Therapy for women hospitalized with acute pyelonephritis: A randomized trial of ampicillin versus trimethoprim-sulfamethoxazole for 14 days

James R. Johnson, M. Frank Lyons, William Pearce, Patrick Gorman, Padta L. Roberts, Nicholas White, Paula Brust, Robin Olsen, John W. Gnann, Walter E. Stamm

Research output: Contribution to journalArticlepeer-review

45 Scopus citations

Abstract

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, 6.6 doses). Antimicrobial resistance necessitated modifying therapy of 14 (32%) of the Amp recipients but of none of the TMP/SMZ recipients (P <.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 languageEnglish (US)
Pages (from-to)325-330
Number of pages6
JournalJournal of Infectious Diseases
Volume163
Issue number2
DOIs
StatePublished - Feb 1991

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