A Critical Review of Cephalexin and Cefadroxil for the Treatment of Acute Uncomplicated Lower Urinary Tract Infection in the Era of “Bad Bugs, Few Drugs”

Nguyen, Hien M.; Graber, Christopher J.

doi:10.1016/j.ijantimicag.2020.106085

Cited by 13 publications

(11 citation statements)

References 71 publications

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“…ALUTI is a common and frequent clinical disease with a high incidence, and patients often present with symptoms such as urinary frequency, urinary urgency, and painful urination; in severe cases, symptoms of systemic infection may occur, requiring reasonable antimicrobial therapy with antibacterial drugs [ 16 ]. Clinically, different antibacterial drugs are often taken for the treatment of different pathogenic bacteria, and among the treatments for UTI, antibiotics are definitely effective, but before the results of urine bacterial culture drug sensitivity are obtained, drugs can only be used based on clinical experience, which sometimes delays the treatment and prolongs the treatment time [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Changes in Serum CRP and PCT Levels in Patients with Acute Simple Lower Urinary Tract Infection and Evaluation of the Efficacy of Treatment with Shuangdong Capsules

Tang

Zhou

2022

Emergency Medicine International

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Objective. The aim of this study is to investigate the changes and significance of serum C-reactive protein (CRP) and procalcitonin (PCT) levels in patients with acute simple lower urinary tract infection (ALUTI) and to analyze the efficacy of treatment with Shuangdong capsules, so as to provide a basis for the rational clinical application of drugs. Methods. 92 patients with ALUTI (observation group) were randomly divided into 46 cases each in group A and group B. Group A was treated with basic anti-infective drugs, while group B was treated with Shuangdong capsules, and the duration of treatment in both groups was 14 days. The curative effect of the two groups was analyzed, and the changes in serum PCT and CRP levels were compared before and after treatment and compared with 40 healthy people in the control group. Results. The serum PCT and CRP levels, the number of urinary leukocyte count (LEU), and the number of urinary bacterial count (BACT) were significantly higher in Group A and Group B than in the healthy control group before treatment ( P < 0.05 ). After treatment, the total clinical efficiency of patients in group B (97.83%) was significantly higher than that in group A (78.26%) ( P < 0.05 ). The serum PCT and CRP levels, the number of urinary LEU, and the number of urinary BACT decreased in both groups after treatment compared with those before treatment, and all of them were significantly lower in group B than in group A ( P < 0.05 ). The area under the curve (AUC) values of serum PCT and CRP levels for the diagnosis of acute simple lower urinary tract infection were 0.747 (95% CI 0.633–0.860) and 0.926 (95% CI 0.870∼0.982), both with high sensitivity and specificity. Conclusion. The Shuangdong capsule combined with conventional antibacterial drugs has better clinical efficacy in the treatment of acute simple lower urinary tract infection; serum CRP and PCT levels in patients with acute simple lower urinary tract infection can be used as indicators for diagnosis and efficacy determination of the infection.

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Section: Discussionmentioning

confidence: 99%

Changes in Serum CRP and PCT Levels in Patients with Acute Simple Lower Urinary Tract Infection and Evaluation of the Efficacy of Treatment with Shuangdong Capsules

Tang

Zhou

2022

Emergency Medicine International

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“…β-Lactam antibiotics have historically been considered second-or third-line agents for uncomplicated UTIs due to concerns over inferior efficacy based on trials published before the 2000s; however, these trials varied in treatment duration, selection of comparative antimicrobials, antibiotic dosing, and definition of UTI and clinical cure. 10 Sigurdsson et al 4 compared a 3-day regimen of amoxicillin therapy to a 3-day regimen of trimethoprim-sulfadiazine, and found amoxicillin to be less effective at eradication; however, this study determined therapeutic efficacy according to bacteriological findings and did not look at symptomatic improvement. Similarly, a 3-day regimen of amoxicillin-clavulanate (58% clinical cure rate) was not as effective as ciprofloxacin (77% clinical cure rate), even in women infected with susceptible urinary pathogens.…”

Section: Discussionmentioning

confidence: 99%

“…While this clinical success rate is slightly lower than previously published success rates of >90%, only 8.3% of patients returned for nonresolving symptoms, and of these, only 2 of the total 264 patients included in this study (0.8%) had a non-cefazolin-susceptible urinary pathogen. 10 It should be noted that clinical success even among patients who receive antibiotics is difficult to assess, as previous studies have shown that 25%-54.2% of uncomplicated UTIs will resolve spontaneously without antibiotics. 15 Of all the patients analyzed in this study, only 4.2% returned with nonresolving symptoms who had monomicrobial infections with cefazolinsusceptible urinary pathogens that should have been adequately treated with cephalexin therapy.…”

Section: Discussionmentioning

confidence: 99%

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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

Benning

Acosta

Sarangarm

et al. 2022

The Journal of Clinical Pharma

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The 2011 Infectious Diseases Society of America guidelines for treatment of uncomplicated urinary tract infections (UTIs) recommend non-β-lactam antibiotics for empiric therapy. However, increasing Escherichia coli and Klebsiella spp. resistance to first-line antibiotic therapies has necessitated the need for alternative agents. Based on local antibiogram data, cephalexin has become the preferred oral antibiotic for empiric treatment of UTIs at our institution. The purpose of this single-center retrospective review was to assess clinical outcomes of patients discharged from the emergency department (ED) who received cephalexin for the treatment of uncomplicated UTIs. The primary outcome of this study was to assess the proportion of patients with clinical success 30 days after discharge from the ED. Patients were excluded if they were <18 years of age, received ≥10 days of cephalexin, received antibiotics for any indication other than uncomplicated UTI, received antibiotics within 60 days of their ED visit, or had structural abnormalities. A total of 264 patients were included for evaluation, and 214 patients (81.1%) met the criteria for clinical success. Overall, 28 (10.6%) patients required a change in antibiotics based on cultures and sensitivities, 18 (6.8%) patients returned for nonresolving or worsening symptoms, and 4 (1.5%) patients required both a change in antibiotics and returned for nonresolving or worsening symptoms. Short courses of twice-daily cephalexin appear to be a safe and effective option for the empiric treatment of uncomplicated UTIs.

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“…In continuation of our research, the current study reports the synthesis and use of several cephalexin Schiff bases as additives to enhance the photostability of PS when exposed to UV radiation. Cephalexin is a β-lactamase antibiotic that is mainly used to treat Gram-positive bacteria [ 33 ]. It is a solid with a high melting point, is very stable, and contains an aromatic moiety as well as heteroatoms (sulfur, oxygen, and nitrogen).…”

Section: Introductionmentioning

confidence: 99%

Effect of Ultraviolet Irradiation on Polystyrene Containing Cephalexin Schiff Bases

et al. 2021

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The scale of production of polystyrene has escalated in the recent past in order to meet growing demand. As a result, a large quantity of polystyrene waste continues to be generated along with associated health and environmental problems. One way to tackle such problems is to lengthen the lifetime of polystyrene, especially for outdoor applications. Our approach is the synthesis and application of new ultraviolet photostabilizers for polystyrene and this research is focused on four cephalexin Schiff bases. The reaction of cephalexin and 3-hydroxybenzaldehyde, 4-dimethylaminobenzaldehyde, 4-methoxybenzaldehyde, and 4-bromobanzaldehyde under acidic condition afforded the corresponding Schiff bases in high yields. The Schiff bases were characterized and their surfaces were examined. The Schiff bases were mixed with polystyrene to form homogenous blends and their effectiveness as photostabilizers was explored using different methods. The methods included monitoring the changes in the infrared spectra, weight loss, depression in molecular weight, and surface morphology on irradiation. In the presence of the Schiff bases, the formation of carbonyl group fragments, weight loss, and decrease in molecular weight of polystyrene were lower when compared with pure polystyrene. In addition, undesirable changes in the surface such as the appearance of dark spots, cracks, and roughness were minimal for irradiated polystyrene containing cephalexin Schiff bases. Mechanisms by which cephalexin Schiff bases stabilize polystyrene against photodegradation have also been suggested.

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A Critical Review of Cephalexin and Cefadroxil for the Treatment of Acute Uncomplicated Lower Urinary Tract Infection in the Era of “Bad Bugs, Few Drugs”

Cited by 13 publications

References 71 publications

Changes in Serum CRP and PCT Levels in Patients with Acute Simple Lower Urinary Tract Infection and Evaluation of the Efficacy of Treatment with Shuangdong Capsules

Changes in Serum CRP and PCT Levels in Patients with Acute Simple Lower Urinary Tract Infection and Evaluation of the Efficacy of Treatment with Shuangdong Capsules

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

Effect of Ultraviolet Irradiation on Polystyrene Containing Cephalexin Schiff Bases

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