A comparative trial of pivmecillinam and ampicillin in bacteriuria of pregnancy

Bint, A. J.; Bullock, D.W.; Reeves, D. S.; Wilkinson, P. J.

doi:10.1007/bf01642151

Cited by 12 publications

(15 citation statements)

References 9 publications

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“…We have included five studies examining different antibiotic regimens: Bayrak 2007 compared a single dose of fosfomycin trometamol 3 g with a five-day course of twice daily cefuroxime.In a study reported by Bint 1979, pivmecillinam 400 mg was compared with ampicillin 500 mg. Women in both arms of the trial had antibiotics four times each day for seven days.In the study by Campbell-Brown 1987, a three-day course of cephalexin 1 g twice-daily was compared with Miraxid® (pivmecillinam 200 mg and pivampicillin 250 mg) twice daily for three days.In the most recent and largest trial, a one-day versus a seven-day regimen of nitrofurantoin was compared (Lumbiganon 2009). Women received either nitrofurantoin 100 mg twice for one day (with placebo twice daily for the following six days) or a seven-day course of twice-daily nitrofurantoin.The study by Robertson 1968 compared cycloserine 250 mg given twice a day for 14 days with sulphadimidine 500 mg given for 14 days.…”

Section: Resultsmentioning

confidence: 99%

“…In a study reported by Bint 1979, pivmecillinam 400 mg was compared with ampicillin 500 mg. Women in both arms of the trial had antibiotics four times each day for seven days.…”

Section: Resultsmentioning

confidence: 99%

“…In the remaining studies the method used to generate the sequence was not clear. Bayrak 2007 specifies that block randomization was used, but there were no further details on sequence generation, and in Bint 1979 andCampbell-Brown 1987 no information was provided.…”

Section: Resultsmentioning

confidence: 99%

“…In the study by Robertson 1968, allocation was alternate and could be anticipated in advance. In the two remaining studies there was little information on methods and it was not clear what steps, if any, were taken to conceal allocation (Bint 1979; Campbell-Brown 1987).…”

Section: Resultsmentioning

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%

“…In a study reported by Bint 1979, pivmecillinam 400 mg was compared with ampicillin 500 mg. Women in both arms of the trial had antibiotics four times each day for seven days.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

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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“…In particular, nalidixic acid and trimethoprim-sulfamethoxazole are not recommended for use in pregnancy. Pivmecillinam has been shown to be effective but was associated with a significantly higher rate of side effects than ampicillin (2).…”

Section: Discussionmentioning

confidence: 99%

Comparative study of amoxicillin-clavulanic acid and cephalexin in the treatment of bacteriuria during pregnancy

Pedler¹,

Bint²

1985

Antimicrob Agents Chemother

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A comparative clinical trial of amoxicillin-clavulanic acid and cephalexin was carried out in 80 women with bacteriuria of pregnancy. Treatment was randomly aUlocated and consisted of either one tablet of amoxicillin plus clavulanic acid (250 and 125 mg, respectively) three times daily or cephalexin (250 mg) three times daily for 7 days. Overall bacteriological cure rates at 2 weeks were 77% in the amoxicillin-clavulanic acid group and 74% in the cephalexin group. At 6 weeks the respective rates were 76 and 60%. Twenty-five episodes of infection were with ampicillin-resistant strains; cure rates were 82% (2 weeks) and 80% (6 weeks) in the amoxicillin-clavulanic acid group and 85 and 64%, respectively, in the cephalexin group. Differences in cure rates were not statistically significant. No significant difference in the rate of side effects was found. In particular, no toxicity to the fetus was seen which could be ascribed to either drug. Amoxiciflin-clavulanic acid would appear to be a safe and effective treatment for bacteriuria of pregnancy.Ampicillin and amoxicillin are popular choices for the treatment of bacteriuria of pregnancy. They are active against the majority of commonly isolated infecting organisms and enjoy a low incidence of unwanted effects in the mother, with the further advantage that there is no evidence of toxicity to the developing fetus. Resistance to ampicillin, however, is increasing both in hospitals and in the community; in the main, this is due to plasmid-directed production of P-lactamase. There is therefore a need for antimicrobial agents possessing the same properties as ampicillin and amoxicillin but with activity against 3-lactamase-producing organisms resistant to these antibiotics.Clavulanic acid is an inhibitor of several of the more usual plasmid-mediated P-lactamases (7,8). It has been shown in vitro that this agent will render an ampicillin-resistant organism susceptible to ampicillin if resistance is due to production of a P-lactamase which is inhibited by clavulanic acid (1,5,10,12). This in vitro effect has been confirmed in vivo in several trials of a combination of amoxicillin with clavulanic acid in the treatment of urinary tract infections (1,3,4,6 Growth from this specimen was regarded as significant if it yielded more than 105 CFU/ml of a single species. Significant pyuria was defined as -20 pus cells per ,ul. Patients with significant growth from this specimen were entered into the trial, but a second MSU was taken before treatment was started; only if the result of this specimen confirmed that of the first were data from that patient used in assessing efficacy. Patients were excluded from the trial if they were known to be hypersensitive to the penicillins or cephalosporins, if the infection was caused by an organism resistant to one of the trial drugs, or if the patient was already taking an antibiotic or had taken one since the first MSU was collected.Sensitivity testing to cephalexin was carried out by the breakpoint method (11), using diagnostic sensitivity te...

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