Cefuroxime axetil versus ofloxacin for short-term therapy of acute uncomplicated lower urinary tract infections in women

Naber, Kurt G.; Koch, Ernst

doi:10.1007/bf01739308

Cited by 36 publications

(9 citation statements)

References 9 publications

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“…At 28 days after the discontinuation of therapy, clinical cures were observed in 87.3 and 85% of the patients in the cefpodoxime-proxetil and TMP-SMX arms, respectively, and the rates of overall bacteriological eradication were 86 and 84% in the two arms, respectively. Although there is some evidence that short-term ciprofloxacin therapy may be more efficient for the eradication of urinary pathogens (11), the regimens used in the present study were better than those obtained with a short course of cefixime (18) and were similar to those obtained by Cox et al (4) when cefpodoxime-proxetil was administered for 7 days (14). Two double-blind multicenter trials (4) compared cefpodoxime-proxetil (100 mg twice daily) with cefaclor (250 mg three times daily) or amoxicillin (250 mg three times daily) in 463 evaluable adult patients with uncomplicated UTIs.…”

Section: Discussionsupporting

confidence: 82%

“…In a multicenter study, a 3-day regimen of cefuroxime-axetil proved to be as effective as a 3-day regimen of ofloxacin for the treatment of uncomplicated UTIs in 163 women (14). In the latter study, clinical cure and improvement were registered in 84.8 and 95.2% of the patients, respectively, at 7 to 9 days posttherapy, whereas bacteriuria (Ͻ10 3 /ml) was eliminated from 80.3 and 89.1% of the evaluable patients receiving cefuroxime-axetil and ofloxacin, respectively, with no statistically significant difference between treatment groups.…”

Section: Discussionmentioning

confidence: 99%

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Cefpodoxime-Proxetil versus Trimethoprim-Sulfamethoxazole for Short-Term Therapy of Uncomplicated Acute Cystitis in Women

Kavatha

Giamarellou

Alexiou

et al. 2003

Antimicrob Agents Chemother

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One hundred sixty-three women with uncomplicated acute lower urinary tract infections were included in a multicenter randomized study comparing cefpodoxime-proxetil (one 100-mg tablet twice daily) with trimethoprim-sulfamethoxazole (one double-strength tablet [160/800 mg] twice daily) for 3 days. A total of 30 women in both arms were excluded from the study for various reasons. At 4 to 7 days after the discontinuation of therapy, 62 of 63 (98.4%) cefpodoxime-proxetil recipients and 70 of 70 (100%) trimethoprim-sulfamethoxazole patients were clinically cured and demonstrated bacteriological eradication, respectively. At 28 days after treatment, 48 of 55 (87.3%) and 43 of 50 (86%) cefpodoxime-proxetil recipients as well as 51 of 60 (85%) and 42 of 50 (84%) trimethoprim-sulfamethoxazole recipients were clinically cured and demonstrated bacteriological eradication, respectively. Independently of the prescribed regimen, a significant difference (P < 0.001) in failure rates was observed only for patients with a previous history of three or more episodes of acute cystitis per year. With the exception of one patient in the trimethoprim-sulfamethoxazole arm who discontinued therapy because of gastrointestinal pain, both antimicrobials were well tolerated. In conclusion, cefpodoximeproxetil treatment for 3 days was as safe and effective as trimethoprim-sulfamethoxazole for 3 days for the treatment of uncomplicated acute cystitis in women.Among pre-and postmenopausal women, uncomplicated lower urinary tract infections (UTIs) constitute a common reason for seeking medical assistance. Short-course, 3-day therapeutic regimens with trimethoprim-sulfamethoxazole (TMP-SMX) and fluoroquinolones have been proven to be as effective as longer courses of Ն5 days and are widely used (13,22). Their advantages are based on increased patient compliance, with decreased adverse effects, decreased costs, and deceased rates of resistance development among the gut and vaginal flora (20). However, the increasing rates of TMP-SMX resistance in the community worldwide (2, 10, 17) as well as the adverse effects of TMP-SMX (3) are causes for concern. Thus, alternative short-course antimicrobial regimens are required. Unfortunately, amoxicillin and older cephalosporins are efficacious only when they are administered for Ն5 days, while nitrofurantoin requires at least 7 days of therapy (16).Cefpodoxime-proxetil is an orally administered prodrug which is absorbed and deesterified by the intestinal mucosa to release the advanced cephalosporin cefpodoxime, which has approximately 50% systemic bioavailability (5). Cefpodoxime absorption is significantly increased by food, whereas it is reduced by agents that elevate the gastric pH (5). It has a broad spectrum of antibacterial activity encompassing both gramnegative and gram-positive bacteria and is stable against the most commonly found plasmid-mediated beta-lactamases including the TEM-2 and SHV-1 enzymes (5, 23); however, cefpodoxime is hydrolyzed by SHV-2, which is produced by some Klebsiella pneumon...

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Cefpodoxime-Proxetil versus Trimethoprim-Sulfamethoxazole for Short-Term Therapy of Uncomplicated Acute Cystitis in Women

Kavatha

Giamarellou

Alexiou

et al. 2003

Antimicrob Agents Chemother

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“…In general, first-and second-generation oral cephalosporines are not recommended as first-line antimicrobials for a 3-day treatment of uncomplicated UTI [2,84,85]. However, among third-generation oral cephalosporins, a 3-day course with cefpodoxime-proxetil (200 mg twice daily) was as safe and effective as that of TMP-SMX in 133 evaluble patients [86].…”

Section: Beta-lactam Antibioticsmentioning

confidence: 96%

Suitable Antibacterial Substances for the Treatment of Urinary Tract Infections

Wagenlehner¹,

Naber

2006

AIAMC

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Bacterial urinary tract infections (UTIs) are frequently found in the outpatient as well as in the nosocomial setting. The bacterial UTIs can be stratified into uncomplicated and complicated UTIs. In uncomplicated UTIs Escherichia coli is the leading organism, whereas in complicated UTIs the bacterial spectrum is much broader including Gramnegative and Gram-positive organisms. Therapy of uncomplicated UTIs is almost exclusively antibacterial, whereas in complicated UTIs the complicating factors have to be treated as well. Antibiotic resistance nowadays plays an important role in the treatment of uropathogens causing uncomplicated and complicated UTIs. Especially in nosocomially acquired complicated UTIs antibiotic resistance rates are increasing to levels where empiric treatment with orally available antibiotics becomes difficult. In recent years also uropathogens causing uncomplicated UTIs became more resistant to the antibiotic substances most frequently used for this indication.There are two predominant aims in the antimicrobial treatment of both uncomplicated and complicated UTIs: i.) rapid and effective response to therapy, prevention of complications and prevention of recurrence in the individual patient treated, and ii.) prevention of emergence of resistance to anti-infective agents in the microbial environment.Bacterial resistance mechanisms to antibiotics are nowadays better understood which helps to design derivatives and new substances that will hopefully be less susceptible for the emergence of resistance.Pharmacokinetic and pharmacodynamic parameters are increasingly used to improve dosing strategies of the current antiinfective agents, to predict efficacy in patients and to minimize emergence of resistance. For the treatment of UTIs, however, these instruments are not yet developed satisfactorily enough. New treatment strategies are also needed to maintain effective treatment of UTIs.The aim of this review is to highlight the current and to describe future treatment options for UTIs. The chemistry of current substance groups and its importance for the antiinfective spectrum and activity is explained. Pharmacokinetic/ pharmacodynamic models for UTIs are described and new treatment options to cope with antimicrobial resistance are discussed.

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“…There are, however, country-specific differences. Three-day therapy with cefuroxime axetil is not well established because studies have been underpowered to demonstrate its equivalence to cotrimoxazole [35]. It is also debatable whether the same breakpoints can be applied for the oral form as for the parenteral form, because the absolute bioavailability of the parenteral form is about six to 12 times higher when the usual intravenous dose of 750 mg is compared with the usual oral dose of 250 mg (or 125 mg), assuming an enteral reabsorption of about 50%.…”

Section: Oral Cephalosporinsmentioning

confidence: 99%

Antibiotic treatment of uncomplicated urinary tract infection in premenopausal women

Naber

Wullt

Wagenlehner

2011

International Journal of Antimicrobial Agents

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Cefuroxime axetil versus ofloxacin for short-term therapy of acute uncomplicated lower urinary tract infections in women

Cited by 36 publications

References 9 publications

Cefpodoxime-Proxetil versus Trimethoprim-Sulfamethoxazole for Short-Term Therapy of Uncomplicated Acute Cystitis in Women

Cefpodoxime-Proxetil versus Trimethoprim-Sulfamethoxazole for Short-Term Therapy of Uncomplicated Acute Cystitis in Women

Suitable Antibacterial Substances for the Treatment of Urinary Tract Infections

Antibiotic treatment of uncomplicated urinary tract infection in premenopausal women

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