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The efficacy of the traditionally recommended ampicillin (Amp) plus gentamicin (GM) regimen was compared with that of a trimethoprim-sulfamethoxazole (TMP/SMZ)-plus-GM regimen and the adequacy of 14 days total therapy for acute uncomplicated pyelonephritis (AUPN). Eighty-five women hospitalized for AUPN were randomly assigned to receive either Amp, 1 g intravenously (iv) every 6 h for 3 days, then 500 mg orally four times daily, or TMP/SMZ, 160/800 mg iv every 12 h for 3 days, then 160/800 mg orally twice daily. Initially, all patients also received GM every 8 h iv (mean, 606 doses). Antimicrobial resistance necessitated modifying therapy of 14 (32%) of the Amp recipients but of none of the TMP/SMZ recipients (P less than .001). Both regimens produced a satisfactory bacteriologic and clinical response in all cases. Reinfection occurred in 11% of Amp and in 8% of TMP/SMZ recipients. No patient experienced relapsing infection. The TMP/SMZ regimen was less costly and less likely to require modification due to antimicrobial resistance.

Original publication

DOI

10.1093/infdis/163.2.325

Type

Journal article

Journal

The Journal of infectious diseases

Publication Date

02/1991

Volume

163

Pages

325 - 330

Addresses

Department of Medicine, University of Washington, Seattle.

Keywords

Humans, Pyelonephritis, Acute Disease, Ampicillin, Gentamicins, Drug Therapy, Combination, Adult, Aged, Aged, 80 and over, Middle Aged, Female, Trimethoprim, Sulfamethoxazole Drug Combination