Cefaclor as a first-line treatment for acute uncomplicated cystitis

Abstract Background: Wide-spectrum antibiotics have been favored to treat acute uncomplicated cystitis (AUC) for a long time, leading to the emergence of multi-drug resistant bacteria. We hypothesize that narrow-spectrum antibiotics might mitigate the issue and aim to investigate the clinical efficacy of cefaclor in patients with AUC. Methods : We retrospectively reviewed the clinical data of female outpatients with AUC treated with cefaclor and evaluated the safety and clinical efficacy. Clinical cure was defined as the elimination of clinical symptom under 4 white blood cells (WBCs) per high power field on microscopy. Results : Overall, 223 women with AUC were enrolled. Escherichia coli was the dominant pathogen (n=160; 68.6%), followed by Klebsiella species and E. coli -extended spectrum β-lactamase (ESBL) (n=19; 8.1% and n=18; 7.7%). Overall success rate was 94.0% (n=219) and susceptibility rate of cefazolin was 84.1%, which was close to that of levofloxacin (82.9%). Ampicillin showed the lowest rate of 63.7% with a significantly greater resistance rate of 35.3% among all antibiotics (P<0.001). In the subgroup analysis, the success rate in patients with resistance to levofloxacin or cefazolin was 100% (n=24) or 93.3% (n=14). The rate in patients with resistance to both antibiotics was 60.0% (n=9), and the pathogens in the other 40.0% (n=6) of patients with treatment failure were E. coli -ESBL. Conclusion : Cefaclor showed excellent efficacy in AUC patients, even in those with in vitro resistance to cefazolin or levofloxacin. Cefaclor may be considered as a first-line option in patients with AUC and a second-line option for those with levofloxacin treatment failure.

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Cefaclor as a first-line treatment for acute uncomplicated cystitis

10.21203/rs.2.21475/v1 ◽

2020 ◽

Author(s):

Dai Koguchi ◽

Yasukiyo Murakami ◽

Masaomi Ikeda ◽

Masato Dobashi ◽

Junichiro Ishii

Keyword(s):

Treatment Failure ◽

Success Rate ◽

Clinical Efficacy ◽

Wide Spectrum ◽

White Blood Cells ◽

Resistant Bacteria ◽

First Line ◽

E Coli ◽

Acute Uncomplicated Cystitis ◽

Uncomplicated Cystitis

Abstract Background: Wide-spectrum antibiotics have been favored to treat acute uncomplicated cystitis (AUC) for a long time, leading to the emergence of multi-drug resistant bacteria. We hypothesize that narrow-spectrum antibiotics might mitigate the issue and aim to investigate the clinical efficacy of cefaclor in patients with AUC.Methods: We retrospectively reviewed the clinical data of female outpatients with AUC treated with cefaclor and evaluated the safety and clinical efficacy. Clinical cure was defined as the elimination of clinical symptom under 4 white blood cells (WBCs) per high power field on microscopy.Results: Overall, 223 women with AUC were enrolled. Escherichia coli was the dominant pathogen (n=160; 68.6%), followed by Klebsiella species and E. coli-extended spectrum β-lactamase (ESBL) (n=19; 8.1% and n=18; 7.7%). Overall success rate was 94.0% (n=219) and susceptibility rate of cefazolin was 84.1%, which was close to that of levofloxacin (82.9%). Ampicillin showed the lowest rate of 63.7% with a significantly greater resistance rate of 35.3% among all antibiotics (P<0.001). In the subgroup analysis, the success rate in patients with resistance to levofloxacin or cefazolin was 100% (n=24) or 93.3% (n=14). The rate in patients with resistance to both antibiotics was 60.0% (n=9), and the pathogens in the other 40.0% (n=6) of patients with treatment failure were E. coli-ESBL.Conclusion: Cefaclor showed an excellent efficacy in AUC patients, even in those with resistance to cefazolin or levofloxacin. Cefaclor has the potential to be the first-line and second-line therapies for patients with levofloxacin treatment failure.

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Cefaclor as a first-line treatment for acute uncomplicated cystitis: a retrospective single-center study

10.21203/rs.2.21475/v3 ◽

2020 ◽

Author(s):

Dai Koguchi ◽

Yasukiyo Murakami ◽

Masaomi Ikeda ◽

Masato Dobashi ◽

Junichiro Ishii

Keyword(s):

Treatment Failure ◽

Success Rate ◽

Clinical Efficacy ◽

Wide Spectrum ◽

White Blood Cells ◽

Resistant Bacteria ◽

First Line ◽

E Coli ◽

Acute Uncomplicated Cystitis ◽

Uncomplicated Cystitis

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Fosfomycin: A First-Line Oral Therapy for Acute Uncomplicated Cystitis

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2016/2082693 ◽

2016 ◽

Vol 2016 ◽

pp. 1-10 ◽

Cited By ~ 29

Author(s):

George G. Zhanel ◽

Andrew J. Walkty ◽

James A. Karlowsky

Keyword(s):

Clinical Trials ◽

Safety Profile ◽

Cross Resistance ◽

Adult Women ◽

First Line ◽

Favorable Safety Profile ◽

E Coli ◽

Acute Uncomplicated Cystitis ◽

Uncomplicated Cystitis ◽

Favorable Safety

Fosfomycin is a new agent to Canada approved for the treatment of acute uncomplicated cystitis (AUC) in adult women infected with susceptible isolates ofE. coliandEnterococcus faecalis. We reviewed the literature regarding the use of oral fosfomycin for the treatment of AUC. All English-language references from 1975 to October 2015 were reviewed. In Canada, fosfomycin tromethamine is manufactured as Monurol® and is available as a 3-gram single dose sachet. Fosfomycin has a unique chemical structure, inhibiting peptidoglycan synthesis at an earlier site compared toβ-lactams with no cross-resistance with other agents. Fosfomycin displays broad-spectrum activity against ESBL-producing, AmpC-producing, carbapenem-non-susceptible, and multidrug-resistant (MDR)E. coli. Resistance to fosfomycin inE. coliis rare (<1%). Fosfomycin is excreted unchanged in the urine by glomerular filtration with peak urinary concentration ~4000 µg/mL and remains at concentrations >100 µg/mL for 48 hours after a single 3-gram oral dose. No dosage adjustments are required in elderly patients, in pregnant patients, or in either renal or hepatic impairment. Fosfomycin demonstrates a favorable safety profile, and clinical trials have demonstrated efficacy in AUC that is comparable to ciprofloxacin, nitrofurantoin, and trimethoprim-sulfamethoxazole. Fosfomycin’s in vitro activity against common uropathogens, including MDR isolates, its favorable safety profile including pregnancy patients, drug interactions, and clinical trials data demonstrating efficacy in AUC, has resulted in Canadian, US, and European guidelines/authorities recommending fosfomycin as a first line agent for the treatment of AUC.

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Preferential Use of Nitrofurantoin Over Fluoroquinolones for Acute Uncomplicated Cystitis and Outpatient Escherichia coli Resistance in an Integrated Healthcare System

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.315 ◽

2017 ◽

Vol 38 (4) ◽

pp. 461-468 ◽

Cited By ~ 6

Author(s):

Rebecca L. Pedela ◽

Katherine C. Shihadeh ◽

Bryan C. Knepper ◽

Michelle K. Haas ◽

William J. Burman ◽

...

Keyword(s):

Healthcare System ◽

First Line ◽

Integrated Healthcare ◽

Acute Cystitis ◽

E Coli ◽

First Line Therapy ◽

System A ◽

Line Therapy ◽

Acute Uncomplicated Cystitis ◽

Uncomplicated Cystitis

OBJECTIVESTo evaluate changes in outpatient fluoroquinolone (FQ) and nitrofurantoin (NFT) use and resistance among E. coli isolates after a change in institutional guidance to use NFT over FQs for acute uncomplicated cystitis.DESIGNRetrospective preintervention–postintervention study.SETTINGUrban, integrated healthcare system.PATIENTSAdult outpatients treated for acute cystitis.METHODSWe compared 2 time periods: January 2003–June 2007 when FQs were recommended as first-line therapy, and July 2007–December 2012, when NFT was recommended. The main outcomes were changes in FQ and NFT use and FQ- and NFT-resistant E. coli by time-series analysis.RESULTSOverall, 5,714 adults treated for acute cystitis and 11,367 outpatient E. coli isolates were included in the analysis. After the change in prescribing guidance, there was an immediate 26% (95% CI, 20%–32%) decrease in FQ use (P<.001), and a nonsignificant 6% (95% CI, −2% to 15%) increase in NFT use (P=.12); these changes were sustained over the postintervention period. Oral cephalosporin use also increased during the postintervention period. There was a significant decrease in FQ-resistant E. coli of −0.4% per quarter (95% CI, −0.6% to −0.1%; P=.004) between the pre- and postintervention periods; however, a change in the trend of NFT-resistant E. coli was not observed.CONCLUSIONSIn an integrated healthcare system, a change in institutional guidance for acute uncomplicated cystitis was associated with a reduction in FQ use, which may have contributed to a stabilization in FQ-resistant E. coli. Increased nitrofurantoin use was not associated with a change in NFT resistance.Infect Control Hosp Epidemiol 2017;38:461–468

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1237. New York State Outpatient Regional Antibiogram for Urinary Pathogens: Have We Reached a Post Antibiotic Era for the Treatment of UTIs?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1070 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S376-S376

Author(s):

Elliot Rank ◽

Thomas P Lodise ◽

Lisa Avery ◽

Eve Bankert ◽

Erica Dobson ◽

...

Keyword(s):

New York ◽

New York State ◽

Empiric Therapy ◽

Outpatient Setting ◽

York State ◽

E Coli ◽

Enterococcus Spp ◽

Acute Uncomplicated Cystitis ◽

Uncomplicated Cystitis ◽

Outpatient Settings

Abstract Background Outpatient prescribing for acute uncomplicated cystitis is a significant driver of antimicrobial use. Empiric therapy should be based on local susceptibility data. However, there is limited guidance on regional susceptibility trends in outpatient settings. This study describes the epidemiology and prevalence of antimicrobial resistance in uropathogens in New York State outpatient settings to help inform empiric treatment decisions. Methods Retrospective analysis of positive urine cultures sent to Quest Diagnostics in 2016 from outpatient settings. Cultures that grew ≥105 CFU/mL were included from 17 NYS counties. Bacterial identification and antimicrobial sensitivities were determined on the Vitek-2 using CLSI M-100 S-25 breakpoints. Data were summarized as proportions and stratified by age (<17, 18–64, ≥65) and sex. Results Over 78,000 isolates were included (Table 1). The most prevalent isolates were Escherichia coli (65.2%), Enterococcus spp. (11.9%), and Klebsiella pneumoniae (9.9%). E. coli was highly susceptible to nitrofurantoin (NTF, 97.2%) and cefazolin (CFZ, 89.9%) and less susceptible to trimethoprim–sulfamethoxazole (TMP-SMX, 72.9%) and ciprofloxacin (CIP, 78.0%). Enterococcus spp. was highly susceptible to NTF (99.0%) and ampicillin (99.8%). K. pneumoniae was highly susceptible to TMP-SMX (90.0%) and CIP (95.2%) and markedly less susceptible to NTF (42.0%). E. coli was more prevalent in females (69.7% vs. 39.6%, P < 0.001). Enterococcus was more prevalent in males (39.6% vs. 10.1%, P < 0.001). The prevalence of K. pneumoniae was similar in men and women (9.6% vs. 10.1%, P = 0.08). Resistance was more prevalent in males (NTF: 6.3% vs. 4.2%; TMP-SMX: 26.3% vs. 22.7%; CIP: 35% vs. 17.3%) and for adults ≥65 (NTF: 6.2% vs. 3.6%; TMP-SMX: 25.1% vs. 22.1%; CIP: 30.0% vs. 14.0%) P < 0.001 for all comparisons. Conclusion NTF appears to be the best empiric choice for outpatient treatment of acute uncomplicated cystitis in New York State. TMP-SMX and ciprofloxacin should be avoided empirically. These data also highlight the necessity to obtain uropathogen sensitivity data to confirm empiric therapy or make appropriate adjustments in the outpatient setting. Table 1. Summary of Antimicrobial Susceptibilities Disclosures T. P. Lodise Jr., Motif BioSciences: Board Member, Consulting fee.

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Antimicrobial Resistance of Urinary Tract Isolates in Acute Uncomplicated Cystitis Among College-Aged Women: Choosing a First-Line Therapy

Journal of American College Health ◽

10.3200/jach.56.2.153-158 ◽

2007 ◽

Vol 56 (2) ◽

pp. 153-156 ◽

Cited By ~ 7

Author(s):

Leesa Hames ◽

Craig E. Rice

Keyword(s):

Urinary Tract ◽

Antimicrobial Resistance ◽

First Line ◽

First Line Therapy ◽

Line Therapy ◽

Acute Uncomplicated Cystitis ◽

Uncomplicated Cystitis

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Susceptibility to First-Line Antimicrobials Among Escherichia coli and Other Uropathogens Collected From Acute Uncomplicated Cystitis in Seattle, 1998–2014

Open Forum Infectious Diseases ◽

10.1093/ofid/ofv133.1126 ◽

2015 ◽

Vol 2 (suppl_1) ◽

Author(s):

Ann Stapleton ◽

Pacita Roberts ◽

Marsha Cox ◽

Aurelio Silvestroni ◽

Thomas Hooton

Keyword(s):

Escherichia Coli ◽

First Line ◽

Acute Uncomplicated Cystitis ◽

Uncomplicated Cystitis

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1421. Empiric Fluoroquinolone Prescribing Trends for Cystitis in Primary Care

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1613 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S794-S794

Author(s):

Kaitlin Brueggen ◽

Sara Revolinski ◽

Mickey Hart ◽

Magdalena Wrzesinski ◽

Anne R Daniels

Keyword(s):

Primary Care ◽

Adverse Effect ◽

Adverse Effects ◽

Primary Outcome ◽

Antibiotic Prescribing ◽

First Line ◽

Prescribing Trends ◽

Acute Uncomplicated Cystitis ◽

Tract Infections ◽

Uncomplicated Cystitis

Abstract Background Understanding outpatient antibiotic prescribing practices for urinary tract infections (UTIs) is vital in guiding future stewardship initiatives. Focusing on fluoroquinolones (FQs) is of value as FQs are commonly prescribed, but not recommended as first line therapy by the Infectious Diseases Society of America (IDSA) cystitis treatment guidelines and are also associated with multiple adverse effects. Boxed warnings state FQs should be reserved for patients with no alternative treatment options, due to risk of aortic dissection, C. difficile infection, antimicrobial resistance as well as tendon, joint, muscle, and nervous system damage. Methods This descriptive study assessed rates of guideline concordant empiric FQ prescribing from March 1 to June 30, 2019. Adult women prescribed an oral FQ for acute uncomplicated cystitis at a primary care clinic were included. Men, pregnant or breastfeeding women, and patients with pyelonephritis, urologic abnormality, or antibiotic use in the past 30 days were excluded. The primary outcome was the incidence of IDSA guideline concordance among FQs empirically prescribed. Guideline concordant empiric FQ therapy was defined as correct drug, dose, duration and frequency per IDSA guidelines when no first line drug is indicated due to allergy, adverse effect, previous treatment failure or most recent previous urine culture showing bacterial resistance. Secondary outcomes were mean dose (mg), mean duration (days) and incidence of adverse effects. Results Of 95 FQ prescriptions included, none met the primary outcome definition. Rates of guideline concordance for each component of the primary outcome definition were 6% for drug selection, 38% for dose, 37% for duration, and 99% for frequency. Mean daily doses exceeded guideline recommended doses by 62% and 100% for ciprofloxacin and levofloxacin, respectively. Mean duration was 5 days, 66% longer than 3 days as recommended by IDSA guidelines. Of 66 patients with documented follow up within 30 days, 3 (5%) experienced an adverse effect, and none developed C. difficile infection. Conclusion Current outpatient FQ prescribing for acute uncomplicated cystitis does not align with IDSA guidelines. Multifaceted antimicrobial stewardship initiatives are required to improve appropriate FQ use. Disclosures All Authors: No reported disclosures

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