Cefpodoxime doesn't match ciprofloxacin for acute cystitis

JAMA : The Journal of the American Medical Association Cefpodoxime doesn't match ciprofloxacin for acute cystitis February 8, 2012 ST LOUIS (MD Consult) - The cephalosporin antibiotic cefpodoxime is not as effective as the fluoroquinolone ciprofloxacin for treatment of acute cystitis, reports a trial in the February 8, 2012, issue of The Journal of the American Medical Association. The randomized, double-blind trial included 300 women, aged 18 to 55, with acute, uncomplicated cystitis. One group received ciprofloxacin, 250 mg twice daily, and the other received cefpodoxime proxetil, 100 mg twice daily. Both treatments were given for 3 days. Clinical cure rates, defined as not requiring antimicrobial treatment during follow-up, were compared at 30 days. Clinical and microbiologic cure rates at the first follow-up visit and vaginal Escherichia coli colonization rate at each visit were assessed as well. The study specified a 10% noninferiority margin between treatments. The lead author was Dr Thomas M. Hooton of University of Miami. On intention-to-treat analysis considering patients lost to follow-up as cured, clinical cure rates were 93% with ciprofloxacin and 82% with cefpodoxime. With patients lost to follow-up considered as nonresponders, the cure rates were 83% and 71%, respectively. Microbiologic cure rates were 96% with ciprofloxacin versus 81% with cefpodoxime. For all outcomes, the difference between treatments exceeded the 10% noninferiority margin. Colonization with E. coli was found at the first follow-up visit in 16% of the ciprofloxacin group versus 40% of the cefpodoxime group. Because of rising resistance rates, there is a need for non-fluoroquinolone alternatives for treatment of urinary tract infections. However, the new trial finds that cefpodoxime is not as an effective as ciprofloxacin for initial treatment of acute uncomplicated cystitis. The investigators conclude, "These findings, along with concerns about possible adverse ecological effects associated with other broad-spectrum β-lactams, do not support the use of cefpodoxime as a first-line fluoroquinolone-sparing antimicrobial for acute uncomplicated cystitis." JAMA. 2012;307:583-589.