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Cefdinir Versus Cephalexin for the Treatment of Uncomplicated Urinary Tract Infections
Tyler M Mitzner1, Kristen M Eid1, Destiny M Hughson1
1Department of Pharmacy, Trinity Health Grand Rapids Hospital, Grand Rapids, Michigan, USA.
Background:
Due to its low bioavailability and poor urinary penetration, there are concerns that cefdinir is a suboptimal agent for the treatment of urinary tract infections (UTIs). Limited available literature examining cefdinir's use for UTIs has not shown worse outcomes compared with other oral beta-lactams; however, these studies are limited by small sample size or lack of symptom assessment as a measure of clinical cure.
Methods:
This retrospective, multicenter cohort study included adult female patients who received either cefdinir or cephalexin for 5-7 days for symptomatic uncomplicated UTI (uUTI). The primary objective was to compare treatment failure, defined as recurrent or continued urinary symptoms necessitating re-treatment within 30 days, between patients treated with oral cefdinir 300 mg twice daily (cefdinir group) and cephalexin 500 mg twice daily (cephalexin group) in the outpatient setting.
Results:
Three hundred sixty-seven patients were included (cefdinir n = 167; cephalexin, n = 200). Patients treated with cefdinir experienced a significantly higher rate of treatment failure (23.4% vs 12.5%, P = .006), and cefdinir was independently associated with treatment failure (odds ratio: 1.9 [95% CI: 1.1-3.4]). Additionally, patients who experienced treatment failure with cefdinir had a higher incidence of cefazolin nonsusceptible pathogens (cefdinir 37.5% vs cephalexin 0%; P = .024) and ceftriaxone nonsusceptible pathogens (cefdinir 31.2% vs cephalexin 0%; P = .053) on repeat culture.
Conclusions:
Cefdinir was independently associated with treatment failure with nearly twice as high of failure rate compared with cephalexin for the treatment of outpatient uUTI. Patients who failed treatment with cefdinir were more likely to demonstrate cephalosporin resistance on subsequent urine culture.
Insights
Cefdinir showed a higher treatment failure rate for uncomplicated urinary tract infections (uUTIs) compared to cephalexin. Patients failing cefdinir treatment were more likely to have resistant pathogens on repeat urine culture.
Area of Science:
- Infectious Diseases
- Pharmacology
- Urology
Background:
- Concerns exist regarding cefdinir's efficacy for urinary tract infections (UTIs) due to low bioavailability and poor urinary penetration.
- Existing literature on cefdinir for UTIs is limited, with small sample sizes and insufficient symptom assessment for clinical cure.
- This study addresses the need for robust data on cefdinir's real-world effectiveness in treating uncomplicated UTIs (uUTIs).
Purpose of the Study:
- To compare treatment failure rates between cefdinir and cephalexin in adult female patients with symptomatic uncomplicated UTIs (uUTIs).
- To evaluate the association between cefdinir use and treatment failure in an outpatient setting.
Main Methods:
- Retrospective, multicenter cohort study including adult female patients with symptomatic uUTI.
- Patients received either cefdinir (300 mg twice daily) or cephalexin (500 mg twice daily) for 5-7 days.
- Treatment failure was defined as recurrent or continued urinary symptoms requiring re-treatment within 30 days.
Main Results:
- A total of 367 patients were included (cefdinir n=167; cephalexin n=200).
- Cefdinir treatment failure rate was significantly higher (23.4%) compared to cephalexin (12.5%) (P=.006).
- Cefdinir was independently associated with treatment failure (OR: 1.9; 95% CI: 1.1-3.4), with higher rates of cefazolin and ceftriaxone non-susceptible pathogens upon failure.
Conclusions:
- Cefdinir demonstrated a nearly twofold higher rate of treatment failure compared to cephalexin for outpatient uUTI.
- Patients experiencing treatment failure with cefdinir were more likely to have cephalosporin-resistant pathogens identified on subsequent urine cultures.
- These findings suggest cefdinir may be a suboptimal choice for treating uncomplicated UTIs in this patient population.
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