Impact of Allergy and Resistance on Antibiotic Selection for Recurrent Urinary Tract Infections in Older Women

• Published in: Urology (Ridgewood, N.J.) Vol. 113; pp. 26 - 33
• Main Authors: Malik, Rena D., Wu, Yuefeng (Rose), Christie, Alana L., Alhalabi, Feras, Zimmern, Philippe E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2018
• Subjects: Age Factors; Aged; Aged, 80 and over; Anti-Infective Agents - adverse effects; Anti-Infective Agents - immunology; Anti-Infective Agents - therapeutic use; Anti-Infective Agents, Urinary - adverse effects; Anti-Infective Agents, Urinary - therapeutic use; Chronic Disease; Cohort Studies; Cystoscopy - methods; Databases, Factual; Drug Resistance, Microbial; Female; Fluoroquinolones - adverse effects; Fluoroquinolones - therapeutic use; Geriatric Assessment; Humans; Hypersensitivity - epidemiology; Hypersensitivity - immunology; Microbial Sensitivity Tests; Nitrofurantoin - adverse effects; Nitrofurantoin - therapeutic use; Prognosis; Recurrence; Retrospective Studies; Risk Assessment; Sulfonamides - adverse effects; Sulfonamides - therapeutic use; Treatment Outcome; Urinalysis - methods; Urinary Tract Infections - diagnosis; Urinary Tract Infections - drug therapy; Urinary Tract Infections - epidemiology; Urinary Tract Infections - microbiology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2017.08.070

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.
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.
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).
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.