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A Comparison of the Therapeutic Efficacy of Cefuroxime versus Cefotaxime as an Initial Antimicrobial Therapy for Community-Onset Complicated Non-Obstructive Acute Pyelonephritis due to Enterobacteriaceae Infection in Women Using Propensity-Matched Analysis.
Antimicrob Agents Chemother. 2015 Feb 2;
Authors: Chang UI, Kim HW, Wie SH
Abstract
This study was performed to compare the therapeutic efficacy of cefuroxime with that of cefotaxime as initial antimicrobial therapies in women with complicated non-obstructive acute pyelonephritis (APN) caused by Enterobacteriaceae infections. The clinical characteristics and outcomes of a cefuroxime-treated group (n=156) were compared with those of a cefotaxime-treated group (n=166). Of these 322 women, 90 from each group were matched with propensity scores. The defervescence rates were not significantly different in the cefuroxime and cefotaxime groups at 72 hours after the start of the antimicrobial therapies (81.1% versus 78.9%, P = 0.709). The clinical and microbiological cure rates during the follow-up visits that were 4 to 14 days after the end of the antimicrobial therapies were not significantly different in the cefuroxime versus cefotaxime groups, which were 97.8% (87/89) versus 97.8% (87/89) (P > 0.999) and 89.5% (68/76) versus 90.7% (68/75) (P = 0.807), respectively. The median hospital stay duration and the median times to defervescence in the cefuroxime vs. cefotaxime groups were 8 (interquartile range [IQR], 7 to 10) versus 9 (IQR, 7 to 11) days and 55 (IQR, 37 to 70) versus 55 (IQR, 35 to 69) hours, respectively. Bacteremia, extended-spectrum β-lactamase producing Enterobacteriaceae, the C-reactive protein levels that were ≥15 mg/dL, and the white blood cell counts that were ≥15,000/mm(3) of blood had independent effects on the early clinical failure rates. Our data suggest that the effects of cefuroxime are not different than those of cefotaxime when they are used as an initial antimicrobial agent treatment for community-onset complicated non-obstructive APN in women.
PMID: 25645837 [PubMed - as supplied by publisher]