I read with interest the article by Beerepoot et al1 on urinary tract infection (UTI) prophylaxis, which raises important points that merit comment. From a resistance perspective, the article re-emphasizes that trimethoprim-sulfamethoxazole (TMP-SMX) is a “high resistance potential” antibiotic that predisposes to resistance among uropathogens. Clinicians should be reminded that resistance is not related to antibiotic volume, duration, or class per se, but rather is associated with individual agents from all antibiotic classes.2 Nitrofurantoin does not predispose to uropathogen resistance for prophylaxis and therapy of short or long duration.3 Another point deserving re-emphasis is that antibiotics with a high resistance potential not only predispose to increased resistance during treatment but such resistant uropathogens may persist in fecal flora for up to 3 months following therapy. Clinicians should take great care in selecting an appropriate antibiotic with a low resistance potential, both to minimize the resistance potential and to prevent prolonged carriage of resistant uropathogens in the fecal flora.2
Cunha BA. Prophylaxis for Recurrent Urinary Tract Infections: Nitrofurantoin, Not Trimethoprim-Sulfamethoxazole or Cranberry Juice. Arch Intern Med. 2012;172(1):82–83. doi:10.1001/archinternmed.2011.613
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