The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform

Javier Garau - One of the best experts on this subject based on the ideXlab platform.

  • other antimicrobials of interest in the era of extended spectrum β lactamases fosfomycin Nitrofurantoin and tigecycline
    Clinical Microbiology and Infection, 2008
    Co-Authors: Javier Garau
    Abstract:

    The progressive increase of extended-spectrum β-lactamase (ESBL) -producing enteric bacteria in recent years has called for a re-evaluation of current antibiotic therapy for these infections. The activity and potential use of two old antimicrobials, Nitrofurantoin and fosfomycin, and the new compound tigecycline for treatment of infections due to ESBL-producing Enterobacteriaceae, with special emphasis on E. coli, are reviewed. Fosfomycin continues to be active against the most common uropathogens; in a recent survey from Spain, among the 428 ESBL-producing isolates, the resistance rate of E. coli to fosfomycin was 0.3%, whereas the resistance rate of K. pneumoniae was 7.2%. Other recent surveys, from other parts of the world, confirm the activity of fosfomycin against ESBL-producing E. coli. The rate of resistance to Nitrofurantoin in recent surveys in the USA and Canada was 1.1% among 1142 isolates of E. coli from outpatient urinary isolates. However, among 115 clinical isolates of E. coli ESBL producers, only 71.3% were sensitive to Nitrofurantoin. Also, E. coli resistance to Nitrofurantoin has been reported to be high in a recent survey in Latin American hospitals and in Italy. Tigecycline is a glycylcycline that circumvents efflux and ribosomal protection, the two most frequent genetic mechanisms of tetracycline resistance. The recent activity of tigecycline against 285 nonclonally related isolates expressing well-characterised ESBLs from hospital settings and the community reveal susceptibility rates for tigecycline of 97.5%. Because responses to Nitrofurantoin may be less satisfactory and may require longer courses of therapy, Nitrofurantoin is considered to be an alternative, rather than a first-line, therapeutic agent for this clinical syndrome. Fosfomycin trometamol is a safe and effective alternative for the treatment of cystitis and asymptomatic UTI during pregnancy, and has become, in many countries, the first choice for treatment of any type of cystitis. Finally, for treatment of systemic infections in the hospital setting, tigecycline could be an option that would reduce selection for ESBL-producing organisms.

  • other antimicrobials of interest in the era of extended spectrum β lactamases fosfomycin Nitrofurantoin and tigecycline
    Clinical Microbiology and Infection, 2008
    Co-Authors: Javier Garau
    Abstract:

    The progressive increase of extended-spectrum β-lactamase (ESBL) -producing enteric bacteria in recent years has called for a re-evaluation of current antibiotic therapy for these infections. The activity and potential use of two old antimicrobials, Nitrofurantoin and fosfomycin, and the new compound tigecycline for treatment of infections due to ESBL-producing Enterobacteriaceae, with special emphasis on E. coli, are reviewed. Fosfomycin continues to be active against the most common uropathogens; in a recent survey from Spain, among the 428 ESBL-producing isolates, the resistance rate of E. coli to fosfomycin was 0.3%, whereas the resistance rate of K. pneumoniae was 7.2%. Other recent surveys, from other parts of the world, confirm the activity of fosfomycin against ESBL-producing E. coli. The rate of resistance to Nitrofurantoin in recent surveys in the USA and Canada was 1.1% among 1142 isolates of E. coli from outpatient urinary isolates. However, among 115 clinical isolates of E. coli ESBL producers, only 71.3% were sensitive to Nitrofurantoin. Also, E. coli resistance to Nitrofurantoin has been reported to be high in a recent survey in Latin American hospitals and in Italy. Tigecycline is a glycylcycline that circumvents efflux and ribosomal protection, the two most frequent genetic mechanisms of tetracycline resistance. The recent activity of tigecycline against 285 nonclonally related isolates expressing well-characterised ESBLs from hospital settings and the community reveal susceptibility rates for tigecycline of 97.5%. Because responses to Nitrofurantoin may be less satisfactory and may require longer courses of therapy, Nitrofurantoin is considered to be an alternative, rather than a first-line, therapeutic agent for this clinical syndrome. Fosfomycin trometamol is a safe and effective alternative for the treatment of cystitis and asymptomatic UTI during pregnancy, and has become, in many countries, the first choice for treatment of any type of cystitis. Finally, for treatment of systemic infections in the hospital setting, tigecycline could be an option that would reduce selection for ESBL-producing organisms.

Daniel F Sahm - One of the best experts on this subject based on the ideXlab platform.

  • susceptibility of antimicrobial resistant urinary escherichia coli isolates to fluoroquinolones and Nitrofurantoin
    Clinical Infectious Diseases, 2003
    Co-Authors: James A Karlowsky, Clyde Thornsberry, Mark E Jones, Daniel F Sahm
    Abstract:

    In vitro surveillance data from across the United States indicate that approximately 10%-20% of urinary Escherichia coli isolates from female outpatients are resistant to trimethoprim-sulfamethoxazole (TMP-SMX). Alternative therapies for uncomplicated urinary tract infections in women include fluoroquinolones and Nitrofurantoin, but the activities of these agents against TMP-SMX-resistant isolates are rarely reported. Among TMP-SMX-resistant urinary E. coli isolates tested in US laboratories from 1998 through 2001, 9.5% (5767 of 60,414) were resistant to ciprofloxacin and 1.9% (1214 of 63,817) were resistant to Nitrofurantoin; 10.4% of ciprofloxacin-resistant isolates (683 of 6560) were resistant to Nitrofurantoin. An association between resistance to fluoroquinolones and Nitrofurantoin in E. coli has not been previously reported and warrants further study.

  • trends in antimicrobial resistance among urinary tract infection isolates of escherichia coli from female outpatients in the united states
    Antimicrobial Agents and Chemotherapy, 2002
    Co-Authors: James A Karlowsky, Clyde Thornsberry, Mark E Jones, Laurie J Kelly, Daniel F Sahm
    Abstract:

    The Infectious Diseases Society of America advocates trimethoprim-sulfamethoxazole (SXT) as initial therapy for females with acute uncomplicated bacterial cystitis in settings where the prevalence of SXT resistance does not exceed 10 to 20%. To determine trends in the activities of SXT, ampicillin, ciprofloxacin, and Nitrofurantoin among urine isolates of Escherichia coli from female outpatients, susceptibility testing data from The Surveillance Network (TSN) Database-USA (n = 286,187) from 1995 to 2001 were analyzed. Resistance rates among E. coli isolates to ampicillin (range, 36.0 to 37.4% per year), SXT (range, 14.8 to 17.0%), ciprofloxacin (range, 0.7 to 2.5%), and Nitrofurantoin (range, 0.4 to 0.8%) varied only slightly over this 7-year period. Ciprofloxacin was the only agent studied that demonstrated a consistent stepwise increase in resistance from 1995 (0.7%) to 2001 (2.5%). In 2001, SXT resistance among E. coli isolates was >10% in all nine U.S. Bureau of the Census regions. At institutions testing ≥100 urinary isolates of E. coli (n = 126) in 2001, ampicillin (range, 27.3 to 98.8%) and SXT (range, 7.5 to 47.1%) resistance rates varied widely while ciprofloxacin (range, 0 to 12.9%) and Nitrofurantoin (range, 0 to 2.8%) resistance rates were more consistent. In 2001, the most frequent coresistant phenotypes were resistance to ampicillin and SXT (12.0% of all isolates; 82.3% of coresistant isolates) and resistance to ampicillin, ciprofloxacin, and SXT (1.4% of all isolates; 9.9% of coresistant isolates). Coresistance less frequently included resistance to Nitrofurantoin (3.5% of coresistant isolates) than resistance to ciprofloxacin (15.8%), SXT (95.7%), and ampicillin (98.1%). In conclusion, among urinary isolates of E. coli from female outpatients in the United States, national resistance rates to SXT were relatively consistent (14.8 to 17.0%) from 1995 to 2001 but demonstrated considerable regional and institutional variation in 2001. Therapies other than SXT may need to be considered in some locations.

  • trends in antimicrobial resistance among urinary tract infection isolates of escherichia coli from female outpatients in the united states
    Antimicrobial Agents and Chemotherapy, 2002
    Co-Authors: James A Karlowsky, Clyde Thornsberry, Mark E Jones, Laurie J Kelly, Daniel F Sahm
    Abstract:

    The Infectious Diseases Society of America advocates trimethoprim-sulfamethoxazole (SXT) as initial therapy for females with acute uncomplicated bacterial cystitis in settings where the prevalence of SXT resistance does not exceed 10 to 20%. To determine trends in the activities of SXT, ampicillin, ciprofloxacin, and Nitrofurantoin among urine isolates of Escherichia coli from female outpatients, susceptibility testing data from The Surveillance Network (TSN) Database-USA (n = 286,187) from 1995 to 2001 were analyzed. Resistance rates among E. coli isolates to ampicillin (range, 36.0 to 37.4% per year), SXT (range, 14.8 to 17.0%), ciprofloxacin (range, 0.7 to 2.5%), and Nitrofurantoin (range, 0.4 to 0.8%) varied only slightly over this 7-year period. Ciprofloxacin was the only agent studied that demonstrated a consistent stepwise increase in resistance from 1995 (0.7%) to 2001 (2.5%). In 2001, SXT resistance among E. coli isolates was >10% in all nine U.S. Bureau of the Census regions. At institutions testing ≥100 urinary isolates of E. coli (n = 126) in 2001, ampicillin (range, 27.3 to 98.8%) and SXT (range, 7.5 to 47.1%) resistance rates varied widely while ciprofloxacin (range, 0 to 12.9%) and Nitrofurantoin (range, 0 to 2.8%) resistance rates were more consistent. In 2001, the most frequent coresistant phenotypes were resistance to ampicillin and SXT (12.0% of all isolates; 82.3% of coresistant isolates) and resistance to ampicillin, ciprofloxacin, and SXT (1.4% of all isolates; 9.9% of coresistant isolates). Coresistance less frequently included resistance to Nitrofurantoin (3.5% of coresistant isolates) than resistance to ciprofloxacin (15.8%), SXT (95.7%), and ampicillin (98.1%). In conclusion, among urinary isolates of E. coli from female outpatients in the United States, national resistance rates to SXT were relatively consistent (14.8 to 17.0%) from 1995 to 2001 but demonstrated considerable regional and institutional variation in 2001. Therapies other than SXT may need to be considered in some locations.

Angela Huttner - One of the best experts on this subject based on the ideXlab platform.

  • the pharmacokinetics of Nitrofurantoin in healthy female volunteers a randomized crossover study
    Journal of Antimicrobial Chemotherapy, 2019
    Co-Authors: Angela Huttner, Stéphan Juergen Harbarth, Andrew J. Stewardson, Johan W Mouton, Rixt A Wijma, Flaminia Olearo, Elodie Von Dach, Roger J M Bruggemann, Anouk E Muller
    Abstract:

    Background Use of Nitrofurantoin has increased significantly since its recent repositioning as a first-line agent for uncomplicated cystitis by multiple guidelines. However, current dosing regimens were developed in an era before robust pharmacokinetic testing and may not be optimal. Furthermore, formulations have been modified over the years. Objectives To reassess the plasma and urinary pharmacokinetic profile of macrocrystalline Nitrofurantoin in two commonly used dosing regimens. Methods In this open-label, randomized crossover pharmacokinetic trial, 12 healthy adult female volunteers were randomized to receive oral Nitrofurantoin 100 mg q8h on days 1 and 2 and, after a washout period, 50 mg q6h on days 30 and 31, or the same dosing schemes in reversed order. Urine and blood were collected at steady state and analysed by UPLC. Pharmacokinetic analysis was performed by WinNonlin. Results Plasma peak concentrations were low (mean 0.33 mg/L, SD 0.08, and 0.69 mg/L, SD 0.35, after 50 and 100 mg, respectively) and dose dependent. The AUC0-24 was higher (6.49 versus 4.43 mg·h/L, P = 0.021) for the 100 mg q8h dosing regimen, but the dose-normalized AUC was similar for the two regimens. In contrast, urinary concentrations were dose independent: increasing the Nitrofurantoin dose delayed the time to peak urinary concentration, while steady-state AUC0-24 values remained unchanged (943.49 and 855.95 mg·h/L at 50 mg q6h and 100 mg q8h, respectively). Conclusions Plasma concentrations were relatively low and dose dependent. The dose-independent urinary concentrations suggest that excretion of Nitrofurantoin into the urine is saturable. Pharmacodynamic studies are urgently required to determine the impact of these findings.

  • effect of 5 day Nitrofurantoin vs single dose fosfomycin on clinical resolution of uncomplicated lower urinary tract infection in women a randomized clinical trial
    JAMA, 2018
    Co-Authors: Angela Huttner, Anna Kowalczyk, Adi Turjeman, Tanya Babich, Caroline Brossier, Noa Eliakimraz, Katarzyna Kosiek, Begona Martinez De Tejada, Xavier Roux
    Abstract:

    Importance The use of Nitrofurantoin and fosfomycin has increased since guidelines began recommending them as first-line therapy for lower urinary tract infection (UTI). Objective To compare the clinical and microbiologic efficacy of Nitrofurantoin and fosfomycin in women with uncomplicated cystitis. Design, Setting, and Participants Multinational, open-label, analyst-blinded, randomized clinical trial including 513 nonpregnant women aged 18 years and older with symptoms of lower UTI (dysuria, urgency, frequency, or suprapubic tenderness), a positive urine dipstick result (with detection of nitrites or leukocyte esterase), and no known colonization or previous infection with uropathogens resistant to the study antibiotics. Recruitment took place from October 2013 through April 2017 at hospital units and outpatient clinics in Geneva, Switzerland; Lodz, Poland; and Petah-Tiqva, Israel. Interventions Participants were randomized in a 1:1 ratio to oral Nitrofurantoin, 100 mg 3 times a day for 5 days (n = 255), or a single 3-g dose of oral fosfomycin (n = 258). They returned 14 and 28 days after therapy completion for clinical evaluation and urine culture collection. Main Outcomes and Measures The primary outcome was clinical response in the 28 days following therapy completion, defined as clinical resolution (complete resolution of symptoms and signs of UTI without prior failure), failure (need for additional or change in antibiotic treatment due to UTI or discontinuation due to lack of efficacy), or indeterminate (persistence of symptoms without objective evidence of infection). Secondary outcomes included bacteriologic response and incidence of adverse events. Results Among 513 patients who were randomized (median age, 44 years [interquartile range, 31-64]), 475 (93%) completed the trial and 377 (73%) had a confirmed positive baseline culture. Clinical resolution through day 28 was achieved in 171 of 244 patients (70%) receiving Nitrofurantoin vs 139 of 241 patients (58%) receiving fosfomycin (difference, 12% [95% CI, 4%-21%]; P  = .004). Microbiologic resolution occurred in 129 of 175 (74%) vs 103 of 163 (63%), respectively (difference, 11% [95% CI, 1%-20%]; P  = .04). Adverse events were few and primarily gastrointestinal; the most common were nausea and diarrhea (7/248 [3%] and 3/248 [1%] in the Nitrofurantoin group vs 5/247 [2%] and 5/247 [1%] in the fosfomycin group, respectively). Conclusions and Relevance Among women with uncomplicated UTI, 5-day Nitrofurantoin, compared with single-dose fosfomycin, resulted in a significantly greater likelihood of clinical and microbiologic resolution at 28 days after therapy completion. Trial Registration ClinicalTrials.gov Identifier:NCT01966653

  • Nitrofurantoin s efficacy and safety as prophylaxis for urinary tract infections a systematic review of the literature and meta analysis of controlled trials
    Clinical Microbiology and Infection, 2017
    Co-Authors: Anouk E Muller, Stéphan Juergen Harbarth, Els Verhaegh, Johan W Mouton, Angela Huttner
    Abstract:

    Abstract Objectives Nitrofurantoin has been used for the prevention of urinary tract infection (UTI) for over 60 years. We conducted a systematic review and meta-analysis to assess its efficacy and safety in the prophylaxis of UTI. Methods We performed a systematic review of all controlled trials in humans assessing Nitrofurantoin for UTI prophylaxis published from 1946 to 2015. We further reviewed population-level cohort studies evaluating Nitrofurantoin's toxicity. Meta-analyses assessing efficacy and adverse events were conducted on controlled trials. Results Twenty-six controlled trials including 3052 patients fulfilled entry criteria for the systematic review and meta-analysis on efficacy and toxicity, and 16 population-level cohort studies were identified for review of toxicity. Overall quality was poor, with all studies at increased risk for various biases. When compared with no prophylaxis, Nitrofurantoin is effective in the prevention of UTI (risk ratio 0.38 in favour of Nitrofurantoin, 95% CI 0.30–0.48). Its prophylactic efficacy is superior to that of methenamine hippurate and comparable to that of other antibacterials. Compared with patients receiving other antibacterials, those receiving Nitrofurantoin had an increased risk of 2.24 (95% CI 1.77–2.83) for a non-severe adverse effect. In all controlled trials, only one patient experienced a severe adverse effect (interstitial pneumonia). Cohort studies reported severe adverse effect frequencies of 0.02–1.5 per 1000 Nitrofurantoin users. Conclusions Nitrofurantoin is effective in the prevention of UTI. Its use may be associated with increased non-severe adverse effects; severe adverse effects occur infrequently. The risk of severe toxicity seems to increase with the duration of Nitrofurantoin prophylaxis.

Loren G Miller - One of the best experts on this subject based on the ideXlab platform.

  • Nitrofurantoin preferred empiric therapy for community acquired lower urinary tract infections in response
    Mayo Clinic Proceedings, 2011
    Co-Authors: James A Mckinnnel, Loren G Miller
    Abstract:

    We appreciate Dr Cunha’s correspondence regarding the use of Nitrofurantoin for the treatment of urinary tract infections (UTIs). We agree that Nitrofurantoin should have a major contemporary role in outpatient treatment of uncomplicated UTIs in the United States and worldwide.1 Dr Cunha noted one known mechanism of action of Nitrofurantoin; we add that the mechanism of bactericidal activity of Nitrofurantoin remains unclear and that other mechanisms, including bacterial DNA damage and inhibition of ribosomal translation, may play a role.2,3 The renal excretion of Nitrofurantoin that Dr Cunha quotes is lower than that in other reports.4-6 We concur that Nitrofurantoin use is relatively contraindicated in patients with renal insufficiency. The urinary recovery of Nitrofurantoin is linearly related to creatinine clearance and may not achieve therapeutic concentrations in patients with renal insufficiency.6 Experts suggest that Nitrofurantoin be avoided in patients with a glomerular filtration rate lower than 60 mL/min,7 a threshold different from the creatinine clearance of lower than 30 mL/min mentioned by Dr Cunha. As far as the statement that Nitrofurantoin may be a useful agent in the hospital setting, we agree that it may have a role, especially with the increasing incidence of UTIs caused by multidrug-resistant organisms. Of note, the role of Nitrofurantoin for nosocomial UTIs is poorly studied.8 We also caution that Nitrofurantoin resistance among uropathogens that cause catheter-associated UTIs has been reported to be as high as 29%, thus limiting its role as empiric therapy.9 We encourage publica tions on clinical experience, or ideally prospective study, with Nitrofurantoin in this setting because such data will be a welcome and important addition to the clinical literature.

  • Nitrofurantoin compares favorably to recommended agents as empirical treatment of uncomplicated urinary tract infections in a decision and cost analysis
    Mayo Clinic Proceedings, 2011
    Co-Authors: Loren G Miller, James A Mckinnell, Nicholas Stollenwerk, Chin W Jung
    Abstract:

    OBJECTIVE To analyze the costs of Nitrofurantoin use compared to those of other antibiotics recommended for treatment of uncomplicated urinary tract infection (UTI). PATIENTS AND METHODS We used a decision analysis model to perform cost-minimization and sensitivity analyses to determine the level of trimethoprim-sulfamethoxazole (TMP-SMX) and fluoroquinolone resistance that would favor the use of Nitrofurantoin as a first-line empirical treatment of uncomplicated UTIs. The model used a program perspective to evaluate costs. RESULTS Nitrofurantoin was cost-minimizing when the prevalence of fluoroquinolone resistance exceeded 12% among uropathogens or the prevalence of TMP-SMX resistance exceeded 17%. On 2-way sensitivity analysis, variables that had a significant impact on our cost-minimization threshold included cost of antibiotics and probability of clinical cure with antibiotics. CONCLUSION From a payer perspective, Nitrofurantoin appears to be a reasonable alternative to TMP-SMX and fluoroquinolones for empirical treatment of uncomplicated UTIs, especially given the current prevalence of antibiotic resistance among community uropathogens. On the basis of efficacy, cost, and low impact on promoting antimicrobial resistance, clinicians should consider Nitrofurantoin as a reasonable alternative to TMP-SMX and fluoroquinolones for first-line therapy for uncomplicated UTIs.

James A Karlowsky - One of the best experts on this subject based on the ideXlab platform.

  • susceptibility of antimicrobial resistant urinary escherichia coli isolates to fluoroquinolones and Nitrofurantoin
    Clinical Infectious Diseases, 2003
    Co-Authors: James A Karlowsky, Clyde Thornsberry, Mark E Jones, Daniel F Sahm
    Abstract:

    In vitro surveillance data from across the United States indicate that approximately 10%-20% of urinary Escherichia coli isolates from female outpatients are resistant to trimethoprim-sulfamethoxazole (TMP-SMX). Alternative therapies for uncomplicated urinary tract infections in women include fluoroquinolones and Nitrofurantoin, but the activities of these agents against TMP-SMX-resistant isolates are rarely reported. Among TMP-SMX-resistant urinary E. coli isolates tested in US laboratories from 1998 through 2001, 9.5% (5767 of 60,414) were resistant to ciprofloxacin and 1.9% (1214 of 63,817) were resistant to Nitrofurantoin; 10.4% of ciprofloxacin-resistant isolates (683 of 6560) were resistant to Nitrofurantoin. An association between resistance to fluoroquinolones and Nitrofurantoin in E. coli has not been previously reported and warrants further study.

  • trends in antimicrobial resistance among urinary tract infection isolates of escherichia coli from female outpatients in the united states
    Antimicrobial Agents and Chemotherapy, 2002
    Co-Authors: James A Karlowsky, Clyde Thornsberry, Mark E Jones, Laurie J Kelly, Daniel F Sahm
    Abstract:

    The Infectious Diseases Society of America advocates trimethoprim-sulfamethoxazole (SXT) as initial therapy for females with acute uncomplicated bacterial cystitis in settings where the prevalence of SXT resistance does not exceed 10 to 20%. To determine trends in the activities of SXT, ampicillin, ciprofloxacin, and Nitrofurantoin among urine isolates of Escherichia coli from female outpatients, susceptibility testing data from The Surveillance Network (TSN) Database-USA (n = 286,187) from 1995 to 2001 were analyzed. Resistance rates among E. coli isolates to ampicillin (range, 36.0 to 37.4% per year), SXT (range, 14.8 to 17.0%), ciprofloxacin (range, 0.7 to 2.5%), and Nitrofurantoin (range, 0.4 to 0.8%) varied only slightly over this 7-year period. Ciprofloxacin was the only agent studied that demonstrated a consistent stepwise increase in resistance from 1995 (0.7%) to 2001 (2.5%). In 2001, SXT resistance among E. coli isolates was >10% in all nine U.S. Bureau of the Census regions. At institutions testing ≥100 urinary isolates of E. coli (n = 126) in 2001, ampicillin (range, 27.3 to 98.8%) and SXT (range, 7.5 to 47.1%) resistance rates varied widely while ciprofloxacin (range, 0 to 12.9%) and Nitrofurantoin (range, 0 to 2.8%) resistance rates were more consistent. In 2001, the most frequent coresistant phenotypes were resistance to ampicillin and SXT (12.0% of all isolates; 82.3% of coresistant isolates) and resistance to ampicillin, ciprofloxacin, and SXT (1.4% of all isolates; 9.9% of coresistant isolates). Coresistance less frequently included resistance to Nitrofurantoin (3.5% of coresistant isolates) than resistance to ciprofloxacin (15.8%), SXT (95.7%), and ampicillin (98.1%). In conclusion, among urinary isolates of E. coli from female outpatients in the United States, national resistance rates to SXT were relatively consistent (14.8 to 17.0%) from 1995 to 2001 but demonstrated considerable regional and institutional variation in 2001. Therapies other than SXT may need to be considered in some locations.

  • trends in antimicrobial resistance among urinary tract infection isolates of escherichia coli from female outpatients in the united states
    Antimicrobial Agents and Chemotherapy, 2002
    Co-Authors: James A Karlowsky, Clyde Thornsberry, Mark E Jones, Laurie J Kelly, Daniel F Sahm
    Abstract:

    The Infectious Diseases Society of America advocates trimethoprim-sulfamethoxazole (SXT) as initial therapy for females with acute uncomplicated bacterial cystitis in settings where the prevalence of SXT resistance does not exceed 10 to 20%. To determine trends in the activities of SXT, ampicillin, ciprofloxacin, and Nitrofurantoin among urine isolates of Escherichia coli from female outpatients, susceptibility testing data from The Surveillance Network (TSN) Database-USA (n = 286,187) from 1995 to 2001 were analyzed. Resistance rates among E. coli isolates to ampicillin (range, 36.0 to 37.4% per year), SXT (range, 14.8 to 17.0%), ciprofloxacin (range, 0.7 to 2.5%), and Nitrofurantoin (range, 0.4 to 0.8%) varied only slightly over this 7-year period. Ciprofloxacin was the only agent studied that demonstrated a consistent stepwise increase in resistance from 1995 (0.7%) to 2001 (2.5%). In 2001, SXT resistance among E. coli isolates was >10% in all nine U.S. Bureau of the Census regions. At institutions testing ≥100 urinary isolates of E. coli (n = 126) in 2001, ampicillin (range, 27.3 to 98.8%) and SXT (range, 7.5 to 47.1%) resistance rates varied widely while ciprofloxacin (range, 0 to 12.9%) and Nitrofurantoin (range, 0 to 2.8%) resistance rates were more consistent. In 2001, the most frequent coresistant phenotypes were resistance to ampicillin and SXT (12.0% of all isolates; 82.3% of coresistant isolates) and resistance to ampicillin, ciprofloxacin, and SXT (1.4% of all isolates; 9.9% of coresistant isolates). Coresistance less frequently included resistance to Nitrofurantoin (3.5% of coresistant isolates) than resistance to ciprofloxacin (15.8%), SXT (95.7%), and ampicillin (98.1%). In conclusion, among urinary isolates of E. coli from female outpatients in the United States, national resistance rates to SXT were relatively consistent (14.8 to 17.0%) from 1995 to 2001 but demonstrated considerable regional and institutional variation in 2001. Therapies other than SXT may need to be considered in some locations.