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Article: 6382 Date: March 15, 2012 Title: Cefpodoxime fails to meet criteria for noninferiority in women with

uncomplicated cystitis as compared to ciprofloxacin.

SMS: JAMA: Ciprofloxacin may be better than cefpodoxime for acute

uncomplicated cystitis. Topic title: Acute uncomplicated cystitis: Cefpodoxime vs ciprofloxacin Journal: Journal of the American Medical Association. Summary: When compared with ciprofloxacin, cefpodoxime failed to meet criteria for noninferiority in women with uncomplicated cystitis. The results do not support the use of cefpodoxime as a first-line antimicrobial for acute uncomplicated cystitis. Basis for Study: Fluoroquinolones are considered the most reliable for treating uncomplicated urinary infections, but the search has been on for other, effective antimicrobials in this setting because of rising resistance to fluoroquinolones. The researchers studied whether cefpodoxime is noninferior to ciprofloxacin for treating acute cystitis. Study: The trial randomized 300 women, aged 18 to 55, with acute uncomplicated cystitis to double blind treatment with a three day course of either ciprofloxacin orally (250 mg twice daily) or oral cefpodoxime (100 mg twice daily). The researchers hypothesized that cefpodoxime would be noninferior to ciprofloxacin by a 10% margin. Primary treatment outcome was overall clinical cure (30-day follow-up visit). Secondary treatment outcomes were clinical and microbiological cure at the first follow-up visit and vaginal Escherichia coli colonization at each follow-up visit. Results: Using an intent to treat approach in women who lost to follow up, the overall cure rate at 30 days was 93% in the women who received ciprofloxacin vs 82% in the women receiving cefpodoxime (difference of 11%; 95% CI, 3%-18%). Among women who lost to follow-up having been considered as treatment nonresponders, the clinical cure rates were 83% in the ciprofloxacin group vs 71% in the cefpodoxime group (difference of 12%; 95% CI, 3%-21%). Microbiologic cure rates were 96% and 81% respectively. At the first follow-up visit, scheduled for 5 to 9 days after completion of treatment, 40% women in the cefpodoxime group and 16% women in ciprofloxacin group had vaginal colonization with Escherichia coli.

Source: Hooton TM, Roberts PL, Stapleton AE. Cefpodoxime vs ciprofloxacin for shortcourse treatment of acute uncomplicated cystitis: a randomized trial. JAMA 2012 Feb 8; 307(6):583-9. Index terms: Acute cystitis Acute Uncomplicated Cystitis Cefpodoxime Ciprofloxacin Fluoroquinolones Uncomplicated urinary infections Urinary tract infection (UTI) UTI (Urinary tract infections) Alert type: Drug trial