Trimethoprim-sulfa vs cranberries to prevent recurrent UTI

January 01, 0001

Trimethoprim-sulfa vs cranberries to prevent recurrent UTI

In this double-blind, double-dummy noninferiority trial by Dutch investigators, 221 premenopausal women with recurrent UTIs were randomized to 12-month prophylaxis use of trimethoprim-sulfamethoxazole (TMP-SMX), 480 mg once daily, or cranberry capsules, 500 mg twice daily. Primary end points were the mean number of symptomatic UTIs over 12 months, the proportion of patients with at least 1 symptomatic UTI, the median time to first UTI, and development of antibiotic resistance in indigenous Escherichia coli.

They found: "After 12 months, the mean number of patients with at least 1 symptomatic UTI was higher in the cranberry than in the TMP-SMX group (4.0 vs 1.8), and the proportion of patients with at least 1 symptomatic UTI was higher in the cranberry than in the TMP-SMX group (78.2% vs 71.1%). Median time to the first symptomatic UTI was 4 months for the cranberry and 8 months for the TMP-SMX group. After 1 month, in the cranberry group, 23.7% of fecal and 28.1% of asymptomatic bacteriuria E coli isolates were TMP-SMX resistant, whereas in the TMP-SMX group, 86.3% of fecal and 90.5% of asymptomatic bacteriuria E coli isolates were TMP-SMX resistant. Similarly, we found increased resistance rates for trimethoprim, amoxicillin, and ciprofloxacin in these E coli isolates after 1 month in the TMP-SMX group. After discontinuation of TMP-SMX, resistance reached baseline levels after 3 months. Antibiotic resistance did not increase in the cranberry group. Cranberries and TMP-SMX were equally well tolerated."

The authors concluded: "In premenopausal women, TMP-SMX, 480 mg once daily, is more effective than cranberry capsules, 500 mg twice daily, to prevent recurrent UTIs, at the expense of emerging antibiotic resistance."

Over a longer period the issue of resistance might well outweigh the benefit of reduction in recurrences.

For the full abstract, click here.

Arch Intern Med 171(14):1270-1278, 25 July 2011 © 2011 to the American Medical Association
Cranberries vs Antibiotics to Prevent Urinary Tract Infections-A Randomized Double-blind Noninferiority Trial in Premenopausal Women. Mariëlle A. J. Beerepoot, Gerben ter Riet, Sita Nys, et al. Correspondence to Dr. Geeerlings: [email protected]

Category: U. Urinary. Keywords: urinary tract infection, prevention, trimethoprim- sulfamethoxizole, cranberries, antibiotic resistance, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 9 August 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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