Infectious Disease

Among the first-line UTI agents, TMP / SMX is associated with a higher risk of adverse drug reactions

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Butler does not report any relevant financial information. Please refer to the study for all relevant financial information from the other authors.

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Of two first-line drugs for uncomplicated urinary tract infections, trimethoprim-sulfamethoxazole was associated with a higher risk of multiple adverse drug events compared to nitrofurantoin, researchers reported in Clinical Infectious Diseases.

Non-first-line drugs were also associated with a higher risk of adverse drug events when compared to nitrofurantoin, in addition to potential microbial-related adverse events, including diarrhea, according to Anne M. Butler, PhD, Assistant Professor of Medicine in the Department of Infectious Diseases at Washington University and colleagues.

Anne M. Butler

“Urinary tract infections are among the most common indications for antibiotics, but we have limited knowledge of the relative benefits and harms of the different antibiotics prescribed to treat urinary tract infections,” Butler told Healio. “Existing evidence comes mainly from randomized clinical trials, which are limited by small sample sizes, short follow-up times, heterogeneous study populations, and large differences in the duration of antibiotic prescriptions. In addition, randomized clinical trials only compare antibiotics in limited combinations, for example ciprofloxacin vs. amoxicillin clavulanate. “

Because of this, Butler says there are big differences in prescribing practices for urinary tract infections, which led the current study to compare the risk of adverse events associated with commonly used oral antibiotic regimens for outpatient treatment of uncomplicated urinary tract infections in young women in the United States States.

Butler and colleagues used a commercial insurance database to identify more than 1.1 million otherwise healthy, non-pregnant women aged 18 to 44 with uncomplicated urinary tract infections who took an oral antibiotic between July 1, 2006 and September 30, 2015 used with effect against common uropathogens.

Compared to nitrofurantoin, trimethoprim-sulfamethoxazole (TMP / SMX) was at a higher risk of hypersensitivity reactions (HR = 2.62; 95% CI 2.30–2.98), acute renal failure (HR = 2.56; 95% CI 1.55-4.25.), Rash (HR = 2.42; 95% CI 2.13-2.75), urticaria (HR = 1.37; 95% CI 1.19-1 , 57), abdominal pain (HR = 1.14; 95% CI 1.09-1.19), and nausea and / or vomiting (HR = 1.18; 95% CI, 1.10-1.28) were reported Butler and colleagues.

In addition, they found that fluoroquinolones and beta-lactams – non-first-line drugs – were associated with a higher risk of multiple adverse drug events and potential microbial adverse events, including non-Clostridioides difficile diarrhea, C. difficile infection , Vaginitis and / or vulvovaginal candidiasis and pneumonia.

Butler and colleagues also found that, consistent with previous evidence, the duration of treatment changed the risk of potential microbiological side effects, “likely due to an antibiotic-induced disruption of the microbiota”.

In particular, treating patients with TMP / SMX and fluoroquinolones durations longer than the guidelines recommended resulted in a higher 30-day risk for non-C. difficile diarrhea and inappropriately long durations of TMP / SMX, fluoroquinolones, and broad-spectrum beta-lactams were all associated with a higher 90-day risk of pneumonia.

“Addressing the threat of antimicrobial resistance requires a better understanding of the consequences of prescribing antibiotics, including the side effects that are commonly treated by drug withdrawal and subsequent prescriptions with alternative agents,” said Butler.

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