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[Cefixime versus amoxicillin plus netilmicin in the treatment of community-acquired non-complicated acute
A Moreno-Martínez1, J Mensa, J A Martínez
1Servicios de Enfermedades Infecciosas y Microbiología, Hospital Clínic i Provincial, Barcelona.
Background:
Community-acquired non-complicated acute pyelonephritis (APN) is a frequent, occasionally serious infection (around 20% of the cases are bacteremic) that usually requires hospital admission. The third generation oral cephalosporins which are active against more than 95% of E. coli strains should allow the outpatient management of these patients.
Objective:
To evaluate the bacteriological and clinical efficacy of oral cefixime in comparison to amoxicilin plus netilcilin in the treatment of APN.
Patients And Methods:
Patients older than 18 years affected by APN were included in a fourteen month prospective study. According to a random numbers chart, the patients received cefixime (400 mg/24 h in a single daily dose for 12 days) or amoxicilin (1 g/8 h per os) plus netilmicin (4 mg/kg/24 h in a single intramuscular daily dose) during five days followed by 7 days of an oral treatment chosen according to the susceptibility pattern of isolated microorganism.
Results:
Sixty-one patients received cefixime and 65 amoxicillin plus retilmicin. There were no significant differences between both groups of patients. Thirty-two patients presented bacteremia (25.4%). The mean (SD) eak and trough concentrations of netilmicin were 11.4 (2.8) mg/l and 0.38 (0.4) mg/l, respectively. Clinical response was favorable in 97% of patients treated with cefixime and in 98% of those treated with amoxicilin plus netilmicin (p = NS). The infection recurred in 10 out of 59 patients (16.9%) in the cefixime arm of the study and in 9 out of 64 patients (14%) treated with amoxicillin plus netilmicin (p = NS). Tolerance to the study drugs was good in both arms of the study, and renal function remained normal.
Conclusion:
Cefixime seems to be an acceptable alternative to the regimens containing an aminopenicillin and an aminoglycoside for the treatment of community-acquired non-complicated APN.
Insights
Oral cefixime offers an effective outpatient treatment for acute pyelonephritis (APN), demonstrating comparable clinical efficacy to amoxicillin plus netilmicin. This approach provides a viable alternative for managing this common infection.
Area of Science:
- Infectious Diseases
- Pharmacology
- Nephrology
Background:
- Community-acquired acute pyelonephritis (APN) is a common infection often requiring hospitalization.
- Bacteremia occurs in approximately 20% of APN cases.
- Third-generation oral cephalosporins show high activity against common E. coli strains, suggesting potential for outpatient management.
Purpose of the Study:
- To compare the bacteriological and clinical effectiveness of oral cefixime versus amoxicillin plus netilmicin for APN treatment.
- To evaluate cefixime as an outpatient management option for APN.
Main Methods:
- A prospective study involving adult patients diagnosed with APN.
- Patients were randomized to receive either oral cefixime (400 mg daily for 12 days) or a combination of oral amoxicillin and intramuscular netilmicin for 5 days, followed by oral treatment.
- Clinical and bacteriological outcomes were assessed.
Main Results:
- No significant differences in efficacy were observed between the cefixime and amoxicillin/netilmicin groups.
- Favorable clinical responses were achieved in 97% of the cefixime group and 98% of the amoxicillin/netilmicin group.
- Recurrence rates were similar (16.9% for cefixime vs. 14% for amoxicillin/netilmicin), with good drug tolerance and preserved renal function.
Conclusions:
- Oral cefixime is a suitable alternative to amoxicillin/netilmicin regimens for treating community-acquired non-complicated APN.
- Cefixime facilitates outpatient management, potentially reducing hospital admissions.
- The study supports the use of cefixime in managing APN effectively and safely.