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Clinical Notes
June 16, 1978

Trimethoprim Therapy for Urinary Tract Infection: Long-term Prophylaxis in a Uremic Patient

Author Affiliations

From the Medical Service of the William S. Middleton Veterans Administration Hospital (Drs Kunin, Craig, and Uehling). and Departments of Medicine (Drs Kunin and Craig) and Surgery (Dr Uehling), University of Wisconsin, Madison.

JAMA. 1978;239(24):2588-2590. doi:10.1001/jama.1978.03280510072024

THE COMBINATION of trimethoprim/sulfamethoxazole has been reported by several groups to be effective for prophylaxis of recurrent urinary tract infections in otherwise healthy women.1,2 Previous studies in this laboratory have shown that therapeutically adequate concentrations of trimethoprim can be achieved in the urine of patients with renal failure provided the creatinine clearance is not below 10 ml/min.3 Trimethoprim is not currently available as a single agent in this country, but can be obtained for investigative purposes.

We were asked to care for a patient with severe renal failure, due to chronic pyelonephritis and bilateral vesicoureteral reflux, who was suffering from recurrent episodes of urinary infection associated with Proteus mirabilis. The patient was allergic to sulfonamides and had adverse reactions to drugs commonly used to treat urinary tract infections; she had no known adverse reaction to trimethoprim. Trimethoprim was administered to the patient after she was informed of its