February 13, 2012

Antibiotic’s Effectiveness for Bladder Infections

(Ivanhoe Newswire) -- A recent study has discovered that short-term use of the antibiotic cefpodoxime for treatment of bladder infections (uncomplicated cystitis) in women did not meet criteria for achieving clinical cure compared to ciproflaxacin, a drug classified as fluoroquinolone antibiotics, that is under concern for overuse and resulting in an increase in resistance rates. While fluoroquinolone has minimal adverse drug reactions when used in a 3-day regimen and high efficacy rates, increasing rates of antimicrobial resistance among fluoroquinolone were reported.

To prevent further emergence of fluoroquinolone resistance, professionals want to restrict fluoroquinolones to specific cases of bladder infections when other UTI antimicrobials are not efficient. According to the study published in JAMA, Cefpodoxime would provide a useful alternative to fluoroquinolone for the treatment of bladder infection if proven to be similar in efficacy and without adverse ecological effects. The clinical trial was conducted at the University of Miami to assess if cefpodoxime would be acceptable compared to ciproflaxacin. Intent-to-treat and per-protocol analyses were performed and 15 women in the ciprofloxacin and 17 in the cefpodoxime group were lost to follow-up.

From 2005 until 2009, the study included 300 women aged 18 to 55 years old who had a bladder infection. Participants were assessed at 5 to 9 days and again at 28 to 30 days after completion of therapy; intent-to-treat and per-protocol analyses were conducted. Patients were randomly given 250 mg of ciprofloxacin twice a day (orally) for 3 days or 100 mg of cefpodoxime orally twice a day for 3 days. The overall clinical cure was defined as not requiring antimicrobial treatment during the follow-up visit after 30 days. Researchers found that the overall clinical cure rate with the intent-to-treat approach in which patients lost to follow-up were attributed as having clinical cure was 93% (139/150) for ciprofloxacin compared with 82% (123/150) for cefpodoxime. In another intent-to-treat analysis in which patients who were lost to follow-up were considered to have not responded to treatment. The clinical cure rate was 83% for ciprofloxacin compared with 71% for cefpodoxime. Also women who had no previous UTI in the past year, the cure rate was 96% for ciprofloxacin and 83% for cefpodoxime, a huge difference that was not seen in women who reported 1 or more in the past year.

The clinical cure at the first follow-up visit was 93% for ciprofloxacin compared to 88% for cefpodoxime. The microbiological cure rate was 96% for ciprofloxacin compared to 81% for cefpodoxime; also at first follow-up 16% of women in the ciprofloxacin group compared with 40% in the cefpodoxime group had vaginal E. coli colonization.  Researchers think that the effect of the two drugs on vaginal E. coli colonization may have had something to do with the difference in clinical outcomes.

Lead investigator of the study at the University of Miami, Thomas M. Hooten, M.D., was quoted as saying, “Among women with uncomplicated cystitis, a 3-day regimen of cefpodoxime compared with ciprofloxacin did not meet criteria for noninferiority for achieving clinical cure. This finding, along with concerns about possible ecological adverse effects associated with other broad-spectrum antimicroboials that include cefpodoxime, do not support the use of cefpodoxime as a first-line fluoroquinolone-sparing antimicrobial for acute uncomplicated cystitis.”

SOURCE: JAMA, February 2012