…but don’t use either of them first-line. And, of course, your mileage may vary based on local resistance patterns.
This study, in JAMA, is from Seattle, where their ciprofloxacin resistance in e. coli is extraordinarily low – only 4%. Their e. coli resistance to cefpodoxime, a third-generation cephalosporin, was 8%. They randomized 300 women with uncomplicated cystitis into, luckily, two rather similar groups – and found a 93% clinical cure rate for ciprofloxacin and an 82% cure rate with cefpodoxime. Microbiologic cure rate at 5 days was 96% in the ciprofloxacin group and 81% in the cefpodoxime group. And, then, there are a bunch of minor details in laborious text regarding the microbiology of the non-responders, but I’m not sure any of it’s actually relevant. Seven women in the ciprofloxacin group required treatment for an “adverse effect” (nausea, headache, vaginal discomfort), compared with three in the cefpodoxime group.
However, neither of these agents should be considered first-line for uncomplicated cystitis. Nitrofurantoin and fosfomycin are recommended as first-line therapy in the most recent guidelines, along with trimethoprim-sulfamethoxazole depending on local resistance. After that, consult your local antibiogram to determine whether beta-lactams are viable, or whether a fluroquinolone or a third-generation cephalosporin should be your next option.
“Cefpodoxime vs ciprofloxacin for short-course treatment of acute uncomplicated cystitis: a randomized trial.”
http://www.ncbi.nlm.nih.gov/pubmed/22318279
2 thoughts on “Ciprofloxacin is Better Than Cefpodoxime for UTI”
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One issue here is that beta-lactams just have lower cure rates than other agents for uti's. Look at the microbiologic cure rates–cipro was right on line at 96%, whereas cefpodoxime performed much lower than expected at 81%. Lot's of people will just look at their antibiograms and say, well E coli here is usually susceptible to 3rd gen ceph's, lets go for Vantin. This study demonstrates, yet again, that this is incorrect reasoning.
One issue here is that beta-lactams just have lower cure rates than other agents for uti's. Look at the microbiologic cure rates–cipro was right on line at 96%, whereas cefpodoxime performed much lower than expected at 81%. Lot's of people will just look at their antibiograms and say, well E coli here is usually susceptible to 3rd gen ceph's, lets go for Vantin. This study demonstrates, yet again, that this is incorrect reasoning.