RANDOMIZED COMPARATIVE TRIAL AND COST-ANALYSIS OF 3-DAY ANTIMICROBIALREGIMENS FOR TREATMENT OF ACUTE CYSTITIS IN WOMEN

Objective.-To determine the efficacy, safety, and costs associated wit h four different 3-day regimens for the treatment of acute uncomplicat ed cystitis in women. Design.-A prospective randomized trial with a co st analysis. Study Population.-Women with acute cystitis attending a s tudent health center.Interventions.-Treatment with 3-day oral regimens of trimethoprim-sulfamethoxazole, 160 mg/800 mg twice daily, macrocry stalline nitrofurantoin, 100 mg four times daily, cefadroxil, 500 mg t wice daily, or amoxicillin, 500 mg three times daily. Results.-Six wee ks after treatment, 32 (82%) of 39 women treated with trimethoprim-sul famethoxazole were cured compared with 22 (61%) of 36 treated with nit rofurantoin (P=.04 vs trimethoprim-sulfamethoxazole), 21 (66%) of 32 t reated with cefadroxil (P=.11 vs trimethoprim-sulfamethoxazole), and 2 8 (67%) of 42 treated with amoxicillin (P=.11 vs trimethoprim-sulfamet hoxazole). Persistence of significant bacteriuria was less common with trimethoprim-sulfamethoxazole (3%) and cefadroxil (0%) compared with nitrofurantoin (16%; P=.05 vs trimethoprim-sulfamethoxazole) and amoxi cillin (14%; P=.11 vs trimethoprim-sulfamethoxazole). Persistence of b acteriuria was associated with amoxicillin-resistant strains in the am oxicillin group but nitrofurantoin-susceptible strains in the nitrofur antoin group, Trimethoprim-sulfamethoxazole was more successful in era dicating Escherichia coli from rectal cultures soon after therapy and from urethral and vaginal cultures at all follow-up visits compared wi th the other treatment regimens. Adverse effects were reported by 16 ( 35%) of 46 patients receiving trimethoprim-sulfamethoxazole, 18 (43%) of 42 receiving nitrofurantoin, 12 (30%) of 40 receiving cefadroxil, a nd 13 (25%) of 52 receiving amoxicillin. The mean costs per patient we re less with trimethoprim-sulfamethoxazole ($114) and amoxicillin ($13 1) compared with nitrofurantoin ($155) and cefadroxil ($155). Conclusi ons.-A 3-day regimen of trimethoprim-sulfamethoxazole is more effectiv e and less expensive than 3-day regimens of nitrofurantoin, cefadroxil , or amoxicillin for treatment of uncomplicated cystitis in women. The increased efficacy of trimethoprim-sulfamethoxazole is likely related to its antimicrobial effects against E coli in the rectum, urethra, a nd vagina.