Yonsei Med J.  2015 Sep;56(5):1266-1273. 10.3349/ymj.2015.56.5.1266.

Comparison of Second- and Third-Generation Cephalosporin as Initial Therapy for Women with Community-Onset Uncomplicated Acute Pyelonephritis

• Chang UI
• Kim HW
• Wie SH

• KMID: 2163618
• DOI: http://doi.org/10.3349/ymj.2015.56.5.1266

Abstract

PURPOSE
This study examined the clinical effectiveness of parenteral cefuroxime and cefotaxime as empirical antibiotics for treating hospitalized women with uncomplicated acute pyelonephritis (APN).
MATERIALS AND METHODS
This study was based on the clinical and microbiologic data of 255 hospitalized women with APN. Of these 255 women, 144 patients received cefuroxime and 111 received cefotaxime.
RESULTS
There were no marked differences in the demographic features, clinical characteristics, and treatment duration between the populations of the cefuroxime and cefotaxime groups. The rates of defervescence showed no significant differences in the two groups at 48, 72, 96, and 120 hours. The clinical cure rates observed at the follow-up visit 4 to 14 days after the completion of antimicrobial therapy were not statistically different between the cefuroxime and cefotaxime groups [94.9% (129 of 136) versus 98.0% (100 of 102), respectively; p=0.307], and the microbiological cure rates were also not significantly different [88.3% (91 of 103) versus 95.0% (76 of 80), respectively; p=0.186]. The median hospitalization periods in the cefuroxime and cefotaxime groups were 7 (6-8) and 7 (6-8) days (p=0.157), respectively. Microbiological success rates after 72-96 hours of initial antimicrobial therapy were also not statistically different in the cefuroxime and cefotaxime groups, 89.4% (110 of 123) versus 94.9% (93 of 98; p=0.140).
CONCLUSION
Cefuroxime, a second-generation cephalosporin, is an appropriate antibiotic option for the initial treatment of uncomplicated APN and its efficacy does not differ from cefotaxime, a third-generation cephalosporin, in the initial parenteral therapy for community-onset APN.

Keyword

Pyelonephritis; E. coli; cefotaxime; cefuroxime

MeSH Terms

Administration, Intravenous
Adult
Aged
Anti-Bacterial Agents/administration & dosage/*therapeutic use
Cefotaxime/administration & dosage/*therapeutic use
Cefuroxime/administration & dosage/*therapeutic use
Community-Acquired Infections/*drug therapy
Escherichia coli/drug effects
Female
Humans
Infusions, Parenteral
Length of Stay
Male
Middle Aged
Pyelonephritis/*drug therapy/microbiology
Retrospective Studies
Treatment Outcome
Anti-Bacterial Agents
Cefotaxime
Cefuroxime

Figure

• 

  Fig. 1 A schematic diagram showing the subject selection and enrollment. Tx, therapy.

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