女子再発性尿路感染症の再発予防に関する臨床的研究

Abstract

Prophylactic efficacy of long-term low-dose antimicrobial treatment in urinary tract infection (UTI) was studied. Female patients with a history of at least two recurrent episodes of UTI in the past year were entered into the study, and prophylactic regimens were not started until existing UTI had been eradicated. Patients received prophylactic agent daily at bedtime after voiding, and this treatment had been continued for 3 to 6 months. 1. Nalidixic acid (NA) was administered 1.0g to adult patients daily at bedtime, and children received each dose of 250 or 500 mg according to body weight. Female patients with uncomplicated UTI were divided into two groups, the NA group (53 cases) and the placebo group (27 cases), and the incidence of reinfections in the NA group was significantly lower than in the placebo group both at 3 and 6 months (p<0.05). All patients with complicated UTI (16 men and 19 women) received NA regimen, and the incidence of reinfections was 20% at 3 months and 7.4% at 6 months. Adverse reactions of NA were noted in 7 of 88 patients (7.9%) during the treatment. Anorexia was observed in 5 cases, a rash in 1, and general itching in 1. No significant laboratory abnormalities were observed. 2. Female adult patients were treated with one tablet of trimethoprim-sulfamethoxazole (TMP -SMX, 80 and 400 mg, respectively) daily at bedtime, while children received half the adult dose taken according to the same schedule. Incidences of recurrence of UTI in 44 patients with uncomplicated UTI and 23 patients with complicated UTI were decreased to 0.48 and 0.52 per year during the treatment compared with 4.73 and 3.35 per year before entry into the study, respectively. After completion of 6 months period of prophylactic therapy, patients who remained free from UTI were divided into two groups by envelope method. Eleven cases were treated for a further 6 months and 12 cases followed by no medication. There was no significant difference in the incidence of recurrence between two groups. These findings suggest that the period of prophylaxis might be sufficient for 6 months. Examination of periurethral swab showed that E. coli were present in 63.8% of the subjects before the treatment, while after 1 to 3 months of treatment S. faecalis were increased and E. coli were decreased. MICs of TMP-SMX against these organisms generally showed a tendency to increase during the treatment. Urinary levels of TMP-SMX in the morning urine with patients administered one tablet at bedtime averaged 35.1 ug/ml and 76.7 ug/ml, respectively. These values were about 2 times higher than those found in the evening urine after administration of one tablet in the morning. Adverse reactions of TMP-SMX were observed in 7 of 67 cases (10.4%). As side effects, two cases of thrombocytopenia and one case of elevation of serum alkaline-phosphatase were observed but all of side effects were transient.