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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
(2010) Clin Transplant 24: 636-42
MeSH Terms: Adult, Anti-Infective Agents, Urinary, Antibiotic Prophylaxis, Cohort Studies, Dapsone, Female, Graft Survival, Humans, Immunosuppressive Agents, Kidney Transplantation, Male, Middle Aged, Pneumocystis Infections, Pneumocystis carinii, Retrospective Studies, Risk Factors, Survival Rate, Trimethoprim, Sulfamethoxazole Drug Combination, Urinary Tract Infections
Show Abstract · Added March 7, 2014
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.
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19 MeSH Terms
A 14-year-old boy with kidney allograft failure in the first month after transplantation.
Revelo MP, Paueksakon P, Goral S, Helderman H, Fogo AB
(2000) Am J Kidney Dis 36: 871-4
MeSH Terms: Acute Disease, Adolescent, Anti-Infective Agents, Urinary, Biopsy, Creatinine, Diagnosis, Differential, Graft Rejection, Humans, Immunosuppressive Agents, Kidney Transplantation, Male, Neutrophils, Ofloxacin, Pseudomonas Infections, Pyelonephritis, Tacrolimus, Time Factors
Added January 20, 2012
1 Communities
1 Members
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17 MeSH Terms
Trimethoprim-sulfamethoxazole in cyst fluid from autosomal dominant polycystic kidneys.
Elzinga LW, Golper TA, Rashad AL, Carr ME, Bennett WM
(1987) Kidney Int 32: 884-8
MeSH Terms: Adult, Anti-Infective Agents, Urinary, Biological Availability, Enterococcus faecalis, Escherichia coli, Female, Genes, Dominant, Humans, Male, Microbial Sensitivity Tests, Middle Aged, Polycystic Kidney Diseases, Proteus mirabilis, Sulfamethoxazole, Trimethoprim
Show Abstract · Added August 10, 2015
Cyst infection in patients with autosomal-dominant polycystic kidney disease (ADPKD) is often refractory to therapy, in part because of the limited entry of commonly used antibiotics into cyst fluid. To study the efficacy of trimethoprim-sulfamethoxazole in cyst infection, cyst fluid was obtained by percutaneous aspiration or at surgery from eight patients with ADPKD receiving trimethoprim-sulfamethoxazole. Cysts were categorized as nongradient or gradient by cyst-fluid sodium concentration. Trimethoprim-sulfamethoxazole concentrations within cysts were determined and cyst fluid inhibitory and bactericidal titers were assessed in vitro against Escherichia coli, Proteus mirabilis and Streptococcus fecalis. The mean cyst fluid trimethoprim and sulfamethoxazole concentrations were 15.2 micrograms/ml and 42.5 micrograms/ml, respectively. Preferential accumulation of trimethoprim was observed in gradient cysts, exceeding serum levels more than eightfold. Sulfamethoxazole penetrated cysts to a lesser extent, with concentrations ranging from 10 to 70 percent of the serum level. Cyst fluid sampled prior to trimethoprim-sulfamethoxazole administration (control) demonstrated no antibacterial activity, while cyst fluid inhibitory and bactericidal titers following antibiotic administration were 1:32 or greater in most instances. These studies indicate that trimethoprim-sulfamethoxazole is likely to be efficacious in the treatment of cyst infection in polycystic kidneys.
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15 MeSH Terms