A retrospective review of oral cephalosporins versus fluoroquinolones for the treatment of pyelonephritis

Lin, Kevin; Zahlanie, Yorgo; Ortwine, Jessica; Wei, Wenjing; Mang, Norman; Prokesch, Bonnie C

doi:10.1371/journal.pone.0274194

Cited by 2 publications

(1 citation statement)

References 19 publications

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“… 6 Fewer treatment failures have been observed with C2Gs compared with first- and third-generation cephalosporins. 7 …”

Section: Introductionmentioning

confidence: 99%

Intravenous cefuroxime as a first-line treatment for women hospitalized for pyelonephritis

Everard,

Schampaert,

Doyen

et al. 2024

JAC-Antimicrobial Resistance

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Background Empirical treatment of pyelonephritis in the emergency ward includes broad-spectrum antibiotics. Such a strategy favours broad-spectrum antibiotic overuse. Local antibiotic stewardship teams can propose local recommendations to adapt empirical antibiotic treatment devoted to spare precious molecules that remain active on MDR bacteria, such as fluoroquinolones or other broad-spectrum antibiotics. Objectives We aimed to evaluate the incidence of urinary tract infection recurrence within 3 months after hospital discharge following empirical antibiotic therapy with cefuroxime in women with pyelonephritis in the emergency room. Patients and methods We conducted a retrospective, single-centre study. We identified 109 women treated for pyelonephritis, 95 with cefuroxime at any time, and 14 with only other antibiotics, and divided them into subgroups based on antibiotic switch to other molecules. We compared the incidence of urinary tract infection recurrence in the subgroups. Results In the group of patients treated with cefuroxime only, we identified five cases of recurrence (9.4%) in a total of 53 patients, but only 1 (1.9%) case of recurrence associated with the same uropathogen. No significant difference in clinical outcome, length of antibiotic treatment, or urinary tract infection recurrence was observed between the subgroups. Conclusions Our study supports that a strategy elaborated by an antibiotic stewardship team based on local ecology and aimed at proposing the narrowest-spectrum antibiotic upon treatment initiation in the emergency room is safe.

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“… 6 Fewer treatment failures have been observed with C2Gs compared with first- and third-generation cephalosporins. 7 …”

Section: Introductionmentioning

confidence: 99%

Intravenous cefuroxime as a first-line treatment for women hospitalized for pyelonephritis

Everard,

Schampaert,

Doyen

et al. 2024

JAC-Antimicrobial Resistance

View full text Add to dashboard Cite

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Rise of the beta-lactams: a retrospective, comparative cohort of oral beta-lactam antibiotics as step-down therapy for hospitalized adults with acute pyelonephritis

Hobbs,

Hemmige,

Reel

et al. 2024

ASHE

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Objective: The aim of this study was to determine if oral beta-lactam therapy is non-inferior to alternative therapy at discharge following inpatient treatment with an IV cephalosporin for acute pyelonephritis. Design: Institutional Review Board (IRB)-approved, multicenter, retrospective, non-inferiority cohort (15% non-inferiority margin). Setting: Six hospitals within two healthcare systems. Patients: Hospitalized patients admitted to the medical floor with acute pyelonephritis without urologic abnormalities who received cefazolin or ceftriaxone followed by step-down therapy. Methods: Patients were discharged with either an oral beta-lactam or an oral alternative agent (ie, fluoroquinolone or trimethoprim-sulfamethoxazole) to complete therapy. The primary objective was treatment failure defined as a composite of hospital readmission or an ED visit for a urinary cause within 30 days of discharge of the index hospitalization. Data were extracted manually from the electronic medical record. Results: A total of 211 patients were included; 122 received an oral beta-lactam and 89 received an oral alternative agent at discharge. There was no difference in 30-day treatment failure between the two groups (4.9% vs 5.6% for oral beta-lactams vs oral alternatives, respectively. Absolute difference = 0.7%; 95% CI -5.4% to 6.8%; P = .82). The median length of hospital stay, number of patients treated with intravenous ceftriaxone, duration of IV therapy, and median duration of oral therapy were no different between groups. Conclusions: In non-ICU patients admitted for pyelonephritis without urologic abnormalities, oral beta-lactams were non-inferior to oral alternatives for step-down therapy. In finding non-inferiority between the regimens, we show the feasibility of administering oral beta-lactams to complete therapy for acute pyelonephritis.

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A retrospective review of oral cephalosporins versus fluoroquinolones for the treatment of pyelonephritis

Cited by 2 publications

References 19 publications

Intravenous cefuroxime as a first-line treatment for women hospitalized for pyelonephritis

Intravenous cefuroxime as a first-line treatment for women hospitalized for pyelonephritis

Rise of the beta-lactams: a retrospective, comparative cohort of oral beta-lactam antibiotics as step-down therapy for hospitalized adults with acute pyelonephritis

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