Kemal SANDAL, Murat YASSA, Arzu BİLGE TEKİN, Mehmet Akif SARGIN, Niyazi TUĞ

Düşük Doz Nitrofurantoin ile Postkoital Antimikrobiyal Profilaksinin Premenapozal Gebe Olmayan Kadınlarda Komplike Olmayan Rekurren Uriner Trakt Enfeksiyonlarının Önlenmesinde Etkinliği

ÖZETGiriş ve AmaçRekürren üriner trakt enfeksiyonları (RUTE) yönetilmesi güç önemli bir halk sağlığı sorunudur. En sık etkeni Escherichia coli’dir. RUTE’nin önlenmesinde kontinü ve post-koital profilaksi seçenekleri arasından post-koital profilaksi daha az doz gerektirmesi ve benzer etkinlik ile öne çıkmaktadır. Bu çalışmada post-koital profilaksinin RUTE’nin önlenmesindeki etkinliğinin araştırılması amaçlanmıştır. Materyal ve MetodBu retrospektif çalışmaya RUTE sebebiyle düşük doz nitrofurantoin ile post-koital profilaksi ve yaşam tarzı değişiklikleri uygulanan premenapozal, gebe olmayan, cinsel aktif kadınlar dahil edilmiştir. Profilaksi altı ayda sonlandırılmış ve sonraki altı aylık takipleri değerlendirilmiştir.BulgularÇalışmaya toplam 39 hasta dahil edilmiştir. 1 hasta hafif gastrointestinal yan etki üzerine ilacı bırakmıştır. Tanımlayıcı istatistik analizine 38 hasta dahil edilmiştir. Profilaksi süresince hiçbir hastada rekürrens görülmemiş olup başarı oranı %100’dür. Profilaksi sonrası altı aylık dönemde ise 1 hastada (%2.63) 4.ayda rekürrens görülmüştür. Profilaksi başlangıcından itibaren 12 aylık başarı %97.37 (n=37/38) olarak bulunmuştur.Sonuç Düşük doz (50 mg) nitrofurantoin ile post-koital profilaksisi; premenapoz, gebe olmayan rekürren üriner trakt enfeksiyonlu kadınlarda profilaksi süresince ve profilaksi sonrası ilk altı ayda etkili ve güvenli bulunmuştur. Bu etkinin doğrulanması için longitudinal prospektif çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

Nitrofurontain, Rekürren Üriner Trakt Enfeksiyonları, Postkoital profilaksi

The Effectiveness of Postcoital Antimicrobial Prophylaxis Low Dose Nitrofurantoin in Uncomplicated Recurrent Urinary Tract İnfections Among Non-Pregnant Premenopausal Women

IntroductionRecurrent urinary tract infection (RUTI) is an important public health problem in terms of disease management. Most frequently the agent is Escherichia coli. Protection methods include continous and post-coital prophylaxis, latter has similar efficiency with lesser drug dosage. In this study we aimed to investigate the efficiency of post-coital prophylaxis in prevention of RUTI. Material and MethodWe retrospectively evaluated premenopausal, non-pregnant, and sexually active adult women whom were suggested to use single dose of 50 mg of nitrofurantion per oral in terms of post-coital prophylaxis for six months along with lifestyle modifications. Data of follow up examination after six months of therapy were also included. ResultsThirty nine patients were included. One patient couldn’t complete the prophylaxis due to gastrointestinal side effects. Data of thirty eight patients were statistically evaluated. There wasn’t any recurrence of RUTI and success rate was 100%. In terms of follow up examinations, one patient had a recurrent four months after the end of prophylaxis. Overall success rate for twelve months was 97.4%. ConclusionPost-coital prophylaxis with low dose nitrofurantion was found both effective and safe for treatment of premenopausal, non-pregnant women with RUTI for both six months of treatment and six months of follow up period. This effect should be further evaluated with longitudinal prospective studies.

Keywords:

Recurrent urogenital tract infection, Nitrofurontain, Post coital prophylaxis,

PDF

___

1. Hooton TM, Besser R, Foxman B, Fritsche TR, Nicolle LE. Acute uncomplicated cystitis in an era of increasing antibiotic resistance: a proposed approach to empirical therapy. Clinical Infectious Diseases. 2004;39(1):75-80.
2. Nosseir SB, Lind LR, Winkler HA. Recurrent uncomplicated urinary tract infections in women: a review. Journal of women's health. 2012;21(3):347-54.
3. Vermeulen SH, Hanum N, Grotenhuis AJ, Castano-Vinyals G, Van Der Heijden AG, Aben KK, et al. Recurrent urinary tract infection and risk of bladder cancer in the Nijmegen bladder cancer study. British journal of cancer. 2015;112(3):594.
4. Scholes D, Hooton TM, Roberts PL, Stapleton AE, Gupta K, Stamm WE. Risk factors for recurrent urinary tract infection in young women. The Journal of infectious diseases. 2000;182(4):1177-82.
5. Aydin A, Ahmed K, Zaman I, Khan MS, Dasgupta P. Recurrent urinary tract infections in women. International urogynecology journal. 2015;26(6):795-804.
6. Al-Badr A, Al-Shaikh G. Recurrent urinary tract infections management in women: a review. Sultan Qaboos University Medical Journal. 2013;13(3):359.
7. Nicolle LE. Prophylaxis: recurrent urinary tract infection in women. Infection. 1992;20(3):S203-S5.
8. Pfau A, Sacks T. Effective postcoital prophylaxis of recurrent urinary tract infections in premenopausal women: a review. International Urogynecology Journal. 1991;2(3):156-60.
9. Dason S, Dason JT, Kapoor A. Guidelines for the diagnosis and management of recurrent urinary tract infection in women. Canadian Urological Association Journal. 2011;5(5):316.
10. Hooton TM. Recurrent urinary tract infection in women. International journal of antimicrobial agents. 2001;17(4):259-68.
11. Albert X, Huertas I, Pereiró I, Sanfelix J, Gosalbes V, Perrota C. Antibiotics for preventing recurrent urinary tract infection in non-pregnant women. The Cochrane database of systematic reviews. 2004(3):CD001209-CD.
12. Price JR, Guran LA, Gregory WT, McDonagh MS. Nitrofurantoin vs other prophylactic agents in reducing recurrent urinary tract infections in adult women: a systematic review and meta-analysis. American journal of obstetrics and gynecology. 2016;215(5):548-60.
13. Zhanel GG, Nicolle LE. Effect of subinhibitory antimicrobial concentrations (sub-MICs) on in-vitro bacterial adherence to uroepithelial cells. Journal of Antimicrobial Chemotherapy. 1992;29(6):617-27.
14. Mavromanolakis E, Maraki S, Samonis G, Tselentis Y, Cranidis A. Effect of norfloxacin, trimethoprim-sulfamethoxazole and nitrofurantoin on fecal flora of women with recurrent urinary tract infections. Journal of chemotherapy. 1997;9(3):203-7.
15. Zhanel GG, Hisanaga TL, Laing NM, DeCorby MR, Nichol KA, Weshnoweski B, et al. Antibiotic resistance in Escherichia coli outpatient urinary isolates: final results from the North American Urinary Tract Infection Collaborative Alliance (NAUTICA). International journal of antimicrobial agents. 2006;27(6):468-75.
16. Barbosa-Cesnik C, Brown MB, Buxton M, Zhang L, DeBusscher J, Foxman B. Cranberry juice fails to prevent recurrent urinary tract infection: results from a randomized placebo-controlled trial. Clinical infectious diseases. 2011;52(1):23-30.
17. Stapleton AE, Dziura J, Hooton TM, Cox ME, Yarova-Yarovaya Y, Chen S, et al., editors. Recurrent urinary tract infection and urinary Escherichia coli in women ingesting cranberry juice daily: a randomized controlled trial. Mayo Clinic Proceedings; 2012: Elsevier.
18. Huttner A, Hatz C, van den Dobbelsteen G, Abbanat D, Hornacek A, Frölich R, et al. Safety, immunogenicity, and preliminary clinical efficacy of a vaccine against extraintestinal pathogenic Escherichia coli in women with a history of recurrent urinary tract infection: a randomised, single-blind, placebo-controlled phase 1b trial. The Lancet infectious diseases. 2017;17(5):528-37.