Response rates were clearly inferior to those achieved with short-course ciprofloxacin.
Uncomplicated urinary tract infection (UTI) in women is easy to treat — so easy that guidelines advise reserving fluoroquinolones like ciprofloxacin for more-serious infections (Clin Infect Dis 2011; 52:e103). However, without the quinolones, the list of first-line drugs for a standard-issue Escherichia coli UTI is quite short.
In a recent, double-blind, randomized trial, researchers compared the oral fourth-generation cephalosporin cefpodoxime (Vantin) with ciprofloxacin in 300 young, healthy women with uncomplicated UTI. Treatment lasted for 3 days in each group.
Compared with women who received ciprofloxacin, those who received cefpodoxime were significantly less likely to sustain a microbiologic cure within 1 week after treatment (81% vs. 96%) and were also less likely to report complete clinical cure 1 month later (82% vs. 93%). Analyses of various subgroups (women with no prior UTI during the past year, women with strains susceptible to the study antibiotic) yielded similar results. Drug-related side effects were similar in both groups.
Comment: These results are sufficient to eliminate cefpodoxime from the list of first-line oral drugs for uncomplicated urinary tract infection. In fact, the official prescribing information for this drug acknowledges its "lower bacterial eradication rates" compared with those of other drug classes. Clinicians are left with trimethoprim-sulfamethoxazole, nitrofurantoin, fosfomycin, and — for those who choose to ignore rising concerns about drug resistance — the ever-tempting and convenient ciprofloxacin.
Published in Journal Watch General Medicine February 16, 2012
No comments:
Post a Comment