COMPARISON OF SUSCEPTIBILITY BETWEEN CONVENTIONAL FIRST LINE ANTIBIOTIC CO-TRIMOXAZOLE AND NEWER ANTIBIOTICS IN RECURRENT UNCOMPLICATED URINARY TRACT INFECTIONS

ABSTRACT Objective: Antibiotics play a crucial role in treating Urinary Tract Infections (UTIs) but due to resistance, the effectiveness of antibiotics is waning. Re-examining old antibiotics is one approach that can address the issue of antimicrobial resistance. The current study aims to evaluate susceptibility pattern of relatively older antibiotic Co-trimoxazole and its comparison with Levofloxacin, Nitrofurantoin and Fosfomycin. Material and Methods: This cross-sectional study was conducted in Mardan Medical Complex, Mardan, and Postgraduate Medical Education Department of Khyber Girls Medical College, Peshawar from April 2022 to September 2022. Both male and female patients, above the age of 15 years with recurrent uncomplicated urinary tract infection were included in the study. The samples were inoculated onto CLED (Cystine-Lactose-Electrolyte-Deficient) Agar, a differential culture medium. The grown bacteria were identified, using Gram staining and BIOMÉRIEUX® API® 10 S kits. Minimum inhibitory concentrations (MIC) were determined by Agar dilution method; as per standard protocol. The results were compared among Co-trimoxazole, Levofloxacin, Nitrofurantoin and Fosfomycin using Statistical tests. Results: A total of 680 samples were received, in which 158 samples were culture positive. Gender distribution of females and males were 63.3% and 36.7%, respectively. Most of the patients were presented in the age group of 21-40 years followed by 41-60 years. The isolated organisms were E.coli (74.1%), Klebsiella (10.8%), Pseudomonas 8(5.1%), Enterococci (6.3%), Proteus species (2.5%) and Citrobacter (1.3%). According to MIC, Co-trimoxazole was sensitive against 77.2% isolates, Levofloxacin 52.5%, Nitrofurantoin 86.7% and Fosfomycin 90.5%. While comparing antibiotics, Co-trimoxazole displayed significantly higher susceptibility than Levofloxacin (p value 0.004), while in comparison with Nitrofurantoin and Fosfomycin, Co-trimoxazole had lower susceptibility with respective p values of 0.000 and 0.007. Conclusion: Study revealed that susceptibility of Co-trimoxazole was significantly higher than Levofloxacin, but lower than Nitrofurantoin and Fosfomycin.   KEY WORDS Antibiotic, Susceptibility, Recurrent uncomplicated urinary tract infections, Minimum inhibitory concentration