Abstract
BackgroundWide-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.MethodsWe 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.ResultsOverall, 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.ConclusionCefaclor 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.
Highlights
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
In Japan, fluoroquinolones have been widely introduced as the treatment for AUC, because levofloxacin (LVFX) was recommended as the first-line therapy for premenopausal women and as the second-line treatment for the menopausal women according to the Japanese Association for Infectious Diseases and Japanese Society of Chemotherapy guidelines 2015 (JAID/JSC) [5]
Female patients aged 16 years or older were recruited for this study if they had the following conditions: i) symptoms of acute uncomplicated cystitis, such as dysuria, urinary urgency, and suprapubic pain occurring within 7 days before their visit to our hospital; ii) pyuria confirmed by reagent strip ≥5 white blood cells (WBCs) per high-power field on microscopy of urine sediment, and iii) bacteriuria ≥104 colony-forming units/ml
Summary
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. Urinary tract infections (UTIs) are the most frequently reported infections, and acute uncomplicated cystitis (AUC) is the most common presentation of UTIs [1, 2]. Koguchi et al BMC Urology (2020) 20:38 the rates of the drug resistance among Enterobacteriaceae in the community had remained low at < 1% for decades, the rate has skyrocketed in recent years, ranging from 10 to 30% in developed countries [6]. The American Urological Association is strengthening the current warnings that fluoroquinolone antibiotics should be avoided for the treatment of AUC due to significant decreases in blood sugar and certain mental health side effects [7]
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