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

Objective: The current study aims to evaluate the 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 the 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 infections 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® 10S kits. Minimum inhibitory concentrations (MIC) were determined by the 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, of which 158 samples were culture-positive. The gender distribution of females and males was 63.3% and 36.7%, respectively. A predominant proportion of the patient cohort manifested within the age range of 21-40 years, with the subsequent highest representation observed in the 41-60 year age group. The isolated organisms were E. coli (74.1%), Klebsiella (10.8%), Pseudomonas (5.1%), Enterococci (6.3%), Proteus species (2.5%), and Citrobacter (1.3%). Based on MIC analysis, 77.2% of isolates were found to be sensitive to Co-trimoxazole, 52.5% to Levofloxacin, 86.7% to Nitrofurantoin, and 90.5% to Fosfomycin. When comparing antibiotics, Co-trimoxazole displayed significantly higher effectiveness against the isolates compared to Levofloxacin (p-value 0.004). However, in comparison to Nitrofurantoin and Fosfomycin, Co-trimoxazole exhibited lower effectiveness, with respective p-values of 0.000 and 0.007. Conclusion: The study revealed that the susceptibility of bacterial isolates to Co-trimoxazole is significantly higher than that to Levofloxacin but lower than that to Nitrofurantoin and Fosfomycin.   KEYWORDS Urinary Tract Infections, Drug Resistance, Culture And Sensitivity, Minimum Inhibitory Concentration