Pivmecillinam for bacteriuria in pregnancy

Sanderson, P.J.; Menday, Paul

doi:10.1093/jac/13.4.383

Cited by 22 publications

(6 citation statements)

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“…The trial by Davies 1975 included men, non-pregnant women, and pregnant women with and without symptoms; separate results were not presented for asymptomatic pregnant women. The study reported by Sanderson 1984 focused on prophylaxis in women who had already been treated for bacteriuria.…”

Section: Resultsmentioning

confidence: 99%

“…single dose of penicillins, cephalosporins, and co-trimoxazole versus their traditional dosing schedules) Reeves 1975 The study randomized only 1 subgroup. It was not clear why that subgroup was randomized Sanderson 1984 This trial focused on prophylaxis in women who had already been treated for bacteriuria Stamatiou 2007 It was not a randomized trial. Some of the subjects had symptomatic urinary tract infection Thoumsin 1990 Only preliminary data were published. Whalley 1977 Short-term therapy (of either 1 of 2 antibiotics) was compared with long therapy (of one of the antibiotics) Zinner 1971 It was not for asymptomatic bacteriuria. Zinner 1990 The study included symptomatic patients.RCT: randomized controlled trial…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

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Different antibiotic regimens for treating asymptomatic bacteriuria in pregnancy

Guinto

Guia

Festin³

et al. 2010

Cochrane Database of Systematic Reviews

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Background Asymptomatic bacteriuria occurs in 5% to 10% of pregnancies and, if left untreated, can lead to serious complications. Objectives To assess which antibiotic is most effective and least harmful as initial treatment for asymptomatic bacteriuria in pregnancy. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (March 2010) and reference lists of retrieved studies. Selection criteria Randomized controlled trials comparing two antibiotic regimens for treating asymptomatic bacteriuria. Data collection and analysis Review authors independently screened the studies for inclusion and extracted data. Main results We included five studies involving 1140 women with asymptomatic bacteriuria. We did not perform meta-analysis; each trial examined different antibiotic regimens and so we were not able to pool results. In a study comparing a single dose of fosfomycin trometamol 3 g with a five-day course of cefuroxime, there was no significant difference in persistent infection (risk ratio (RR) 1.36, 95% confidence interval (CI) 0.24 to 7.75), shift to other antibiotics (RR 0.08, 95% CI 0.00 to 1.45), or in allergy or pruritus (RR 2.73, 95% CI 0.11 to 65.24). A comparison of seven-day courses of 400 mg pivmecillinam versus 500 mg ampicillin, both given four times daily, showed no significant difference in persistent infection at two weeks or recurrent infection, but there was an increase in vomiting (RR 4.57, 95% CI 1.40 to 14.90) and women were more likely to stop treatment early with pivmecillinam (RR 8.82, 95% CI 1.16 to 66.95). When cephalexin 1 g versus Miraxid® (pivmecillinam 200 mg and pivampicillin 250 mg) were given twice-daily for three days, there was no significant difference in persistent or recurrent infection. A one- versus seven-day course of nitrofurantoin resulted in more persistent infection with the shorter course (RR 1.76, 95% CI 1.29 to 2.40), but no significant difference in symptomatic infection at two weeks, nausea, or preterm birth. Comparing cycloserine with sulphadimidine, no significant differences in symptomatic, persistent, or recurrent infections were noted. Authors’ conclusions We cannot draw any definite conclusion on the most effective and safest antibiotic regimen for the initial treatment of asymptomatic bacteriuria in pregnancy. One study showed advantages with a longer course of nitrofurantoin, and another showed better tolerability with ampicillin compared with pivmecillinam; otherwise, there was no significant difference demonstrated between groups treated with different antibiotics. Given this lack of conclusive evidence, it may be useful for clinicians to consider factors such as cost, local availability and side effects in the selection of the best treatment option.

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Section: Resultsmentioning

confidence: 99%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Different antibiotic regimens for treating asymptomatic bacteriuria in pregnancy

Guinto

Guia

Festin³

et al. 2010

Cochrane Database of Systematic Reviews

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“…Mecillinam is effective for the treatment of infections of the urinary tract (Cox, 1983). The oral formulation of this drug, pivmecillinam, is widely used for both symptomatic and asymptomatic infections of this kind during pregnancy (Brumfitt et al, 1979;Sanderson & Menday, 1984). Pivmecillinam is the pivaloyloxymethylester of mecillinam and lacks antibacterial activity per se.…”

Section: Introductionmentioning

confidence: 99%

The pharmacokinetics of mecillinam and pivmecillinam in pregnant and non‐pregnant women.

Heikkilä

Pyykkö

Erkkola

et al. 1992

Brit J Clinical Pharma

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1 The pharmacokinetics of parenteral mecillinam (n = 27) and oral pivmecillinam (n -12) were studied in pregnant (n = 27) and non-pregnant (n = 12) subjects. 2 In early pregnancy (9-14 weeks of gestation) the mean peak plasma drug concentration (Cmax = 19 ± 9 jg ml-1) after an intravenous injection of 200 mg mecillinam was significantly lower (P < 0.05) and the volume of distribution (V = 49 ± 20 1) significantly larger (P < 0.05) than in non-pregnent subjects (Cmax = 35 ± 18 jig ml-1, V = 29 ± 12 1). In late pregnancy (39-40 weeks of gestation) the plasma mean peak concentration (Cmax = (29 ± 14 jig ml-') after parenteral administration of 200 mg mecillinam was slightly lower and the volume of distribution (V = 65 ± 29 1, V = 0.9 ± 0.4 1 kg-') significantly larger than that in non-pregnant subjects (V = 0.4 ± 0.3 1 kg-). Also after oral administration of 200 mg pivmecillinam, equimolar to 136.5 mg mecillinam, the mean peak plasma concentration in pregnant subjects (Cmax = 1.8 ± 1.2 jig ml-') was slightly lower than that in non-pregnant subjects (Cmax = 1.7 ± 1.2 jig mlF1).3 The mean half-life of elimination after parenteral administration of mecillinam was significantly longer during both early (t,/2Z = 133 ± 38 min, P < 0.05) and late pregnancy (tl/2,Z = 107 ± 41 min, P < 0.05) as compared with the non-pregnant state (t/2,Z = 75 ± 21 min). After oral administration of pivmecillinam the elimination half-life was similar in pregnant (t½/2,z = 57 ± 34 min) and non-pregnant women (t/2,Z = 61 ± 32 min). 4 The transfer of mecillinam across the placenta was fast and it was detected in umbilical venous and arterial plasma, and in amniotic fluid. The ratio of umbilical venous plasma concentration to maternal plasma concentration in late pregnancy was 0.85. The ratios of amniotic fluid to maternal plasma drug concentration were 0.18 and 0.21 during early and late pregnancy after parenteral administration. 6 After parenteral administration of mecillinam its urinary recoveries in the first 8 h were 66% in early pregnancy, 72% in late pregnancy and 81% in the non-pregnant state. After oral administration 8 h urine recoveries were 28% and 39% in pregnant and non-pregnant states, respectively. 7 It is concluded that there is no need to increase the dosage of mecillinam or pivmecillinam during pregnancy.

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“…It was not clear why that subgroup was randomized Sanderson 1984 This trial focused on prophylaxis in women who had already been treated for bacteriuria Stamatiou 2007 It was not a randomized trial. Some of the subjects had symptomatic urinary tract infection Thoumsin 1990 Only preliminary data were published.…”

Section: Reeves 1975mentioning

confidence: 99%

Different antibiotic regimens for treating asymptomatic bacteriuria in pregnancy

Guinto¹,

Guia²,

Festin³

2009

Cochrane Database of Systematic Reviews

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Pivmecillinam for bacteriuria in pregnancy

Cited by 22 publications

References 0 publications

Different antibiotic regimens for treating asymptomatic bacteriuria in pregnancy

Different antibiotic regimens for treating asymptomatic bacteriuria in pregnancy

The pharmacokinetics of mecillinam and pivmecillinam in pregnant and non‐pregnant women.

Different antibiotic regimens for treating asymptomatic bacteriuria in pregnancy

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