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A Comparison of Trimethoprim-Sulfamethoxazole, Amoxicillin, and Cyclacillin

Thomas M. Hooton, MD; Kate Running, PA, WHCS; Walter E. Stamm, MD

JAMA. 1985;253(3):387-390.

Abstract
We evaluated single-dose regimens of trimethoprim-sulfamethoxazole, amoxicillin, and cyclacillin as treatment for acute cystitis in 38 women. The trial was prematurely stopped because of frequent treatment failures. At two days after treatment, all 13 patients given trimethoprim-sulfamethoxazole were cured, while four (31%) of 13 given amoxicillin and four (33%) of 12 given cyclacillin had persistent bacteriuria. At two weeks, 11 (85%) of 13 patients given trimethoprim-sulfamethoxazole, six (50%) of 12 given amoxicillin, and three (30%) of ten given cyclacillin were cured. One patient with positive results of antibody-coated bacteria testing who was treated with cyclacillin had signs and symptoms of acute pyelonephritis three days after treatment, and two patients treated with amoxicillin and one treated with trimethoprim-sulfamethoxazole converted antibody-coated bacteria test results from negative to positive after therapy. We conclude that single-dose treatment of cystitis in unselected women with cyclacillin and amoxicillin may result in low cure rates and that progression to acute pyelonephritis may occur following ineffective single-dose therapy.

(JAMA 1985;253:387-390)

Author Affiliations
From the Department of Medicine, Harborview Medical Center and US Public Health Service Hospital, University of Washington School of Medicine, Seattle.

Footnotes
Reprint requests to Department of Medicine, Division of Infectious Diseases, ZA-89, 325 Ninth Ave, Seattle, WA 98104 (Dr Hooton).

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