Revisiting β‐Lactams for Treatment of Urinary Tract Infections: Assessing Clinical Outcomes of Twice‐Daily Cephalexin for Empiric Treatment of Uncomplicated Urinary Tract Infections

Benning, Molly; Acosta, Dominic; Sarangarm, Preeyaporn; Walraven, Carla

doi:10.1002/jcph.2179

Cited by 3 publications

(3 citation statements)

References 12 publications

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“…20 Notably, UTI guidelines are pending a new update and there has been subsequent literature to support use of cephalexin for uncomplicated UTI. [20][21][22][23] Dissemination of updated evidence and implementation into practice is often delayed. 24,25 This study had limitations.…”

Section: Discussionmentioning

confidence: 99%

Impact of mandatory indications for outpatient antibiotic orders on accurate tracking of antibiotic indications

Oertli,

Staub,

Zhang

et al. 2024

Infect. Control Hosp. Epidemiol.

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Objective: We sought to evaluate whether implementing mandatory indications for outpatient electronic antibiotic orders or using encounter International Classification of Diseases, Tenth Revision (ICD10) codes more accurately reflected clinicians’ charted diagnosis in encounter notes. Secondarily, we examined the appropriateness of antibiotic prescriptions. Design: Cross-sectional study. Methods: Mandatory indications were added to all outpatient electronic antibiotic orders on May 18, 2022. A randomly selected convenience sample of 1300 outpatient encounters with antibiotics from walk-in clinics was reviewed. Adjusted logistic regression was used to compare the congruence between encounter ICD10 code and charted diagnosis for encounters from July 15 to September 15, 2021 (pre-implementation period) to the congruence between encounter ICD10 code, charted diagnosis, and mandatory indication for encounters from July 15 to September 15, 2022 (post-implementation period). Antibiotic appropriateness based on charted diagnosis was also evaluated. Results: Among 1300 outpatient encounters, congruence between charted diagnosis and ICD10 code significantly increased in the post-implementation period (87.7% (565/644)) versus pre-implementation (83.3% (540/648), adjusted odds ratio (aOR) 1.52; 95% CI 1.03–2.25). Congruence between charted diagnosis and mandatory indication during post-implementation was 95.2% (613/644) and >5 times more likely to be congruent than charted diagnosis and ICD10 code during pre-implementation (aOR 5.45; 95% CI 3.26–9.11). Antibiotic prescribing based on charted diagnosis was twice as likely to be appropriate in the post-implementation period (aOR1.99; 95% CI 1.32–2.98). Conclusions: Mandatory indications within antibiotic orders show better congruence with charted diagnosis than ICD10 codes and may increase antibiotic appropriateness and congruence between ICD10 code and charted diagnosis.

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Section: Discussionmentioning

confidence: 99%

Impact of mandatory indications for outpatient antibiotic orders on accurate tracking of antibiotic indications

Oertli,

Staub,

Zhang

et al. 2024

Infect. Control Hosp. Epidemiol.

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“…Additionally, rates of Enterobacterales resistance have changed significantly since the time of publication. In 2023, Benning et al evaluated the feasibility of treating uUTI with cephalexin 500 mg twice daily in 264 patients discharged to home from the emergency department [ 21 ]. They reported clinical success at 30 days postdischarge in 81.1% of patients.…”

Section: Discussionmentioning

confidence: 99%

Two Times Versus Four Times Daily Cephalexin Dosing for the Treatment of Uncomplicated Urinary Tract Infections in Females

Yetsko,

Draper,

Eid

et al. 2023

Open Forum Infectious Diseases

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Background The current IDSA treatment guidelines recommend beta-lactam antibiotics as alternative, rather than first-line agents, for the treatment of uncomplicated UTI (uUTI). Cephalexin is a commonly prescribed first-generation cephalosporin with excellent bioavailability and urinary penetration; however, little data exist to support optimal dosing for uUTI. Methods This retrospective, multicenter, cohort study included adult female patients who received 5-7 days of cephalexin for symptomatic uUTI with a cefazolin-susceptible urine culture. The primary objective was to compare uUTI treatment failure (e.g., continued or recurrent symptoms within 30 days) between patients treated with cephalexin 500 mg twice daily (BID Group) versus 500 mg four times daily (QID Group) in the outpatient setting. Secondary outcomes included time to treatment failure, reported adverse events within 7 days of treatment, and occurrence of C. difficile within 30 days of treatment. Results A total of 261 patients were included (BID Group, n = 173; QID Group, n = 88). Baseline characteristics were similar between groups. Escherichia coli was the most commonly isolated pathogen (85.4%). There was no difference in treatment failure observed between groups (BID Group 12.7% vs QID Group 17%, p = 0.343), including failure while on therapy (BID Group 2.3% vs QID Group 5.7%, p = 0.438) or recurrence within 30 days (BID Group 10.4% vs QID Group 11.3%, p = 0.438). No differences in reported adverse events (BID Group 4.6% vs QID Group 5.6%, p = 0.103) were observed between groups. Conclusion Twice daily cephalexin is as effective as four times daily dosing for uUTI. A twice daily dosing strategy may improve patient adherence.

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“…In the case of UTIs, this approach has been pivotal in promptly addressing infections and alleviating symptoms. 6 However, the emergence of antimicrobial resistance has cast doubt on the long-term effectiveness of empiric therapy. The overuse and misuse of antibiotics have fuelled the development of resistant bacterial strains, limiting the available treatment options for various infections, including UTIs.…”

Section: Introductionmentioning

confidence: 99%

Empiric therapy for community acquired urinary tract infection in an era of increasing antimicrobial resistance

Anam,

Mustafa,

Anjum

2024

IJMMTD

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Community-acquired urinary tract infections (CA-UTIs) are widespread bacterial infections often necessitating empirical antibiotic therapy. However, the escalating antimicrobial resistance (AMR) poses a grave threat to treatment efficacy. This study aims to assess the prevalence of AMR in uropathogens causing CA-UTIs and its implications for empirical therapy. The study analyzed data from a tertiary care hospital, to determine AMR rates in common uropathogens, including and . Resistance levels to key antibiotics, such as Ampicillin, Ciprofloxacin, and Norfloxacin, were evaluated. Significant resistance rates were observed in uropathogens, with and showing marked resistance. Notably, resistance to commonly prescribed antibiotics like Ampicillin, Ciprofloxacin, and Norfloxacin was widespread, highlighting the severity of the AMR crisis. The increasing AMR in CA-UTIs calls for a comprehensive approach. Strategies including local resistance pattern monitoring, antimicrobial stewardship programs and the recommendation of drugs like nitrofurantoin (with lower drug resistance potential) are crucial to maintain the effectiveness of empirical therapy. This study underscores the urgent need for collaborative efforts to address AMR, ensuring effective CA-UTI management and safeguarding public health.

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Revisiting β‐Lactams for Treatment of Urinary Tract Infections: Assessing Clinical Outcomes of Twice‐Daily Cephalexin for Empiric Treatment of Uncomplicated Urinary Tract Infections

Cited by 3 publications

References 12 publications

Impact of mandatory indications for outpatient antibiotic orders on accurate tracking of antibiotic indications

Impact of mandatory indications for outpatient antibiotic orders on accurate tracking of antibiotic indications

Two Times Versus Four Times Daily Cephalexin Dosing for the Treatment of Uncomplicated Urinary Tract Infections in Females

Empiric therapy for community acquired urinary tract infection in an era of increasing antimicrobial resistance

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