Single Dose Of Amoxicillin Research Articles

Single-Dose Therapy for Cystitis in Women-Reply

In Reply.— We appreciate Dr Bailey's comments and agree that trimethoprim-sulfamethoxazole appears to be a more effective single-dose agent for treating acute bacterial cystitis than are penicillins and cephalosporins. A recent review of published studies found single-dose amoxicillin to be less effective (mean efficacy, 72%) than single-dose trimethoprim-sulfamethoxazole (mean efficacy, 90%). 1 However, the best single-dose treatment regimen(s) can be ascertained only through randomized comparative trials. The explanation for the apparent difference in efficacy of single-dose trimethoprim-sulfamethoxazole and amoxicillin is unclear. The prevalence of amoxicillin-resistant Escherichia coli strains exceeds that of trimethoprim-sulfamethoxazole-resistant strains in Seattle, and thus offers a partial explanation. However, many reported failures involve E coli susceptible to both drugs. It is likely, although unproved, that the lesser efficacy of the penicillins and cephalosporins relates to their more rapid elimination from the body. This interesting question deserves further investigation. Regarding the antibody-coated bacteria test, published data demonstrate a

Single-dose treatment of uncomplicated urinary tract infections in children

Thirty-six girls, aged two to 17 years, with culture-proven, acute, uncomplicated lower urinary tract infections and without signs or symptoms of upper urinary tract infection, were randomized to receive either single-dose amoxicillin or conventional therapy for ten days. Twenty-six patients completed the study, ten in the single-dose group and 16 in the conventional therapy group. The patients treated with single-dose therapy had cure rates (70% vs 75%), relapse rates (30% vs 25%), and reinfection rates (0% vs 12%) comparable to those of conventionally treated patients. A significant difference in the induction of resistant organisms was seen between treatment groups (P less than .05). All single-dose relapses were due to failure to clear a sensitive organism from the urinary tract. All relapses on conventional therapy resulted from an initially sensitive organism becoming resistant to amoxicillin during treatment. Single-dose antibiotic therapy of uncomplicated urinary tract infections in children is effective in patients with culture-proven infections selected by clinical criteria, and appears to be safe when combined with conscientious long-term follow up and radiographic evaluation. Single-dose therapy offers the advantage of selecting significantly fewer resistant organisms from the gut flora than do conventional antibiotic regimens.

Single-dose amoxicillin therapy of acute uncomplicated urinary tract infections in women.

Of 210 women who were experiencing dysuria, frequent urination, pyuria, and significant bacteriuria and who were treated with a single 3-g dose of amoxicillin, 165 (79%) were cured of their original infections. Patients with infections that were negative by antibody-coated-bacteria assay were cured at a significantly higher rate than those with infections that were positive by antibody-coated-bacteria assay (90 versus 59%; P less than 0.001). Similarly, those with infections caused by amoxicillin-susceptible organisms were cured at a significantly higher rate than those with infections caused by resistant organisms (85 versus 50%; P less than 0.001). Of 27 patients who had infections caused by amoxicillin-susceptible organisms and who had relapses after single-dose therapy, 14 (52%) had relapses again after a conventional 10-day course of therapy, although all responded to a 6-week course. An additional 27 patients experiencing dysuria, frequent urination, and pyuria but who had a lower number of uropathogens in the urine (10(2) to 10(4.5)/ml of urine) were treated with single-dose therapy, with a 100% eradication of organisms and an 89% rate of symptomatic relief.

Single-dose amoxicillin therapy with follow-up urine culture: Effective initial management for acute uncomplicated urinary tract infections: Savard-Fenton M, Fenton BW, Reller LB, et al Am J Med 73:808–813 Dec 1982

Single-dose amoxicillin therapy with follow-up urine culture: Effective initial management for acute uncomplicated urinary tract infections: Savard-Fenton M, Fenton BW, Reller LB, et al Am J Med 73:808–813 Dec 1982

Single-dose Amoxicillin Therapy of Urinary Tract Infection among an Unselected Population of Women

Single-dose Amoxicillin Therapy of Urinary Tract Infection among an Unselected Population of Women

Single-Dose Amoxicillin Therapy of Uncomplicated Pediatric Urinary Tract Infections

Single-Dose Amoxicillin Therapy of Uncomplicated Pediatric Urinary Tract Infections

Single-dose amoxicillin therapy of uncomplicated pediatric urinary tract infections

Forty-nine ambulatory children between 2-1/2 and 12 years of age with acute, clinically uncomplicated urinary tract infections caused by susceptible organisms were randomized to receive a single dose of amoxicillin based on weight or a 10-day course of amoxicillin therapy (conventional therapy). Patients receiving single doses of amoxicillin had a cure rate of 63%, which compares unfavorably with the cure rate of 92% in patients given conventional therapy. A failure of single-dose therapy predicted underlying radiologic abnormalities with a sensitivity of 60% and a specificity of 58%, making it a poor screening test for detecting those patients at risk for renal parenchymal damage. The antibody-coated bacteria assay had no predictive value in separating upper and lower tract disease, although it may predict underlying radiologic abnormalities. The data indicate that the response to single-dose amoxicillin therapy fails to separate upper from lower tract disease reliably and has a limited role in predicting response to conventional antimicrobial therapy.

Successful single-dose amoxicillin prophylaxis against experimental streptococcal endocarditis: evidence for two mechanisms of protection.

Amoxicillin prophylaxis against experimental endocarditis due to one nontolerant and two tolerant strains of streptococci was studied in rats. Single-dose amoxicillin protected against the two tolerant strains in animals challenged with the 90% infective dose (ID90), but protection diminished with increasing inoculum sizes. Protection against the nontolerant strain was successful with inocula that were 100- and 1,000-fold larger than the ID90. Close correlation existed between the speed of bacterial killing in vitro, the time of exposure to bactericidal levels in vivo, and the range of inocula against which prophylaxis was effective. Amoxicillin seemed to protect by at least two mechanisms. (1) When in vitro tests indicated adequate bacterial killing, protection was independent of the inoculum size and was probably conferred by bacterial killing. (2) When in vitro tests indicated bacterial inhibition but not killing, protection was inoculum-dependent and was probably mediated by inhibition of bacterial adherence.

Single-dose amoxicillin therapy with follow-up urine culture: Effective initial management for acute uncomplicated urinary tract infections

To learn whether a single dose of amoxicillin is safe, effective therapy for acute uncomplicated urinary tract infections, 388 symptomatic nonpregnant women were randomly grouped to receive oral amoxicillin, either as a single 3 g dose or 250 mg three times a day for two weeks. Patients had quantitative as well as dip-slide cultures of urine and tests for antibody-coated bacteria in urine. Follow-up urine cultures were obtained one week after completion of treatment. Results of antimicrobial susceptibility and antibody-coated bacterial tests did not alter the randomized therapy. Among 162 patients with bacteriologically confirmed infections, cure rates were 60.6 percent (43 of 71) for single-dose versus 73.6 percent (67 of 91) for two-week treatment (p = 0.07). Although more antibody-coated bacteria-negative patients (89.6 percent; 26 of 29) were cured overall, a substantial proportion of antibody-coated bacteria-positive patients were also cured by both single-dose (59.3 percent; 32 of 54) and 14-day therapy (64.6 percent; 42 of 65). There were fewer adverse effects in the single-dose treatment group. We conclude that a single 3 g dose of amoxicillin, with follow-up urine culture, provides safe and effective management for acute uncomplicated urinary tract infections in nonpregnant women.

Single-dose amoxicillin therapy with follow-up urine culture. Effective initial management for acute uncomplicated urinary tract infections: Savard-Fenton M, Fenton BW, Reller LB, Lauer BA, Byyny RL: Am J Med 1982; 73: 808–813

Single-dose amoxicillin therapy with follow-up urine culture. Effective initial management for acute uncomplicated urinary tract infections: Savard-Fenton M, Fenton BW, Reller LB, Lauer BA, Byyny RL: Am J Med 1982; 73: 808–813

Three-Day Antimicrobial Therapy of Urinary Tract Infection

l. Bailey RR, and Abbott GD: Treatment of urinary-tract infection with a single dose of amoxycillin, Nephron 18:316, 1977. 2. Ronald AR, Boutros P, and Mourtada H: Bacteriuria localization and response to single-dose therapy in women, JAMA 235:1854, 1976. 3. Rubin RH, Fang LST, Jones SR, etal: Single-dose amoxicillin therapy for urinary tract infection, JAMA 244:561, 1980. 4. Anderson JD, Aird MY, Johnson AM, etal: The use of a single 1 g dose of amoxicillin for the treatment of acute urinary tract infections, J Antimicrob Chemother 5:481, 1979. 5. Stamey TA, Fair WR, Timothy MM, Millar MA, Mihara G, and Lowery YC: Serum versus urinary antimicrobial concentrations in cure of urinary-tract infections, N Engl J Med 291:1159, 1974. 6. Kallenius G, and Winberg J: Urinary tract infections treated with single dose of short-acting sulphonamide, Br Med J 1:1175, 1979. 7. McCracken GH Jr, Ginsburg CM, Namasonthi V, and Petruska M: Evaluation of short-term antibiotic therapy in children with uncomplicated urinary tract infections, Pedi. atrics 67:796, I981. 8. Ingelfinger JR, Avner ED, Tolkoff-Rubin NE, et al: Single dose amoxicillin treatment of uncomplicated urinary tract infections as effective as conventional therapy, Pediatr Res 15:694, 1981 (abstr). 9. Ellner PD, and Papachristos T: Detection of bacteriuria by dip-slide: Routine use in a large general hospital, Am J Clin Pathol 63:516, 1975. 10. Bauer AW, Kirby WMM, Sherris JC, e t a l : Antibiotic susceptibility testing by a standardized disk method, Am J Clin Pathol 45:493, 1966. 11. Siegel S: Nonparametric statistics for the behavioral sciences, New York, 1956, McGraw-Hill Book Company, lnc., p. 96. 12. Kunin CM: Detection, prevention and management of urinary tract infections, Philadelphia, 1972, Lea & Febiger, Publishers. 13. Helm EB, Shah PM, and Stille W: Kinetics of bacterial elimination in urine during antimicrobial treatment, J Antimicrob Chemother (Suppl) 5:191, 1979.

Single-dose amoxicillin treatment of urinary tract infections

Single-dose amoxicillin treatment of urinary tract infections

Three-day antimicrobial therapy of urinary tract infection

l. Bailey RR, and Abbott GD: Treatment of urinary-tract infection with a single dose of amoxycillin, Nephron 18:316, 1977. 2. Ronald AR, Boutros P, and Mourtada H: Bacteriuria localization and response to single-dose therapy in women, JAMA 235:1854, 1976. 3. Rubin RH, Fang LST, Jones SR, etal: Single-dose amoxicillin therapy for urinary tract infection, JAMA 244:561, 1980. 4. Anderson JD, Aird MY, Johnson AM, etal: The use of a single 1 g dose of amoxicillin for the treatment of acute urinary tract infections, J Antimicrob Chemother 5:481, 1979. 5. Stamey TA, Fair WR, Timothy MM, Millar MA, Mihara G, and Lowery YC: Serum versus urinary antimicrobial concentrations in cure of urinary-tract infections, N Engl J Med 291:1159, 1974. 6. Kallenius G, and Winberg J: Urinary tract infections treated with single dose of short-acting sulphonamide, Br Med J 1:1175, 1979. 7. McCracken GH Jr, Ginsburg CM, Namasonthi V, and Petruska M: Evaluation of short-term antibiotic therapy in children with uncomplicated urinary tract infections, Pedi. atrics 67:796, I981. 8. Ingelfinger JR, Avner ED, Tolkoff-Rubin NE, et al: Single dose amoxicillin treatment of uncomplicated urinary tract infections as effective as conventional therapy, Pediatr Res 15:694, 1981 (abstr). 9. Ellner PD, and Papachristos T: Detection of bacteriuria by dip-slide: Routine use in a large general hospital, Am J Clin Pathol 63:516, 1975. 10. Bauer AW, Kirby WMM, Sherris JC, e t a l : Antibiotic susceptibility testing by a standardized disk method, Am J Clin Pathol 45:493, 1966. 11. Siegel S: Nonparametric statistics for the behavioral sciences, New York, 1956, McGraw-Hill Book Company, lnc., p. 96. 12. Kunin CM: Detection, prevention and management of urinary tract infections, Philadelphia, 1972, Lea & Febiger, Publishers. 13. Helm EB, Shah PM, and Stille W: Kinetics of bacterial elimination in urine during antimicrobial treatment, J Antimicrob Chemother (Suppl) 5:191, 1979.

Single-Dose Amoxicillin Therapy for Urinary Tract Infection

To the Editor.— Regarding the recent article by Rubin and associates (1980;244:561), Single-Dose Amoxicillin Therapy for Urinary Tract Infection: Multicenter Trial Using Antibody-Coated Bacteria Localization Technique, I agree fully with these authors on the effectiveness of single-dose therapy for uncomplicated urinary tract infection (UTI). I wonder, however, if the article does not overemphasize the positive fluorescent antibody (FAB) test results. First, the chance of a false-positive test with a lower UTI may be frequent. 1 Second, in my experience, even in patients with asymptomatic bacteriuria, the test result may change from positive to negative over a couple of weeks and back again, even though the same organism is grown in the urine. I would agree with Whitworth and Fairley 2 that recurrent urinary-tract infection may not always involve the same site even in a single episode of infection, and we consider the clinical value of such tests in an

Single-Dose Amoxicillin Therapy for Urinary Tract Infection

Urine specimens from 134 women with acute, uncomplicated urinary tract infection at three medical centers were examined by the antibody-coated bacteria (ACB) assay. Patients with negative assays (suggesting bladder infection alone) were randomized to receive either a single 3-g oral dose of amoxicillin trihydrate or conventional ten-day courses of sulfa-methoxazole-trimethoprim or oral ampicillin sodium. Comparable results were obtained with the three regimens for ACG-negative infection: 90% eradication of the original organism with single-dose amoxicillin, 100% with sulfamethoxazole-trimethoprim, and 96% with ampicillin. The overall incidence of ACB positivity was 32.1%, ranging from 8% to 63% at the three institutions. This difference seemed to be related to the ease of access to medical care: women with easy access having low rates of ACB positivity and those with poor access having high rates.

Single-dose amoxicillin therapy for urinary tract infection. Multicenter trial using antibody-coated bacteria localization technique

Single-dose amoxicillin therapy for urinary tract infection. Multicenter trial using antibody-coated bacteria localization technique

Therapy of uncomplicated gonococcal urethritis in the male with a single dose of amoxicillin.

Therapy of uncomplicated gonococcal urethritis in the male with a single dose of amoxicillin.