Sulphadimidine, co-trimoxazole, and a placebo in the management of symptomatic urinary tract infection in general practice.

PAINFUL and frequent micturition are symptoms commonly encountered in general practice particularly in females. Examination of a mid-stream urine specimen reveals significant bacteriuria in about half the females with symptoms implying that bacteria are actually multiplying in the bladder urine. (Kass, 1956; Mond et al, 1965). Prevalence figures vary according to the criterion of infection adopted, but using Kass' criterion a rate of 8-3 per 1,000 patients at risk per year has been reported. (Mond et al, 1965). The condition is, however, five times commoner in females than in males (Loudon and Greenhalgh, 1962). It is accepted practice to give patients with symptoms a sulphonamide or an appro¬ priate antibiotic when significant bacteriuria is demonstrated but there is disagreement about the most suitable preparation. Sulphonamides are commonly favoured because of their effectiveness, lack of side-effects, and low cost (Fry et al., 1962; Gallagher et al., 1965; Brumfitt and Reeves, 1969). Other workers have disputed the value of using a sulphonamide as the drug of first choice because of increasing in vitro resistance (Robert¬ son, 1968; Sleet, 1969; Milne et al, 1969). This trial was designed to find out whether the superior in vitro effectiveness of co-trimoxazole over a sulphonamide alone (Darrell et al, 1968) could also be demonstrated in vivo in the management of acute urine in¬ fection in general practice.