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Cephalosporins for the treatment of uncomplicated pyelonephritis: A systematic review
Insights
Cephalosporins show effectiveness in treating acute uncomplicated pyelonephritis (APN). This systematic review found them to be a viable alternative to traditional treatments like ciprofloxacin or sulfamethoxazole-trimethoprim (SMX-TMP).
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Pharmacology
Background:
- Current guidelines recommend ciprofloxacin or sulfamethoxazole-trimethoprim (SMX-TMP) for uncomplicated acute pyelonephritis (APN).
- Increasing antimicrobial resistance necessitates exploring alternative treatment options.
Purpose of the Study:
- To systematically review the effectiveness of cephalosporins for uncomplicated APN.
- To analyze recent literature on cephalosporin use in APN treatment.
Main Methods:
- Systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
- Searched PubMed, Embase, and Scopus for studies published between January 2010 and September 2022.
- Included studies on uncomplicated APN treated with first- to fourth-generation cephalosporins, excluding specific study types.
Main Results:
- Eight studies (5 cohort, 2 RCTs, 1 nonrandomized experimental) met inclusion criteria.
- Commonly used cephalosporins included cefazolin, cephalexin, cefuroxime, cefotaxime, cefdinir, cefditoren, and ceftriaxone.
- Cephalosporins demonstrated effectiveness in clinical and microbiological outcomes, with no reported inferiority to fluoroquinolones or SMX-TMP.
Conclusions:
- Cephalosporins represent a potentially effective treatment option for uncomplicated APN.
- This finding supports expanding treatment choices beyond current first-line recommendations.
Background:
The 2011 Infectious Diseases Society of America and European Society of Clinical Microbiology and Infectious Diseases guidelines recommend ciprofloxacin or sulfamethoxazole-trimethoprim (SMX-TMP) as first-line agents to treat uncomplicated acute pyelonephritis (APN).
Objective:
With increasing antimicrobial resistance rates and recent changes in practice patterns, the objective of this systematic review was to describe the effectiveness of cephalosporins for uncomplicated APN in more recently published literature.
Methods:
Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for reporting. We searched PubMed, Embase, and Scopus for publications between January 2010 and September 2022. Eligible articles detailed patients with uncomplicated APN, treated with first- to fourth-generation cephalosporins, and identified a clinical, microbiological, or health care utilization outcome. Studies with more than 30% of complicated APN patients, non-English-language studies, case reports, case series, pharmacodynamic or pharmacokinetic studies, and in vitro laboratory or animal studies were excluded. Screening, review, and extraction were performed independently by 2 researchers, plus a third for conflict resolution. Critical appraisal of studies was performed using Joanna Briggs Institute checklists.
Results:
Eight studies met inclusion, including 5 cohort studies (62.5%), 2 randomized controlled trials (25%), and 1 nonrandomized experimental study (12.5%). Cephalosporins most used across the studies included cefazolin, cephalexin, cefuroxime, cefotaxime, cefdinir, cefditoren, and ceftriaxone. Outcomes assessed were diverse, including clinical or microbiological success and time to defervescence or symptom resolution. Cephalosporins displayed effectiveness for the treatment of acute uncomplicated APN regardless of study design or the presence of a comparison group. No trials reported inferiority of clinical treatment outcomes compared with a fluoroquinolone or SMX-TMP.
Conclusion:
Cephalosporins may be viable treatment options for the management of uncomplicated APN.
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