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Single-dose amikacin treatment of first childhood E coli lower urinary tract infections
sented by the study group, multiple-dose therapy with TMP-SMZ results in fewer relapses in women with uncomplicated cystitis than does single-dose therapy, that pretreatment laboratory studies are not routinely necessary before empiric therapy, and that follow-up laboratory studies can be reserved for patients with persistent or recurrent symptoms. [Editor's note: The authors imply an interesting idea: because symptoms of a UTI and vaginitis often overlap, microscopic examination of vaginal fluid may be more appropriate for women with symptoms o f dysuria, urgency, and frequency than is the standard urinalysis.] Martin E Ogle, MD
tests. Of the asymptomatic patients, genitourinary disease was diagnosed in 11% using Level I tests and in 3 2 % using Level I and II tests. The authors conclude that: 1) clinical strategies commonly used in family practice settings can diagnose only one-third of women with GU symptoms; 2) the addition of selected, special laboratory studies could double this diagnostic yield; 3) formal evaluation of the cost effectiveness of selective use of tests now available only in a research setting is needed; and 4) further research is needed to determine the etiology of GU disease in the third of symptomatic patients who cannot be diagnosed using currently available techniques. Richard Grazer, MD
GENITOURINARY INFECTIONS AMIKACIN; URINARY TRACT INFECTIONS
Establishing t h e c a u s e of g e n i t o u r i n a r y s y m p t o m s in w o m e n in a f a m i l y p r a c t i c e : C o m p a r i s o n of clinical e x a m i n a t i o n s and comprehensive microbiology
Single-dose amikacin t r e a t m e n t of first childhood E coil lower urinary tract infections
Berg AO, Heidrich FE, Fihn SD, et al
Wallen L, Zeller WP, Goessler M
JAMA 251:620-625
J Pediatrics 103:316-319
Feb 3, 1984
Aug 1983
Two hundred four female patients were studied prospectively to establish the prevalence of GU tract infections and the diagnostic yield of two levels of laboratory tests in establishing the etiology of GU disease. Eligible patients were non-pregnant women over the age of 18 years, seen either for GU tract symptoms or for routine pelvic examination. The common presenting symptoms were grouped into three categories: 1) urinary, including internal dysuria, urgency, frequency, hematuria, incontinence, and nocturia; 2) vaginal, including odor, discharge, irritation, dyspareunia, and external dysuria; and 3) other, including flank pain, fever, bleeding, warts, and exposure to sexually transmitted disease. All patients underwent a histol~, physical examination, and two levels of lab tests. Level I tests, those considered to be available as standards, were UA with C & S, vaginal pH, saline and KOH smear of vaginal discharge, and gonorrhea C & S. Level II tests, considered to be available only in a research setting, included cultures for Chlamydia, Gardnerella vaginalis, Trichomonas, Candida, Lactobacillus, quantitative leukocyte count of urine, gas liquid chromatography of vaginal secretions, and antibody coating of bacteria. Of the 204 p a t i e n t s , 167 had G U symptomatology and 37 were asymptomatic. Of the symptomatic patients, a diagnosis was established in only 34% using Level I tests and in only 66% using Level I and II
Single-dose amikacin therapy was evaluated for use in urinary tract infections (UTI) in girls. Prior studies have shown one-dose aminoglycoside therapy to be effective in adult women. Fifty-four girls between the ages of 1 and 12 years with culture-documented E coli UTIs were randomized into two groups. Excluded were those with previous UTI, antibiotic use within one week, prior enrollment, or clinical s y m p t o m s of pyelonephritis. Patients received either sulfisoxazole orally for l0 days or 7.5 mg/kg amikacin in one intramuscular injection. Amikacin was chosen because of its high urinary concentration, lack of toxicity in low dose regimens, and the low frequency of amikacin-resistant enteric bacteria. Serial urine cultures were obtained for at least 40 days in 44 patients. Six of 23 patients (26%) in the amikacin group and 4 of 21 patients in the sulfisoxazole group had at least one positive repeat urine culture during the 40-day follow-up. This difference was not statistically significant (P > .5); No toxicity or sideeffects were noted in either group. The authors suggest that single-dose amikacin is as effective as the traditional 10-day sulfisoxazole regimen in treating lower E coli UTIs in girls. Single-dose therapy is attractive because of assurance of patient compliance, fewer side effects, and reduced likelihood of selecting resistant organisms. Judith Brillman, MD
13:8 August1984
Annals of EmergencyMedicine
640/111
tests. Of the asymptomatic patients, genitourinary disease was diagnosed in 11% using Level I tests and in 3 2 % using Level I and II tests. The authors conclude that: 1) clinical strategies commonly used in family practice settings can diagnose only one-third of women with GU symptoms; 2) the addition of selected, special laboratory studies could double this diagnostic yield; 3) formal evaluation of the cost effectiveness of selective use of tests now available only in a research setting is needed; and 4) further research is needed to determine the etiology of GU disease in the third of symptomatic patients who cannot be diagnosed using currently available techniques. Richard Grazer, MD
GENITOURINARY INFECTIONS AMIKACIN; URINARY TRACT INFECTIONS
Establishing t h e c a u s e of g e n i t o u r i n a r y s y m p t o m s in w o m e n in a f a m i l y p r a c t i c e : C o m p a r i s o n of clinical e x a m i n a t i o n s and comprehensive microbiology
Single-dose amikacin t r e a t m e n t of first childhood E coil lower urinary tract infections
Berg AO, Heidrich FE, Fihn SD, et al
Wallen L, Zeller WP, Goessler M
JAMA 251:620-625
J Pediatrics 103:316-319
Feb 3, 1984
Aug 1983
Two hundred four female patients were studied prospectively to establish the prevalence of GU tract infections and the diagnostic yield of two levels of laboratory tests in establishing the etiology of GU disease. Eligible patients were non-pregnant women over the age of 18 years, seen either for GU tract symptoms or for routine pelvic examination. The common presenting symptoms were grouped into three categories: 1) urinary, including internal dysuria, urgency, frequency, hematuria, incontinence, and nocturia; 2) vaginal, including odor, discharge, irritation, dyspareunia, and external dysuria; and 3) other, including flank pain, fever, bleeding, warts, and exposure to sexually transmitted disease. All patients underwent a histol~, physical examination, and two levels of lab tests. Level I tests, those considered to be available as standards, were UA with C & S, vaginal pH, saline and KOH smear of vaginal discharge, and gonorrhea C & S. Level II tests, considered to be available only in a research setting, included cultures for Chlamydia, Gardnerella vaginalis, Trichomonas, Candida, Lactobacillus, quantitative leukocyte count of urine, gas liquid chromatography of vaginal secretions, and antibody coating of bacteria. Of the 204 p a t i e n t s , 167 had G U symptomatology and 37 were asymptomatic. Of the symptomatic patients, a diagnosis was established in only 34% using Level I tests and in only 66% using Level I and II
Single-dose amikacin therapy was evaluated for use in urinary tract infections (UTI) in girls. Prior studies have shown one-dose aminoglycoside therapy to be effective in adult women. Fifty-four girls between the ages of 1 and 12 years with culture-documented E coli UTIs were randomized into two groups. Excluded were those with previous UTI, antibiotic use within one week, prior enrollment, or clinical s y m p t o m s of pyelonephritis. Patients received either sulfisoxazole orally for l0 days or 7.5 mg/kg amikacin in one intramuscular injection. Amikacin was chosen because of its high urinary concentration, lack of toxicity in low dose regimens, and the low frequency of amikacin-resistant enteric bacteria. Serial urine cultures were obtained for at least 40 days in 44 patients. Six of 23 patients (26%) in the amikacin group and 4 of 21 patients in the sulfisoxazole group had at least one positive repeat urine culture during the 40-day follow-up. This difference was not statistically significant (P > .5); No toxicity or sideeffects were noted in either group. The authors suggest that single-dose amikacin is as effective as the traditional 10-day sulfisoxazole regimen in treating lower E coli UTIs in girls. Single-dose therapy is attractive because of assurance of patient compliance, fewer side effects, and reduced likelihood of selecting resistant organisms. Judith Brillman, MD
13:8 August1984
Annals of EmergencyMedicine
640/111