Real-World Experience Using Cefpodoxime and Cefuroxime Axetil for Urinary Tract Infections at a Large Academic Medical Center. Issue 1 (January 2021)

• Record Type: Journal Article
• Authors: Bao, Hongkai; Jen, Shin-Pung; Chen, Xian Jie (Cindy); Siegfried, Justin; Pham, Vinh P.; Papadopoulos, John; Dubrovskaya, Yanina
• Is Part Of: Infectious diseases in clinical practice. Volume 29:Issue 1(2021)
• Publication Date: 2021-01
• Subjects: cephalosporins -- urinary tract infections -- pharmacokinetics -- infectious disease -- clinical pharmacy; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Periodicals; Electronic journals; 616.9
• DOI: 10.1097/IPC.0000000000000911
• Languages: English
• ISSNs: 1056-9103

Abstract

Abstract : Background: Cefpodoxime (CPD) and cefuroxime (CFX) are both oral cephalosporins indicated for urinary tract infection (UTI) treatment. Despite having lower renal excretion and higher risk of collateral damage compared with CFX, CPD is a third-generation cephalosporin (3GC) with broader gram-negative activity than CFX. The objective of this study was to assess the efficacy and safety of these 2 agents for UTI treatment in a real-world clinical setting. Methods: A retrospective evaluation was conducted among adult patients who received CPD or oral CFX for UTI treatment between January 2013 and July 2018. The primary outcome was clinical cure. Secondary outcomes included rate of subsequent UTI, Clostridioides difficile infection, and detection of isolates resistant to 3GC within 90 days after treatment. Results: A total of 747 patients were assessed for study inclusion, of which 295 patients met eligibility criteria (CPD n = 165, CFX n = 130). Clinical cure was 100% versus 98% for CPD versus CFX, P = 0.084. The rate of subsequent UTI for CPD versus CFX was 18% versus 16%, P = 0.647. There were no differences in development of Clostridioides difficile infection or 3GC resistance. After adjusting for multiple factors in multivariate analysis, chronic kidney disease and history of UTI within 180 days, but not the choice of oral cephalosporin, were independent predictors of subsequent UTI. Conclusions: Cefpodoxime and CFX are both favorable treatment options for UTIs, with high rates of clinical cure and limited adverse effects.