Combination of co-trimoxazole and NAC effective in reducing bacterial adherence on ureteral stent surfaces

According to a recent study, a combination of co-trimoxazole and N-acetylcysteine (NAC) is more effective in reducing bacterial adherence on ureteral stent surfaces than either alone. This study was published in the journal, Urolithiasis.

This prospective randomized study included 636 patients, who underwent double J ureteral stent insertion after various urological procedures. Patients were randomized into four groups: no antibiotics or mucolytics during stent indwelling in group A (n = 165); oral NAC (200 mg/day for children aged < 12 years old and 600 mg/day for adults) during stent indwelling in group B (n = 153), oral co-trimoxazole (2 mg TMP/kg/day) during stent indwelling in group C (n = 162), and both oral NAC and co-trimoxazole during stent indwelling in group D (n = 156).

After a duration of two weeks from the insertion of the double J stent (JJ stent), a urinalysis was conducted on all patients and on the day of double J stent removal, a urine culture was carried out for all the patients. 2-weeks postoperatively, the stent was removed, and a stent segment sized 3-5 cm from the bladder segment of the stent was sent for culture. It was found that 63.6%, 43.1%, 37%, and 19.2% patients of groups A, B, C, and D, respectively had positive stent cultures. The most commonly isolated organism from the stent culture in all groups was E. coli.

The above findings suggest that the combination of co-trimoxazole and NAC is more effective in reducing bacterial adherence on ureteral stent surfaces than either alone.