[Cefixime in urinary tract infections. (Specific studies and literature review)]

Abstract

Cefixime, a new oral cephalosporin, is more active against enterobacteriaceae than the conventional oral cephalosporins. About 20% of the drug is excreted by the kidneys as active drug. Therefore, the treatment of urinary tract infection (UTI) by cefixime may be a good alternative. In two smaller uncontrolled and four larger, controlled (amoxicillin, co-trimoxazole) "western" studies as well as in eight Japanese studies the good efficacy of cefixime in uncomplicated UTI could be demonstrated. Because of its antibacterial spectrum in this kind of infection the therapy with cefixime can be initiated already prior to sensitivity testing. Concerning the treatment of acute pyelonephritis only few cases are reported. Good results, except in the case of Proteus mirabilis infection, could be achieved. In the treatment of complicated UTI our own controlled (norfloxacin) and 13 uncontrolled Japanese studies showed cefixime to be an effective antibiotic if infections are caused by sensitive strains. Since in complicated UTI also gram-positive and nonfermenting pathogens resistant to cefixime can be found, treatment should not be initiated without sensitivity testing. Concerning treatment of UTI in children only few, but promising, results are reported. The tolerance of cefixime was similar to that of the comparative drugs. The once daily dose (400 mg), however, showed a higher incidence of gastrointestinal adverse effects than a twice daily dose (200 mg). Therefore, the daily dose should be administered in two divided doses. In summary, cefixime proved to be a good alternative in the treatment of UTI.