Emerging clinical role of pivmecillinam in the treatment of urinary tract infections caused by Extended Spectrum ßeta-lactamase (ESBL) producing Enterobacteriaceae.

BACKGROUND: Extended Spectrum ßeta-lactamase (ESBL)-producing Enterobacteriaceae causing urinary tract infections (UTIs) appear resistant to many common oral agents. There is a growing need to discover new antibiotics to combat with emerging antibiotic resistance problem. Until the discovery of new antimicrobials, we can bring back forgotten antibiotics to our clinical formulary. Pivmecillinam (prodrug of mecillinam), an oral antimicrobial agent is effective against ESBL producing organisms. We analysed the sensitivity rates of ESBL-producing Enterobacteriaceae from urine samples to mecillinam and to document if pivmecillinam is a suitable alternative option in the treatment of UTI. MATERIALS/METHODS: This retrospective study was conducted from September 2015 to September 2017. Data were collected from the pathology information system. Antimicrobial sensitivity testing on ESBL-producing Enterobacteriaceae isolates was carried out by disc diffusion method in accordance with The European Committee on Antimicrobial Susceptibility Testing. RESULTS: A total of 986 ESBL-producing Enterobacteriaceae were tested for mecillinam during the study period. Of 986 organisms, Escherichia coli was the most common organism (889); followed by Klebsiella species (71) and others Enterobacteriaceae (26). Mecillinam sensitivity was found in 96% Escherichia coli (855/889 isolates), 83% Klebsiella species (59/71 isolates) and 88% other Enterobacteriaceae (23/26 isolates). Overall 95% (935/986 isolates) of ESBL-producing urinary isolates were sensitive to mecillinam. CONCLUSIONS: Pivmecillinam appears to be suitable option to treat ESBL-producing Enterobacteriaceae causing uncomplicated UTI. Our results showed low resistance rate to mecillinam. We recommend the use of pivmecillinam in uncomplicated UTIs because of ESBL-producing Enterobacteriaceae. More studies on in vitro activity of mecillinam against ESBL producing organism and its use and clinical outcome should be tried in future.

Ibuprofen lacks direct antimicrobial properties for the treatment of urinary tract infection isolates.

The high incidence of urinary tract infection (UTI) among women and children, in combination with a lack of antibiotic efficacy with regard to pathogen eradication and recurrence prevention, as well as the negative side effects associated with antibiotics, has led researchers to explore the role of non-steroidal anti-inflammatory drugs as a primary management strategy. The aim of this study was to determine whether ibuprofen (IBU) or one of its major metabolites, 2-carboxyibuprofen (CIBU), could affect the growth and adhesion of the two most common uropathogens, Escherichia coli and Enterococcus faecalis. The bacterial growth and adhesion to the urothelial cells of E. coli UTI89 and E. faecalis 1131 in the presence of physiologically relevant concentrations of IBU and CIBU were assessed. The effect of IBU on bacterial adhesion to urothelial cells was also assessed following exposure to trimethoprim/sulfamethoxazole (TMP/SMX) and nitrofurantoin. Bacterial growth was not affected by IBU. Further, only at high levels of IBU not regularly found in the bladder was there a significant increase in E. faecalis 1131 attachment at growth inhibitory concentrations of TMP/SMX. There was no effect on the attachment of E. faecalis or E. coli to urothelial cells in the presence of nitrofurantoin. These studies indicate that the beneficial effects of IBU for UTI management are likely mediated through its anti-inflammatory properties rather than direct interactions with uropathogens in the bladder.

Trimethoprim susceptibility in E. coli community-acquired urinary tract infections in France.

OBJECTIVES: Trimethoprim has been recently included in the French guidelines for the treatment of urinary tract infections, but no epidemiological data supports its use. We aimed to determine the trimethoprim susceptibility of Escherichia coli isolates responsible for community-acquired urinary tract infections in women of childbearing age. MATERIALS AND METHODS: We conducted a national prospective survey. A total of 350 strains of E. coli isolated from urines in 35 laboratories were included. Antibiotic susceptibility testing was performed in each laboratory. RESULTS: We reported a susceptibility rate of 78%, and a similar clinical categorization between trimethoprim and cotrimoxazole for 97.4% of isolates. We pointed out an association between resistance to trimethoprim and other antibiotic classes. CONCLUSION: The results support trimethoprim as a second-line therapy based on antibiotic susceptibility testing results. We confirm that trimethoprim and cotrimoxazole susceptibility rates are very close.

Role of old antimicrobial agents in the management of urinary tract infection.

INTRODUCTION: Urinary tract infection (UTI) is a common infection worldwide. The increase in multidrug resistance together with the paucity of new antibiotics highlights the need for alternative antimicrobials for management of UTI. Among which are older antimicrobials that had been used in the past and now were stopped. AREAS COVERED: In this article, we examine the evidence in literature for the value of use of various antimicrobial agents in UTI. We conducted systematic Pubmed search and journal literature review including early research work on older agents addressed in relation to recent clinical data. Antimicrobials reviewed include temocillin, fosfomycin, mecillinam, methenamine and cycloserine. We review mechanisms of action, spectrum of activity, effect on multidrug resistance, cure rates and patient tolerance. Expert commentary: Rational use of current agents and rehabilitation of older drugs will both be needed, combined with antibiotic stewardship, in order to contain the march of antibiotic resistance.

Antiadhesion therapy for urinary tract infections--a balanced PK/PD profile proved to be key for success.

The initial step for the successful establishment of urinary tract infections (UTIs), predominantly caused by uropathogenic Escherichia coli, is the adhesion of bacteria to urothelial cells. This attachment is mediated by FimH, a mannose-binding adhesin, which is expressed on the bacterial surface. To date, UTIs are mainly treated with antibiotics, leading to the ubiquitous problem of increasing resistance against most of the currently available antimicrobials. Therefore, new treatment strategies are urgently needed, avoiding selection pressure and thereby implying a reduced risk of resistance. Here, we present a new class of highly active antimicrobials, targeting the virulence factor FimH. When the most potent representative, an indolinylphenyl mannoside, was administered in a mouse model at the low dosage of 1 mg/kg (corresponding to approximately 25 µg/mouse), the minimal therapeutic concentration to prevent UTI was maintained for more than 8 h. In a treatment study, the colony-forming units in the bladder could be reduced by almost 4 orders of magnitude, comparable to the standard antibiotic treatment with ciprofloxacin (8 mg/kg, sc).

Arándano americano (Vaccinium macrocarpon): conclusiones de la investigación y de la evidencia clínica / Cranberry (Vaccinium macrocarpon): research findings and clinical evidence

Esta revisión explora la posible relación entre metabolitos del arándano americano o cranberry (fruto de Vaccinium macrocarpon) y un efecto beneficioso sobre la salud humana. Estudios in vitro sobre E. coli han demostrado que el arándano americano posee efecto de antiadhesión bacteriana por su contenido en proantocianidinas (PAC) tipo A, de forma dosis-dependiente. Numerosos estudios en distintas poblaciones han demostrado su efecto preventivo en el desarrollo de infecciones urinarias. Su aparente falta de riesgo durante la gestación, su buena tolerancia y la ausencia de interacciones significativas con fármacos está permitiendo su uso generalizado. Existen estudios experimentales y preclínicos que sugieren posibles beneficios del arándano americano en el terreno antitumoral y antioxidativo. Ensayos clínicos lo vinculan a la prevención de la enfermedad gástrica por H. pylori y de la enfermedad periodontal. Para estas aplicaciones, sin embargo, se deberían desarrollar nuevos estudios que expliquen el mecanismo de acción y confirmen las expectativas clínicas (AU)

This review explores possible relationship between metabolites of cranberry (fruit of Vaccinium macrocarpon) and its beneficial effect on human health. In vitro studies in E. coli have shown that Cranberry has anti bacterial adhesion effect due to its content of proanthocyanidin (PAC) type A, in a dose-dependent way. Many studies have shown its preventive effect in the development of urinary infections in different populations. Its apparent lack of risk during gestation, good tolerability and absence of significative interactions with drugs are allowing their widespread use. Preclinic studies suggest possible benefits of cranberry in antitumoral and antioxidative fields. Clinical assays link cranberry with the prevention of both gastric disease caused by H. pylori and periodontal disease. However, for these applications, additional studies are needed to explain the mechanisms and to confirm clinical expectatives (AU)

Esta revisão aborda possíveis relações entre metabolitos do arando americano (fruto do Vaccinium macrocarpon) e um efeito benéfico sobre a saúde humana. Estudos in vitro em E. coli mostraram que o arando americano tem efeito de anti-adesão bacteriana pelo seu conteúdo em proantocianidinas (PAC) do tipo A, de forma dosedependente. Vários estudos em diferentes populações têm demonstrado o seu efeito preventivo sobre o desenvolvimento de infecções do tracto urinário. A sua aparente falta de risco durante a gravidez, boa tolerância e ausência de interacções significativas com fármacos tem permitido o seu uso generalizado. Existem estudos experimentais e pré-clínicos que sugerem possíveis benefícios do arando americano como anti-tumural e antioxidante. Ensaios clínicos associam-no à prevenção da doença gástrica por H. pylori e doença periodontal. Para estas aplicações, no entanto, mais estudos devem ser desenvolvidos para explicar o mecanismo de acção e confirmar as expectativas clínicas (AU)

The pharmacological activities of Compound Salvia Plebeia Granules on treating urinary tract infection.

AIM OF THE STUDY: Compound Salvia Plebeia Granules (CSPG) had been used for treating urinary tract infection (UTI) for more than 20 years in Drum Tower hospital, but there were lack of sufficient pharmacology studies. The aim of this study was to testify the effects of CSPG on UTI, namely to prove its diuretic, antiblastic, antipyretic and antidynous activities. MATERIALS AND METHODS: This study evaluated the diuretic effect of CSPG on water load Sprague-Dawley (SD) male rats by the method of metabolic cage, and then analysed the contents of Na(+), K(+), and Cl(-) in urine. The antiblastic activity of CSPG was testified by various kinds of strains in vitro. The antipyretic effect was evaluated by carrageenan-induced fever model in mice. Antidynous activity was demonstrated by the method of acetic acid-induced writhing. RESULTS: Intragastric (i.g.) administration of CSPG (20-40 g/kg) (equivalent to crude herb) produced a dose-related diuretic effect on water load mice and promoted excreting of Na(+), K(+), and Cl(-) in urine. In addition, the minimal inhibitory concentrations (MICs) of CSPG on Escherichia coli and Staphylococcus aureus were separately 0.25 g/ml and 0.5 g/ml. Moreover, i.g. the doses of CSPG ranging from 25.2 to 50.4 g/kg showed significantly antipyretic effect on carrageenan-induced fever in mice. CSPG (12.6-50.4 g/kg) can also produce dose-related antidynous effects on acetic acid-induced writhing in mice. CONCLUSIONS: The results described the integrity report of pharmacological studies of CSPG and indicated that it had significantly diuretic, antiblastic, antipyretic, anti-inflammatory and antidynous activities which support its folk medicine use on UTI.

Antibacterial activities of Emblica officinalis and Coriandrum sativum against Gram negative urinary pathogens.

Present investigation is focused on antibacterial potential of aqueous infusions and aqueous decoctions of Emblica officinalis (amla) and Coriandrum sativum (coriander) against 345 bacterial isolates belonging to 6 different genera of Gram negative bacterial population isolated from urine specimens by employing well diffusion technique. Aqueous infusion and decoction of Emblica officinalis exhibited potent antibacterial activity against Escherichia coli (270), Klebsiella pneumoniae (51), K. ozaenae (3), Proteus mirabilis (5), Pseudomonas aeruginosa (10), Salmonella typhi (1), S. paratyphi A (2), S. paratyphi B (1) and Serratia marcescens (2) but did not show any antibacterial activity against Gram negative urinary pathogens.

The effects of methylene blue on renal scarring due to pyelonephritis in rats.

The aim of this study was to evaluate the efficiency of methylene blue (MB) in preventing renal scar formation after the induction of pyelonephritis (PNP) in a rat model with delayed antimicrobial therapy. An inoculum of the K-12 strain of Escherichia coli was injected into both kidneys. Control groups received isotonic saline instead of bacterial solution. Four equal groups were then formed: the PNP group was untreated and the PNP ciprofloxacin (CIP) treated group was treated only with CIP intraperitoneally (i.p.) starting on the third day following bacterial inoculation. In the PNP (MB)-treated group, MB was given i.p., and in the PNP MB + CIP-treated group, MB + CIP were administered i.p.. In the sixth week following bacterial inoculation, all rats were sacrificed, and both kidneys of the rats in all groups were examined biochemically and histopathologically for renal scarring. Renal scar was significant in the groups treated with MB alone or MB + CIP combination compared with untreated or antibiotic only groups. Delayed treatment with antibiotics had no effect on scarring. These results suggest that the addition of MB to the delayed antibiotic therapy might be beneficial in preventing PNP-induced oxidative renal tissue damage.

The sensitivities to first-line antibiotic therapy of the common urinary tract bacterial infections detected in urine samples at a hospital in metropolitan Kampala (Uganda).

BACKGROUND: Urinary tract infections (UTIs) are among the most common human infections. Many urinary tract bacteria are capable of expressing drug resistance. Resistant bacteria may be present from the commencement of the infection or may develop during treatment. This study focused on the problem of antibiotic resistance to the first-line drugs that were used to treat patients presenting with urinary tract infections at Rubaga hospital in Kampala, Uganda. OBJECTIVES: The objective of this study was to isolate and identify the major bacterial pathogens of symptomatic and asymptomatic UTIs among patients at Rubaga hospital. Furthermore, the study sought to determine the antimicrobial susceptibility patterns of the major bacterial isolates to the first-line drugs used to treat UTIs at Rubaga hospital. METHODS: Urine samples were aseptically collected and examined microscopically and were microbiologically cultured on blood agar, nutrient agar and on MacConkey agar. The isolates obtained were then identified using standard tests and tested for antimicrobial sensitivity by the Kirby-Bauer technique. RESULTS: The isolated pathogens included Escherichia coli (10.9%), Staphylococcus (31.9%), Streptococcus (9.2%), Klebsiella species (21.0%) and Proteus species (10.1%). 20 (16.8%) of the isolates were lactose fermenting gram-negative rods that were also indole-negative. These isolates were termed 'unclassified coliforms' in this study but were probably Enterobacter species. On antimicrobial susceptibility testing, all the gram-negative isolates were significantly resistant to amoxycillin, cotrimoxazole, erythromycin, and to nalidixic acid; but were susceptible to nitrofurantoin. Among the gram-negative isolates, only Klebsiella species were significantly resistant (p<0.05) to ciprofloxacin. The gram-positive cocci were susceptible to amoxycillin, ciprofloxacin, and to erythromycin but resistant to cotrimoxazole and nalidixic acid. Unlike the Staphylococcus species that were significantly resistant to nitrofurantoin, Streptococcus species were moderately susceptible to the drug. CONCLUSION: The common urinary tract bacteria detected in Rubaga hospital in Uganda were most sensitive to Ciprofloxacin and Nitrofurantoin.

Comparison of essential oils from three plants for enhancement of antimicrobial activity of nitrofurantoin against enterobacteria.

BACKGROUND: Piperitone from plant essential oils enhancesbactericidal activities of nitrofurantoin and furazolidone against bacteria from the family Enterobacteriaceae. In this study, the essential oils of spearmint (Mentha spicata L.), dill (Anethum graveolens L.) and peppermint (Mentha piperita L.)were screened for augmentation of nitrofurantoin activity and the most active components were determined. METHOD: The effects of essential oils and their components on the bactericidal activity of nitrofurantoin against Enterobacter cloacae were studied using disk-diffusion and agar-dilution methods. The composition of essential oils was studied using gas chromatography-mass spectrometry. RESULTS: M. spicata and A. graveolens oils exhibited the highest effects. Gas chromatography-mass spectrometry analysis showed that the oils of these two plants contained 40.12 and 20.32% carvone, respectively. Pure carvone and piperitone equally increased the bactericidal activity of nitrofurantoin. Other ingredients of essential oils, including camphor, limonene and menthone, were less effective.

[Pharmacodynamic study of Relinqing granules on bacterial pyelonephritis model in rats].

OBJECTIVE: To observe the effects of Relinqing granules (powder of Polygonum capitatum extract) on the bacterial pyelonephritis model in rats. METHOD: The rat bacterial pyelonephritis model was induced by injecting the escherichia coli ATCC-25922 into kidney parenchyma. The rats were divided ramdamly into Relinqing groups(52.32, 26.16 g x kg(-1)), norflorin group (0.03 g x kg(-1)), model group and normal control group, and were given experimental drugs by gastrogavage. The contents of leucocytes (WBC), occult bloo (BLD), glucose (GLU), protein (PRO), ketones, bilirubin and urobilinagen in urine were determined. RESULT: As compared with the model group, Relinqing granules 6.0 g x kg(-1) (crude drug 52.32 g x kg(-1)) could decrease significantly the contents of WBC and BLD in urine and, however, had no markedly effects on the other biochemical parameters of urine. CONCLUSION: Relinqqing granule has significant effects of decreasing urine WBC and BLD on the bacterial pyolonephritis in rats.

[Evaluation of levofloxacin susceptibility against strains isolated from lower urinary tract infections in the community]. / Evaluation de la sensibilité à la lévofloxacine des souches isolées d'infections urinaires basses communautaires.

The aim of this study was to evaluate the in vitro activity of levofloxacin (LVX) in comparison to nalidixic acid (NAL), ofloxacin (OFX), norfloxacin (NOR), amoxicillin (AMX), cefixime (CFM), cotrimoxazole (SXT) and nitrofurantoin (FT), against 402 strains recently isolated from urine specimens in outpatient women suffering from lower urinary tract infections for which short-term treatment was not indicated. MICs were determined by the agar dilution method on Mueller-Hinton medium (Bio-Rad) according to the recommendations of the Comite de l'Antibiogramme de la Societe Francaise de Microbiologie (CA-SFM). Strains were classified as susceptible (S), intermediate (I) or resistant (R) according to the CA-SFM recommended breakpoints. Quality control was carried out using three reference strains: Escherichia coli ATCC 25922, Staphylococcus aureus ATCC 25923 and Pseudomonas aeruginosa ATCC 27853. For E. coli, the most prevalent species (345 isolates: 85.3%), susceptibilities were as follows: AMX: 60.6%, CFM: 99.1%, NAL: 94.8%, NOR: 97.4%, OFX: 97.4%, LVX: 97.4%, SXT: 84.5%, FT: 98%. This study confirms the good in vitro activity of LVX, OFX, and CFM against strains isolated from urinary tract infections in the community and particularly against E. coli, which is by far the most prevalent pathogen, 90% of strains, with more than 97% of strains being susceptible.

Piperitone from Mentha longifolia var. chorodictya Rech F. reduces the nitrofurantoin resistance of strains of enterobacteriaceae.

The diluted essential oil of Mentha longifolia (L.) var. chlorodictya Rech F. foliage enhanced the bactericidal activity of nitrofurantoin decreasing the minimum inhibitory concentration (MIC) of nitrofurantoin for nitrofurantoin-resistant strains of Enterobacteriaceae. Thin-layer chromatography (TLC) analysis of the essential oil detected a fraction (R(f) = 0.35, UV lambda(max) of 232.5), which was the most effective in enhancement of nitrofurantoin activity. Using gas liquid chromatography and known standards, the active fraction was identified as piperitone. 1 microl of the piperitone fraction decreased the MIC of nitrofurantoin 3-20 fold for the different strains of Enterobacteriaceae tested.

Prevalence and treatment of Chlamydia trachomatis, Ureaplasma urealyticum, and Mycoplasma hominis in patients with non-gonococcal urethritis.

The aim of present study was to evaluate the occurrence of Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum in non-gonococcal urethritis (NGU) and to determine the bacterial resistance to six antibiotics in order to determine the most suitable treatment strategy. A total of 50 patients were enrolled into the study. Urethral samples were taken with a dacron swab placed into urethra 2 - 3 cm in males, and vaginal samples were taken from the endocervical region in women. The patient samples that did not grow Neisseria gonorrhoeae were accepted as NGU. Direct immunofluorescence technique was used for the investigation of C. trachomatis. Mycoplasma IST was used for the isolation of M. hominis and U. urealyticum. U. urealyticum was isolated from 24 patients. Thirteen of them had only U. urealyticum, and the rest had mixed pathogen organisms (7 U. urealyticum + M. hominis; 3 U. urealyticum + C. trachomatis, and 1 U. urealyticum + M. hominis + C. trachomatis). C. trachomatis was detected in 12 patients. While 8 patients had C. trachomatis only, the rest had a mixture of the pathogen organisms listed above. Partner examinations could be performed for only 22 patients' partners. In the evaluation of antibiotic susceptibility, higher resistance was obtained against ofloxacin in U. urealyticum, and against erythromycin with M. hominis. Our results indicated that doxycycline or ofloxacin should be the first choice when empirical treatment is necessary.

In vitro evaluation of a new treatment for urinary tract infections caused by nitrate-reducing bacteria.

Dietary and endogenous nitrates are excreted in urine, and during infection with nitrate-reducing bacteria they are reduced to nitrite. At a low pH nitrite is converted to a variety of nitrogen oxides that are toxic to bacteria. We hypothesized that acidification of nitrite-rich infected urine would result in the killing of the nitrate-reducing bacteria. An Escherichia coli control strain and a mutant lacking nitrate reductase activity were preincubated in urine supplemented with sodium nitrate (0 to 10 mM) at pH 7.0. Then, the nitrite-containing bacterial culture was transferred (and diluted 1/10) to slightly acidic urine (pH 5 and 5.5) containing ascorbic acid (10 mM) and growth was monitored. The control strain produced nitrite in amounts related to the amount of nitrate added. This strain was killed when the culture was transferred to acidic urine. In contrast, the mutant that did not produce nitrite retained full viability. When control bacteria were grown in acidic urine with nitrate and ascorbic acid present from the start of the experiment, no inhibition of growth was noted. The MICs and minimal bactericidal concentrations of sodium nitrite-ascorbic acid in acidic urine were comparable to those of conventional antibiotics. Preincubation of nitrate-reducing E. coli in nitrate-rich urine leads to the accumulation of nitrite. Subsequent acidification of the urine results in generation of nitrogen oxides that are bactericidal. Killing, however, requires a sequential procedure in which the bacteria are first allowed to grow in a nitrate-rich neutral environment, later followed by acidification. We speculate that ingestion of nitrate followed some hours later by acidification of urine could be a new therapeutic strategy for the treatment of urinary tract infections.

Estudio comparativo prospectivo aleatorio de antibióticos en resección transuretral de próstata / Comparative prospective randomized study of antibiotics in transurethral resection of the prostate

Comparar las complicaciones infecciosas con el uso de 2 esquemas antibióticos en resección transuretral de próstata (RTU-P) de pacientes con bajo riesgo, de modo de reducir el uso de antibióticos en este tipo de pacientes. Secundariamente, intentar ponderar la influencia de los antecedentes clínicos, hallazgos y complicaciones intraoperatorias y evolución postoperatoria en el desarrollo de dichas complicaciones. Se diseñó un estudio comparativo, prospectivo, aleatorio, abierto de 95 pacientes con orina estéril, no usuarios de sonda uretrovesical, sometidos a RTU-P en el plazo de 1 año. El grupo 1 recibió una modificación del esquema antibiótico mayormente utilizado hasta la fecha, consistente en cefazolina 1 gr IV preoperatorio y cada 8 h durante el primer día (3 dosis), seguido de ciprofloxacino 250 mg VO, cada 12 h, hasta el retiro de la sonda uretrovesical (dosis terapéutica). El grupo 2 recibió cefazolina 1 g IV preoperatorio y a las 8 h postoperatorias (2 dosis), seguido de nitrofurantoína, 100 mg VO en la noche, hasta el retiro de la sonda uretrovesical (dosis profiláctica). Se excluyeron 5 pacientes del análisis después de la distribución aleatoria (5,3'porciento) y no hubo pérdidas en el seguimiento. Se analizan 90 pacientes, 45 en cada grupo, los cuales fueron comparables en sus características clínicas, parámetros quirúrgicos, parámetros postoperatorios y complicaciones. Se presentó fiebre (temperatura axilar igual o mayor a 37,5 °C) en el 2 porciento del grupo 1 y en el 11 porciento del grupo 2 (p=0,091). Se presentó bacteriuria postoperatoria (recuento > 100.000 UFC por mL) precoz o tardía en el 2 porciento del grupo 1 y en el 13 porciento del grupo 2 (p=0,049). Esto, posiblemente, se debió al espectro de acción y dosis de los antimicrobianos utilizados. La fiebre estuvo relacionada estadísticamente con la infección urinaria postoperatoria.

[High sensitivity of Escherichia coli to antimicrobial agents used for first-line treatment of urinary tract infections; results of an examination of feces of healthy subjects in Friesland]. / Goede gevoeligheid van Escherichia coli voor antimicrobiële middelen gebruikt voor de behandeling van urineweginfecties in de eerste lijn; resultaten van een fecesonderzoek onder gezonde personen in Friesland.

OBJECTIVE: To determine the basic sensitivity of Escherichia coli in the province of Friesland, the Netherlands, to antimicrobial agents used by general practitioners to treat urinary tract infections. DESIGN: Inventory. METHOD: Fifty general practitioners in the province were asked in 1999 to have faeces submitted by patients who had not been using antibiotics for at least one month. E. coli was isolated from the faeces using an elective medium. The proportions of resistance were compared with those of strains isolated in urine sent for examination to Friesland Public Health Laboratory by a clinic, outpatient department, general practice or nursing home. RESULTS: The sensitivities were tested of 240 strains from 240 healthy subjects (73 males and 167 females; mean age 47 years (range 0-84)). The proportions of strains resistant to the agents tested were as follows: nitrofurantoin: 0.8%, trimethoprim: 10%, co-trimoxazole: 10%, amoxicillin: 15%, amoxicillin-clavulanic acid 0.4%. Forty-eight per cent of the strains showed intermediate susceptibility to amoxicillin, 63% to amoxicillin/clavulanic acid. The resistance was lower than in isolates submitted for examination from general and specialist practices. CONCLUSION: The antimicrobial agents mentioned are still useful for treatment of urinary tract infections in the general practice.