ORIGINAL ARTICLE

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ANTIMICROBIAL SUSCEPTIBILITY OF COMMUNITY-ACQUIRED UROPATHOGENS IN GENERAL PRACTICE

In the local context, the high rates of resistance to ampicillin and S-T was likely to be due to their widespread use as first line agents for UTI. These antibiotics were the commonly available agents for the treatment of UTI in the public and the private health sectors. In the National Medicine Use Survey 2004, the usage of ampicillin (including bacampicillin) was about 0.5 Defined Daily Dose/1000 population/year 2004 (compare rates for S-T above). Existing clinical practice guidelines had recommended the use of these agents as first line treatment of UTI for more than a decade.41 The ß-lactam antibiotics like ampicillin and cephalosporins have other problems besides resistance. They are found to have relatively poor performance in treating symptomatic cystitis. One postulate is that it is rapidly excreted and the duration of significant drug concentration in the urine is short. An additional reason is that ß-lactams are relatively ineffective in clearing gram negative rods from the vaginal and colonic mucosa, thus possibly predisposing to recurrences when used to treat UTI.³⁶ Commonly available ß-lactam antibiotics for UTI such as cephalexin and cefuroxime may not perform well for these reasons.

In our study of the commonly used antimicrobial agents (Table 3), there was a clear division between the highly resistant group (ampicillin and S-T) and the low resistant group (amoxicillin-clavulanate, cephalexin, norfloxacin, cefuroxime, fosfomycin).

CONCLUSION

In the locality studied, bacteria causing community-acquired UTI showed significantly high resistance rates to ampicillin and S-T. Our study indicated that therapeutic response in the treatment of community-acquired UTI is likely to be inadequate in three out of five patients on ampicillin as well as two out of five patients on S-T. Local antibiotic guidelines should therefore take into consideration this change in resistance pattern. The resistance rates to amoxicillin-clavulanate, cephalexin, cefuroxime, norfloxacin and fosfomycin were low. Treatment regimens should follow prevailing resistance patterns and constant surveillance holds the key to appropriate antibiotic policies to combat resistance.

ACKNOWLEDGEMENT

The assistance and encouragement from the members of the Malaysian Primary Care Research Group is gratefully acknowledged. We would like to thank Miss Amutha Muniandy and other staff members of Gribbles Laboratory for their skilful technical support.

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