Cefaclor as a prophylactic agent for recurrent urinary infections: a comparative trial with macrocrystalline nitrofurantoin

Abstract

Eighty women with recurrent urinary infections (a median of seven episodes per year) were randomized to twelve months prophylaxis with cefaclor 250 mg or macrocrystalline nitrofurantoin 50 mg, at night. Seventy-three patients (37 given cefaclor and 36 given macrocrystalline nitrofurantoin) were assessable for efficacy. The incidence of radiological abnormalities in the two treatment groups was 23% and 30% respectively. Ninety-five percent of the patients taking cefaclor were symptomatically improved during the twelve months of prophylaxis and 86% remained abacteriuric; corresponding figures in the group taking macrocrystalline nitrofurantoin were 86% and 85% respectively. There were 88 breakthrough infections in patients taking cefaclor (6 resistant strains), and 9 in those patients taking macrocrystalline nitrofurantoin (6 by resistant strains). The mean interval between symptomatic episodes on prophylactic therapy increased by 5.6-fold in patients taking cefaclor, and 4.3-fold in those taking macrocrystalline nitrofurantoin. Resistant coliforms were found in only 3 out of 37 patients studied after twelve months prophylaxis; these organisms did not proceed to cause infections. All 80 patients were assessable for adverse events: 5 out of 39 taking cefaclor (12.8%) reported an event "probably" associated with the antibiotic, and 3 (7.7%) stopped taking the drug for various reasons; corresponding figures for macrocrystalline nitrofurantoin were 17.1% and 9.8% respectively. Patients with a radiological abnormality responded well to long-term low-dose prophylaxis with either agent. Cefaclor seems to offer an alternative to macrocrystalline nitrofurantoin for the prophylaxis of recurrent urinary infections in women.