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Pivmecillinam for Uncomplicated Acute Cystitis: A Contemporary Review

Jessica E Burchette1, Kelly Covert1, Patrick Tu2

  • 1Department of Pharmacy Practice, ETSU Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN, USA.

The Annals of Pharmacotherapy
|December 7, 2024
PubMed
Abstract

Insights

Pivmecillinam is effective for treating uncomplicated acute cystitis, offering a valuable option as antimicrobial resistance grows. Higher doses and longer durations show better results for this common urinary tract infection.

Area of Science:

  • Pharmacology and Infectious Diseases
  • Antimicrobial Resistance Studies

Background:

  • Rising resistance to first-line antimicrobials necessitates novel treatment strategies.
  • Pivmecillinam offers a new therapeutic option for uncomplicated acute cystitis in the US.

Purpose of the Study:

  • To review evidence on pivmecillinam for uncomplicated acute cystitis.
  • To discuss its efficacy, safety, and place in therapy.

Main Methods:

  • Literature search of PubMed and ClinicalTrials.gov (2000-2024).
  • Included English-language RCTs on pivmecillinam for UTIs in adults.
  • MeSH terms: mecillinam, pivmecillinam, urinary tract infections.

Main Results:

  • Six RCTs support pivmecillinam for acute uncomplicated cystitis (200-400 mg TID for 3-7 days).
  • 400 mg doses and longer durations yielded better clinical and bacteriologic cure rates.
  • Limited data exist for pyelonephritis; caution advised.

Conclusions:

  • Pivmecillinam is a promising agent for uncomplicated acute cystitis.
  • Its use may be cost-driven but is encouraged for susceptible uropathogens due to low resistance.
  • Considered a key agent when other treatments fail due to resistance.
Keywords:
antimicrobialscystitismecillinampivmecillinamurinary tract infections

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