Lower risk of urinary tract infection with low-dose trimethoprim/sulfamethoxazole compared to dapsone prophylaxis in older renal transplant patients on a rapid steroid-withdrawal immunosuppression regimen.

Giullian JA, Cavanaugh K, Schaefer H
Clin Transplant. 2010 24 (5): 636-42

PMID: 19925478 · PMCID: PMC4489856 · DOI:10.1111/j.1399-0012.2009.01129.x

BACKGROUND - Urinary tract infections (UTI) are common in renal transplant recipients. Trimethoprim/sulfamethoxazole (TMP/SMZ) in moderate to high daily doses prevents Pneumocystis jiroveci (PCP) and reduces the risk of UTI in renal transplant patients. Low-dose TMP/SMZ also reduces the risk of PCP, although its ability to reduce the risk of UTI is uncertain.

DESIGN - Retrospective review of 158 patients who received a renal transplant without corticosteroids for maintenance immunosuppression.

RESULTS - Forty percent of patients initially prescribed TMP/SMZ ultimately stopped this medication early because of an adverse reaction. Urinary infection occurred in 16% without a significant difference in the risk of UTI between those treated with dapsone vs. those treated with TMP/SMZ (HR [95%CI]: 1.7 [0.75, 3.9], p = 0.2). In the subset of patients who were older than age 47 yr (mean age for this cohort, SD ± 6.2 yr), those treated with dapsone originally or who switched from TMP/SMZ to dapsone had a greater risk of UTI compared to patients who remained on TMP/SMZ (HR [95%CI]: 4.3 [1.2, 15.5], p = 0.024).

CONCLUSIONS - For renal transplant recipients over the age of 47 yr, treated without long-term glucocorticoids, our retrospective data suggest that low-dose TMP/SMZ is associated with a lower risk of UTI compared to dapsone prophylaxis.

© 2009 John Wiley & Sons A/S.

MeSH Terms (19)

Adult Anti-Infective Agents, Urinary Antibiotic Prophylaxis Cohort Studies Dapsone Female Graft Survival Humans Immunosuppressive Agents Kidney Transplantation Male Middle Aged Pneumocystis carinii Pneumocystis Infections Retrospective Studies Risk Factors Survival Rate Trimethoprim, Sulfamethoxazole Drug Combination Urinary Tract Infections

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