09:09pm Thursday 12 December 2019

Study in JAMA: Drug for Bladder Infection Not Effective

The study, led by Thomas Hooton, M.D., professor of clinical medicine, was published in the February 8 edition of the Journal of the American Medical Association.

Bladder infections, also known as lower urinary tract infections, are more common in women than men and usually treated with a short-course of antibiotics, such as trimethoprim-sulfamethoxazole (Bactrim, Cotrim, Septra). However, there is increasing resistance to such antibiotics due to their overuse.

One widely used antibiotic for bladder infections is ciprofloxacin, which is in a class of antibiotics called fluoroquinolones. While highly effective for the treatment of urinary tract infections, there is increasing resistance to fluoroquinolones among pathogens causing urinary tract infections and infections outside the urinary tract. Fluoroquinolones have also been associated with increased risk of infection caused by methicillin-resistant Staphylococcus aureus (MRSA).
For these reasons, physicians would like to preserve the efficacy of fluoroquinolones for other important uses, such as respiratory and skin infections.
Hooton’s study, funded by grants from the U.S. National Institute of Diabetes and Digestive and Kidney Diseases, examined whether an oral broad spectrum cephalosporin antibiotic, cefpodoxime, would be as effective as ciprofloxacin and, thus, could be considered a good alternative to ciprofloxacin.

“We wanted to see if cefpodoxime was comparable to the gold standard, but it wasn’t,” said Hooton. “It didn’t perform as well as we would have liked so we do not see it as a good alternative to ciprofloxacin.”

Symptoms of urinary tract infections include burning or pain during urination, frequent or urgent urination, discomfort in the lower abdomen, and urine that is cloudy or tinged with blood.

This study included 300 women, aged 18 to 55 with uncomplicated bladder infections. They received either 250 milligrams of ciprofloxacin twice a day for three days or 100 milligrams of cefpodoxime for the same period.

“We think that doctors should continue to use other recommended first-line agents for bladder infections, like nitrofurantoin and bactrim, not cefpodoxime,” said Hooton. “Moreover, we should reserve ciprofloxacin for cases where those first-line drugs cannot be used.”

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