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| |  Old Remedy Works for Recurrent UTIs in Renal Transplant Recipients: Presented at ATC By Cheryl Lathrop BOSTON -- June 5, 2009 -- Methenamine salt plus vitamin C prophylaxis (PPX), an older remedy for urinary tract infections (UTIs), significantly reduced UTI recurrence and antibiotic resistance in renal transplant recipients (RTRs), according to a study presented here at the 2009 American Transplant Congress (ATC). UTIs occur frequently in RTRs despite sulfamethoxazole/trimetazidine (SMX/TMZ) prophylaxis and may be associated with allograft dysfunction. Frequent and symptomatic UTIs require prophylaxis. However, recurrent UTI therapy may increase antimicrobial resistance of urinary tract pathogens. Demetra Tsapepas, PharmD, New York-Presbyterian Hospital, Weill Cornell Medical College, and colleagues conducted a retrospective case-control chart review of RTRs to evaluate the efficacy and safety of PPX. Patients studied underwent transplantation from January 2003 to December 2008. Findings were presented on June 2. The kidney transplant database generated a report of 167 RTRs who developed a UTI post transplantation. Of these, 27 were in the PPX group and 140 were in the control group (NOPPX). Patients in the PPX group had received PPX for >=3 months. Patients were aged 33 to 66 years, and about 75% were women. Forty percent were white, 30% were African American, and the rest were Asian and Hispanic. UTI recurrence on PPX was described as a UTI while on PPX; UTI recurrence on NOPPX was described as development of a second UTI. The average number of UTIs developed in the PPX versus the NOPPX group was compared by the Mann-Whitney test, time to UTI recurrence was determined by log rank test, and incidence of UTI before and after PPX was compared by paired t test. The researchers found a reduction in UTI recurrence with PPX compared with NOPPX. The average number of UTIs per patient pre-PPX was about 3, and the average post-PPX was about 1. Some patients still developed recurrent UTIs on PPX, but they benefited by having fewer episodes. E coli and Klebsiella pneumoniae were the predominant recurrent organisms; Enterococcus faecalis and Citrobacter freundii also occurred. The PPX benefit was observed despite the SMX/TMZ prophylaxis. The researchers noted that a prospective randomised study to further evaluate PPX is planned. [Presentation title: Revival of an Old Remedy for Recurrent Urinary Tract Infections in Renal Transplantation. Abstract 1610]
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