Cefpodoxime Not Recommended for Acute, Uncomplicated Cystitis

Cefpodoxime found inferior to ciprofloxacin in achieving clinical cure

TUESDAY, Feb. 7 (HealthDay News) -- Cefpodoxime should not be used as a first-line fluoroquinolone-sparing antimicrobial for acute uncomplicated cystitis, according to a study published in the Feb. 8 issue of the Journal of the American Medical Association.

Thomas M. Hooton, M.D., of the University of Miami, and colleagues conducted a randomized, double-blind trial of 300 women (aged 18 to 55 years) with acute uncomplicated cystitis. Outcomes were assessed at five to nine days and 28 to 30 days after completion of therapy. Patients were given 250 mg of ciprofloxacin orally twice daily for three days or 100 mg of cefpodoxime proxetil orally twice daily for three days. Clinical cure was defined as not requiring antimicrobial treatment during follow-up. Noninferiority was defined as less than a 10 percent difference in the upper limit of the confidence interval for the primary outcome for ciprofloxacin minus cefpodoxime.

The researchers found that the overall clinical cure rate at the 30-day visit with the intent-to-treat approach in which patients lost to follow-up were considered as having clinical cure was 93 percent for ciprofloxacin compared with 82 percent for cefpodoxime. For the intent-to-treat approach in which patients lost to follow-up were considered as having not responded to treatment, the clinical cure rate was 83 percent for ciprofloxacin compared with 71 percent for cefpodoxime. The microbiological cure rate was 96 percent for ciprofloxacin compared with 81 percent for cefpodoxime. At first follow-up, 16 percent of women in the ciprofloxacin group had vaginal Escherichia coli colonization, compared with 40 percent of women in the cefpodoxime group.

"Among women with uncomplicated cystitis, a three-day regimen of cefpodoxime compared with ciprofloxacin did not meet criteria for noninferiority for achieving clinical cure," the authors write.

One author disclosed financial ties to pharmaceutical companies.

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