Cefaclor as a first-line treatment for acute uncomplicated cystitis: a retrospective single-center study

Abstract

Background: Wide-spectrum antibiotics have been favored to treat acute uncomplicated cystitis (AUC) for a long time, leading to the emergence of multi-drug resistant bacteria. We hypothesize that narrow-spectrum antibiotics might mitigate the issue and aim to investigate the clinical efficacy of cefaclor in patients with AUC. Methods: We retrospectively reviewed the clinical data of female outpatients with AUC treated with cefaclor and evaluated the safety and clinical efficacy. Clinical cure was defined as the elimination of clinical symptom under 4 white blood cells (WBCs) per high power field on microscopy.Results: Overall, 223 women with AUC were enrolled. Escherichia coli was the dominant pathogen (n = 160; 68.6%), followed by Klebsiella species and E. coli-extended spectrum β-lactamase (ESBL) (n = 19; 8.1% and n = 18; 7.7%). Overall success rate was 94.0% (n = 219) and susceptibility rate of cefazolin was 84.1%, which was close to that of levofloxacin (82.9%). Ampicillin showed the lowest rate of 63.7% with a significantly greater resistance rate of 35.3% among all antibiotics (P < 0.001). In the subgroup analysis, the success rate in patients with resistance to levofloxacin or cefazolin was 100% (n = 24) or 93.3% (n = 14). The rate in patients with resistance to both antibiotics was 60.0% (n = 9), and the pathogens in the other 40.0% (n = 6) of patients with treatment failure were E. coli-ESBL.Conclusion: Cefaclor showed excellent efficacy in AUC patients, even in those with in vitro resistance to cefazolin or levofloxacin. Cefaclor may be considered as a first-line option in patients with AUC and a second-line option for those with levofloxacin treatment failure.

Antibiotic Resistance Pattern of Extended Spectrum Beta Lactamase Producing Escherichia coli Isolated From Patients With Urinary Tract Infection in Morocco

“…In our study, more than two-thirds of the isolates (63%) were ESBL-EC. A high prevalence of ESBL-EC strains have been raised quite consistently from previous studies carried out in Morocco ( Lahlou Amine et al., 2009 ; Romli et al, 2011 ; El Bouamri et al., 2014a ; El bouamri et al., 2014b ; Sbiti et al., 2017 ) and outside ( Gravey et al., 2017 ; Critchley et al., 2019 ; Koguchi et al., 2020 ; Tan et al., 2020 ; van Hout et al., 2020 ).…”

The Appropriateness of Empirical Antimicrobial Treatment of Uncomplicated Urinary Tract Infection in Adult Female Patients in Jazan Region, Saudi Arabia

“…Cefaclor showed suboptimal results with 62% sensitivity and with 68.6% sensitivity against E. coli; this in contrast with other studies which reported an overall 94% and 80% sensitivity [ 45 , 46 ]. Cefaclor has a spectrum of activity that resembles that of cephalexin with added activity against β-lactamase-producing Haemophilus influenza [ 47 ].…”

The Prevalence of Multidrug-Resistant Escherichia coli Producing ESBL among Male and Female Patients with Urinary Tract Infections in Riyadh Region, Saudi Arabia

“…Upwards of one-third of the E. coli strains in our investigation (33.48%) were ESBL- E. coli strains. Several earlier investigations [ 20 , 54 , 55 , 56 ] have repeatedly revealed a significant rate of ESBL- E. coli strains. According to Hashemizadeh et al [ 57 ], 41% of outpatients in Kerman, Iran, had ESBL-positive isolates from UTIs.…”