine as a prophylactic agent

Cephradine 250 mg at night for 12 months was given as a prophylactic measure to 33 female patients of mean age 41.6 years, who had a history in the preceding 12 months of between three and 24 (median = 7) episodes of frequency and/or dysuria. When on such treatment the mean period between symptomatic attacks was 300 days, while before treatment attacks occurred at a mean frequency of 60.3 days. Thus, prophylactic cephradine increased the interval between attacks five-fold. In a total of 9002 patient-days of treatment, only five bacteriuric breakthrough infections occurred. 27% of the patients reported adverse effects "probably" or "possibly" related to treatment. Hence, cephradine appears to be as effective and better tolerated than macrocrystalline nitrofurantoin, presently the drug of choice for the prophylaxis of recurrent urinary infections.

Cycloserine as a urinary tract antiseptic

A short historical review and pharmacological data indicating the suitability of cycloserine for long-term low-dose prophylaxis of urinary tract infection are presented.

Prevention of recurrent urinary infections in women: a comparative trial between nitrofurantoin and methenamine hippurate

We treated 99 female patients suffering from recurrent urinary infections with either 1 gm. methenamine hippurate every 12 hours or 50 mg. nitrofurantoin every 12 hours for intervals of up to 1 year. Monthly microbiological and clinical surveillance was done. Both treatments were effective in reducing the incidence of symptomatic attacks, with nitrofurantoin being more effective. The protective effect of prophylaxis continued after treatment had stopped, suggesting that a permanent beneficial action had been produced. Especially during the first month of treatment methenamine hippurate was tolerated better than nitrofurantoin: 28 per cent discontinued therapy with the latter owing to nausea.

Antibacterial prophylaxis--a clinician's view

The principles of antibacterial prophylaxis and its advantages and disadvantages are reviewed. Controlled trials have shown chemoprophylaxis to be beneficial notably in preventing recurrences of rheumatic carditis and urinary infections and in controlling sepsis after cardiac and hip joint surgery and mid thigh amputations. The recently introduced metronidazole prophylaxis for gastrointestinal and gynaecological operations appears highly effective. The use of prophylaxis is briefly discussed in other situations where its value is less certain or where, in the author's opinion, it is contraindicated.

The periurethral aerobic flora in girls highly susceptible to urinary infections

After the age of 5 years, normal children have but few aerobic gram-negative rods periurethrally. This study examines whether there is an abnormal periurethral colonization in urinary tract infection-prone girls during infection-free intervals, indicating a defective local defence. In 13 girls with a history of recurrent infection, daily bacterial samples were obtained from the periurethral area and from urine. Sampling continued until an infection eventually occurred. Seven girls contracted a urinary tract infection within 3-30 days. All were heavy colonized with gram-negative rods, often several species, before infection appeared. Serotyping of E. coli confirmed that it was the colonizing strain which later invaded the bladder. The findings suggest a local defect in the antibacterial defence of infection-prone individuals and gives strong evidence for ascending infection. Six girls remained uninfected during an observation period of 9-123 days. They all had a normal periurethral flora. A reasonable hypothesis would be that the same factor counteracted colonization and infection. Since abnormal periurethral colonization was not a constant phenomenon the postulated defect may vary. This might explain the fact that urinary tract infections often appear in quick succession, often followed by long infection-free intervals.