Transplant Trial Watch

Comparison of the effect of co-trimoxazole and co-trimoxazole plus ciprofloxacin in urinary tract infection prophylaxis in kidney transplant patients.

Khorvash F, Mortazavi M, et al.

Advanced Biomedical Research 2016; 5: 108.


Aims
To examine the effect of a combination regimen on prophylaxis of urinary tract infection (UTI) in renal transplant patients.

Interventions
Participants were randomized to receive either prophylactic sulfamethoxazole‑trimethoprim (SMZ/TMP) or ciprofloxacin plus SMZ/TMP.

Participants
50 kidney transplant recipients aged > 18 years without UTI or glucose 6 phosphate dehydrogenase.

Outcomes
The primary outcome measured was the incidence of UTI at 1, 3, and 6 months after transplantation. Other outcomes measured were reason for renal failure, urinary infection symptoms and time to first case of infection.

Follow-up
6 months

CET Conclusions
In the interest of antibiotic stewardship this study has attempted to find a way of reducing antibiotic prescription for the treatment of UTI after renal transplantation. However, the method proposed is the prescription of additional prophylactic antibiotics for one month, on top of the standard prophylaxis. This seems a little incongruous. The other key aim was to reduce rates of UTI after renal transplantation, which is of course an important outcome in itself. The allocation of patients was not concealed and it is not completely clear that the method of randomization was indeed random as "the patients were alternately distributed in the two groups in a block-randomised manner". The study was also not blinded. There is no study flow chart to clearly outline the excluded patients at each stage. Although the numbers in the study show a clearly significant reduction in UTI (all culture positive, from 32% to 12%) the authors themselves stop short of writing that a proven benefit has been shown. There is no mention of patients who had adverse reactions to either antibiotic or stopped the prophylaxis, and also no description of immune suppression used in each group.

Jadad score
1

Data analysis
Per protocol analysis

Allocation concealment
No

Trial registration
Iranian Registry of Clinical Trial - IRCT 2015120823743N1

Funding source
No funding received