Objectives
To review the impact of antibiotic allergy and resistance in older women with recurrent
urinary tract infections (RUTIs) as determinants for a suitable oral antibiotic treatment
choice.
Methods
A prospectively maintained database of women 65 years old and older with documented
RUTIs (≥3 UTI/y) and trigonitis on cystoscopy was reviewed. Demographic data, known
drug allergies, renal function, antibiotic susceptibility of most recent urine culture,
allergy, or resistance to trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolones,
and nitrofurantoin were obtained.
Results
From 2006 to 2014, 86 women with RUTIs met study criteria. Mean age was 77.9 ± 7.8,
with 94% being Caucasian. An estimated glomerular filtration rate >30 mL/min was noted
in 94%. The percentage of women allergic, resistant, or both allergic and resistant
to TMP-SMX was 33%, 29%, and 15%, to fluoroquinolones was 14%, 34%, and 8.1%, or nitrofurantoin
was 16%, 14%, and 5%, respectively. Twenty-eight percent (24 of 86) of women who were
allergic and/or resistant to TMP-SMX and fluoroquinolones were sensitive to nitrofurantoin.
Twenty percent (17 of 86) were allergic and/or resistant to all 3 antibiotics. Women
who were allergic or resistant to TMP-SMX had a significantly higher number of other
antibiotic resistances compared with women sensitive to TMP-SMX (4.9 ± 3.6 vs 2.1 ± 2.3;
P < .0001). Similarly, women with fluoroquinolone allergy or resistance had significantly
more antibiotic resistances than those who were fluoroquinolone sensitive (5.8 ± 3.5
vs 2.3 ± 2.5; P < .0001).
Conclusion
Because of allergy and/or antibiotic resistance, several first-line antibiotics are
not available for many older women with RUTIs. In nearly a third of women, nitrofurantoin
was the only viable alternative.
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Article info
Publication history
Published online: November 28, 2017
Accepted:
August 30,
2017
Received:
June 2,
2017
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
