Effect of Antibiotics on Urinary Microbiome

Overview

Planning to study urine microbiota at baseline and after administration of bactrim antibiotics in healthy volunteers. Will intermittently collect voided urine specimens for 16 s DNA analysis over a period of 6 months after 2 weeks of bactrim or placebo.

Full Title of Study: “Effect of Antibiotics on Urinary Microbiome: Randomized Trial”

Study Type

• Study Type: Interventional
• Study Design
  • Allocation: Randomized
  • Intervention Model: Parallel Assignment
  • Primary Purpose: Basic Science
  • Masking: Triple (Participant, Care Provider, Investigator)
• Study Primary Completion Date: February 2025

Detailed Description

Urinary tract infections (UTI) are the most common type of human bacterial disease, prompting more than 10 million physician office visits annually at a healthcare cost of over $1 billion dollars. Treatment of UTI is typically empiric or culture-driven antibiotics which are associated with ever increasing bacterial resistance. Over the last decade, The Human Microbiome Project has established that even 'culture-negative' urine represents a diverse ecosystem of bacteria. Despite broad use of antibiotics to cure disease for the past 90 years, the broader impact of antibiotics on typical flora are not well understood. Antibiotics are also commonly used as prophylaxis for surgical procedures in the urinary tract altering patient outcomes in unforeseen ways. Despite widespread utilization of antibiotics, the longitudinal impact on the dynamic intravesical environment remains completely unknown. Dysbiosis in the microbiome has been suggested as a causative agent in a wide range of disease: arthritis, metabolic disorders, neurologic disease, inflammatory bowel conditions, and cancer. Yet there remains a fundamental knowledge gap regarding the short and long-term effect of antibiotics on microbiota communities. Specifically within the urinary tract, variance in baseline commensal organisms have been associated with interstitial cystitis, overactive bladder, frequent symptomatic urinary tract infection and potentially cancer development. The study of microbiota reveal pathways and mechanisms that play important roles in immunological response and health but studies typically are limited to the gut. To address this knowledge gap, the investigators plan a placebo controlled randomized trial to test the longitudinal impact of 10 days of trimethoprim-sulfamethoxazole on the urinary microbiome in healthy adults. Data collection for individual participants will persist for a period of 6 months. The investigators hypothesize antibiotic administration contributes to a rise in bacterial resistance and directly leads to urine microbiome dysbiosis. The investigators further hypothesize the urinary microbiome does not return to baseline, with loss of certain bacteria permanent during the study period. While the investigators' study is groundbreaking and novel, the feasibility of the investigators' experimental plan has been previously demonstrated in the study of the salivary and gut microbiome. Ultimately the investigators anticipate even a single course of antibiotic treatment may increase the risk of bacterial resistance and lead to long-lasting shifts in the urinary microbiome. If confirmed, this knowledge will directly influence clinical decision making in antibiotic selection, duration, and utility.

Interventions

• Drug: Bactrim DS 800Mg-160Mg Tablet
  • To study effect on urinary microbiome
• Drug: Placebo oral tablet
  • To study effect on urinary microbiome

Arms, Groups and Cohorts

• Placebo Comparator: Placebo
  • Participants will be recruited and enrolled. Participants will be surveyed regarding environmental, health, and behavioral practices. (Instrument 1) . Then a clean catch urine specimen will be collected. Participants will be provided with placebo to be taken twice daily. This will be considered day 0. Participants will then be instructed to take the study drug twice daily and return on Day 2, Day 5, Day 10, Day 30, and Day 180 for additional clean-catch urine specimen.
• Experimental: Bactrim
  • Participants will be recruited and enrolled. Participants will be surveyed regarding environmental, health, and behavioral practices. (Instrument 1) . Then a clean catch urine specimen will be collected. Participants will be provided with Bactrim 800/120 to take twice daily. This will be considered day 0. Participants will then be instructed to take the study drug twice daily and return on Day 2, Day 5, Day 10, Day 30, and Day 180 for additional clean-catch urine specimen.

Clinical Trial Outcome Measures

Primary Measures

• Change in Microbiome flora number of organisms
  • Time Frame: At Baseline, Day 2, Day 5, Day 10, Day 30, and Day 180 of study
  • Analysis of 16S rRNA gene amplicon data to determine number of varied organisms (genus and species).
• Change in Microbiome flora percentage distribution of organisms
  • Time Frame: At Baseline, Day 2, Day 5, Day 10, Day 30, and Day 180 of study
  • Analysis of 16S rRNA gene amplicon data to determine the percent distribution of organisms (microbiologic genus and species).

Participating in This Clinical Trial

Exclusion Criteria

• Diagnosed or suspected urinary tract infection in prior 6 months – Treated with antibiotics for any reason in prior 6 months – Allergy to sulfa – Under 18 – Pregnant or planning to become pregnant in the next 12 months by self report (as is the clinical standard for prescribing this medication for suspected or proven UTI treatment) – Use indwelling or intermittent urinary hardware or implant such as supra-pubic tube or catheter – Neurogenic bladder – Baseline renal insufficiency – Glucose-6-phosphate dehydrogenase deficiency – Taking angiotensin converting enzyme – Angiotensin receptor blocker – Nursing – HIV/AIDS – On Immunosuppressant drugs – On Chemotherapy/Immunotherapy – Liver dysfunction – On the following medications: DOFETILIDE, METHENAMINE & LEVOMETHADYL; WARFARIN & Methotrexate; GEMIFLOXACIN, DIGOXIN, PYRIMETHAMINE, CLASS IA ANTIARRHYTHMIC AGENTS (Quinidine, procainamide, disopyramide), TRICYCLIC ANTIDEPRESSANTS (amitriptyline, desipramine, doxepin, Imipramine, nortriptyline, amoxapine, clomipramine, maprotiline, trimipramine, and protriptyline), LEUCOVORIN CALCIUM.

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: Accepts Healthy Volunteers

Investigator Details

• Lead Sponsor
  • Johns Hopkins University
• Provider of Information About this Clinical Study
  • Sponsor
• Overall Official(s)
  • Andrew J Cohen, MD, Principal Investigator, Johns Hopkins University