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- NEW YORK(Reuters Health)
- Bacteria that often cause kidney infections in women have developed resistance
to a widely used antibiotic, pushing down cure rates and driving up healthcare
costs, researchers at the University of California-Los Angeles (UCLA),
report.
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- Another antibiotic, however, appears to be more effective
in less time, according to a report in this week's issue of The Journal
of the American Medical Association.
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- In a study of 255 women with a kidney infection (pyelonephritis),
researchers found that the drug ciprofloxacin cured 95% of the women took
it, compared with 83% of those on trimethoprim/sulfamethoxazole (TMP/SMX),
a standard drug combination used to treat the infection. While bacterial
resistance was behind most of the treatment failures with TMP/SMX, there
was no evidence of resistance to ciprofloxacin, according to Dr. David
Talan and his colleagues.
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- This study, Talan said in a statement, ``highlights the
growing impact of bacterial resistance and the need to re-evaluate antibiotics
and treatment.''
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- When bacteria are exposed to antibiotics, most are killed
or disabled, but some may mutate into drug-resistant strains. One way this
occurs is through patients' failure to finish all of the pills they are
prescribed for an infection; although patients feel better, some bacteria
may survive to develop into drug-resistant strains.
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- Pyelonephritis is a serious infection of the upper urinary
tract and kidneys that causes symptoms such as fever, nausea and painful,
frequent urination. In this study, more than 90% of cases were caused by
E. coli bacteria. When Talan's team isolated the bacteria, they found that
18% were resistant to TMP/SMX; among patients from Western states, the
resistance rate was 32%, compared with 7% and 14% in the East and Midwest,
respectively.
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- Women on ciprofloxacin took the drug for 7 days, while
those on TMP/SMX had 2 weeks of treatment. Ciprofloxacin is a more costly
drug, but since women with infections resistant to TMP/SMX needed further
care, their healthcare costs were 30% higher, on average.
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- Talan and his colleagues recommend that doctors re-evaluate
the antibiotics they prescribe for kidney infection. In Western states,
they note, TMP/SMX may ``no longer be appropriate'' as a first-line treatment.
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- Researchers at UCLA and the Centers for Disease Control
and Prevention are looking into why TMP/SMX-resistance is so high in certain
US regions.
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- SOURCE: The Journal of the American Medical Association
2000;283:1583-1590.
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