Drugs

, Volume 34, Supplement 2, pp 154–163 | Cite as

Cephalosporins in Urinary Tract Infection

  • Layne O. Gentry
Article

Summary

Despite their greater cost compared with other antibiotics, the cephalosporins continue to be used in the treatment of urinary tract infections. Most cephalosporins are excreted primarily by the kidney (by glomerular filtration, tubular secretion, or both) and urinary concentrations routinely exceed 1000 mg/L after even a small dose; exceptions include cefoperazone and ceftriaxone which both exhibit significant biliary excretion, and in patients with significant renal dysfunction only minimal concentrations of these drugs may be present in the urine.

Although single-dose treatment of uncomplicated lower urinary tract infections with oral cephalosporins has not been as effective as with other antibiotics, cephalexin, cephradine and cefaclor continue to be used. Early clinical trials with cefuroxime axetil also appear promising for short term and single-dose therapy. The parenteral cephalosporins are reserved for use against more resistant strains or in hospitalised patients with upper urinary tract infections, their choice being directed by in vitro susceptibility tests. Newer agents such as ceftazidime and cefsulodin have been shown to be effective in infections due to P. aeruginosa.

Recommended cephalosporin dosage regimens for the common urinary tract pathogens are given.

Keywords

Urinary Tract Infection Cephalosporin Bacteriuria Cephalexin Cefaclor 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Adams, D.H.; Wood, M.J.; Farrell, I.D.; Fox, C.; Ball, A.P.: Oral cefuroxime axetil: clinical pharmacology and comparative dose studies in urinary tract infection. Journal of Antimicrobial Chemotherapy 16: 359 (1985).PubMedCrossRefGoogle Scholar
  2. Andriole, V.T.: Current concepts of urinary tract infections; in Weinstein and Fields (Eds) Seminars in Infectious Diseases, Vol. III, p.89 (Thieme-Stratton, New York 1980).Google Scholar
  3. Andriole, V.T.: Urinary tract infections and pyelonephritis; in Wyngaarden and Smith (Eds) Cecil Textbook of Medicine, Vol. II, p.619 (W.B. Saunders, Philadelphia 1985).Google Scholar
  4. Arthur, L.J.H. and Burland, W.L.: Transfer of cephaloridine from mother to fetus. Archives of Disease in Childhood 44: 82 (1969).PubMedCrossRefGoogle Scholar
  5. Bailey, R.R.; Peddie, B.; Chambers, R.F.M.; Crofts, H.G.; Davies, P.R.; Bishop, V. and Blake, E.: On trial: Single dose doxycycline, cefuroxime and pivmecillinam for treatment of bacterial cystitis. New Zealand Medical Journal 95: 699 (1982).PubMedGoogle Scholar
  6. Balant, L.; Dayer, P. and Rudhardt, M.: Cefoperazone: Pharmacokinetics in humans with normal and impaired renal function and pharmacokinetics in rats. Clinical Therapy 3: 50 (1980).Google Scholar
  7. Barr, W. and Graham, R.: Placental transfer of cephaloridine. Placental transmission of cephaloridine. Postgraduate Medicine Journal 43 (Suppl.): 101 (1967).Google Scholar
  8. Bawdon, R.E.; Cunningham, F.G.; Quick, J.G. and Roark, M.L.: Maternal and fetal pharmacokinetics of moxalactam given intrapartum. American Journal of Obstetrics and Gynecology 141: 546 (1982).Google Scholar
  9. Bergan, T.: Pharmacokinetic properties of the cephalosporins. Drugs 34(Suppl. 2): 89 (1987).PubMedCrossRefGoogle Scholar
  10. Bernard, B.; Barton, L.; Acoste, M. and Ballard, C.A.: Maternalfetal transfer of cefazolin in the first twenty weeks of pregnancy. Journal of Infectious Diseases 136: 377 (1977a).PubMedCrossRefGoogle Scholar
  11. Bernard, B.; Thielen, P.; Garcia-Cazares, S.J. and Ballard, C.A.: Maternal-fetal pharmacology of cefatrizine in the first 20 weeks of pregnancy. Antimicrobial Agents and Chemotherapy 12: 231 (1977b).PubMedCrossRefGoogle Scholar
  12. Buckwold, F.J.; Ludwig, P.; Harding, G.K.M.; Thompson, L.; Slutchuk, M.; Shaw, J. and Ronald, A.R.: Therapy for acute cystitis in adult women: randomized comparison of single-dose sulfisoxazole vs trimethroprim-sulfamethoxazole. Journal of the American Medical Association 247: 1839 (1982).PubMedCrossRefGoogle Scholar
  13. Carlson, K.J. and Mulley, A.G.: Management of acute dysuria: A decision-analysis model of alternative strategies. Annals of Internal Medicine 102: 244 (1985).PubMedGoogle Scholar
  14. Charlton, C.A.C.; Crowther, A.; Davies, J.G.; Dynes, J.; Haward, M.W.A.; Mann, P.G. and Rye, S.: Three-day and ten-day chemotherapy for urinary tract infections in general practice. British Medical Journal 1: 124 (1976).PubMedCrossRefGoogle Scholar
  15. Cox, C.E.: Comparison of ceftazidime and tobramycin in the treatment of complicated urinary tract infections. Journal of Antimicrobial Chemotherapy 12(Suppl. A): 47 (1983).PubMedGoogle Scholar
  16. Cox, C.E.; Sherrill, J.M. and Cocchetto, D.M.: Evaluation of cefuroxime axetil, cefaclor and cephalexin in the treatment of urinary tract infections in adults. Current Therapeutic Research, in press (July, 1987).Google Scholar
  17. Craft, I.; Mullinger, B.M. and Kennedy, M.L.: Placental transfer of cefuroxime. British Journal of Obstetrics and Gynaecology 88: 141 (1981).PubMedCrossRefGoogle Scholar
  18. Creatsas, G.; Paulatos, M.; Lolis, D. and Kaskarelis, D.: A study of the kinetics of cephapirin and cephalexin in pregnancy. Current Medical Research and Opinion 7: 43 (1980).PubMedCrossRefGoogle Scholar
  19. Dabois, M.; Delsneire, D.; Chanteux, L.; Demonty, J.; Lambolte, R.; Kramp, R. and Dresse, A.: A study of the transplacental transfer and the mammary excretion of cefoxitin in humans. Journal of Clinical Pharmacology 21: 477 (1981).Google Scholar
  20. Dekel, A.; Elan, I.; Gikor, Y. and Goldman, J.A.: Transplacental passage of cefazolin in the first trimester of pregnancy. European Journal of Obstetrics Gynecology and Reproductive Biology 10: 303 (1980).CrossRefGoogle Scholar
  21. Doering, P. and Stewart, R.: The extent and character of drug consumption during pregnancy. Journal of the American Medical Association 239: 843 (1978).PubMedCrossRefGoogle Scholar
  22. Elder, H.A. and Roy, I.: Treatment of urinary tract infections due to Pseudomonas aeruginosa with cefsulodin. Reviews of Infectious Diseases 6(Suppl. 3): 734 (1984).CrossRefGoogle Scholar
  23. Elder, H.A.; Sanbmarina, B.A.G.; Smith, S. and Kass, E.H.: The natural history of asymptomatic bacteriuria during pregnancy: The effect of tetracycline on the clinical course and outcome of pregnancy. American Journal of Obstetrics and Gynecology 14: 441 (1971).Google Scholar
  24. Fair, W.R.; Crane, D.B.; Peterson, L.J.; Dahmer, C.; Tague, B. and Amos, W.: Three-day treatment of urinary tract infections. Journal of Urology 123: 717 (1980).PubMedGoogle Scholar
  25. Flakuty, J.F.; Boswell, G.W.; Winkel, C.A. and Elliott, J.P.: Pharmacokinetics of cefoxitin in patients at term gestation: Lavage versus intravenous administration. American Journal of Obstetrics and Gynecology 146: 760 (1983).Google Scholar
  26. Frimodt-Møller, P.C. and Madsen, P.O.: Ceftazidime, a new cephalosporin in the treatment of complicated urinary tract infections. A comparative study with tobramycin. Journal of Urology 130: 796 (1983).PubMedGoogle Scholar
  27. Giamarellou, H.; Petrikkos, G.; Gazis, J.; Tsatsiadis, K.; Antsaklis, A. and Daikos, G.: Penetration of antibiotics with anti-anaerobic activity through the amniotic fluid. Proceedings of the 13th International Congress of Chemotherapy. Section SE 7.6/1-2, p.79/5–8 (1983).Google Scholar
  28. Greenberg, R.N.; Sanders, C.V.; Lewis, A.C. and Marier, R.L.: Single-dose cefaclor therapy of urinary tract infection: Evaluation of antibody-coated bacteria test and C-reactive protein assay as predictors of cure. American Journal of Medicine 71: 841 (1981).PubMedCrossRefGoogle Scholar
  29. Gruneberg, R.N. and Brumfitt, W.: Single-dose treatment of acute urinary tract infection: A controlled trial. British Medical Journal 3: 649 (1967).PubMedCrossRefGoogle Scholar
  30. Harris, R.E.; Gilstrap, L.C. III and Pretty, A.: Single dose antimicrobial therapy for asymptomatic bacteriuria during pregnancy. Obstetrics and Gynecology 59: 546 (1982).PubMedGoogle Scholar
  31. Kafetzis, O.A.; Boster, D.; Fanourpakis, J.E.; Voyatzis, J. and Georpatopowlos, P.: Ceftriaxone distribution between maternal blood and fetal blood and tissues at parturition and between blood and milk postpartum. Antimicrobial Agents and Chemotherapy 23: 870 (1983).PubMedCrossRefGoogle Scholar
  32. Kass, E.H.: The role of asymptomatic bacteriuria in the pathogenesis of pyelonephritis; in Quinn and Kass (Eds) Biology of Pyelonephritis, p.399 (Little, Brown, Boston 1960).Google Scholar
  33. Koch, H.K. and McLemore, T.: National Ambulatory Medical Care Survey: 1975 - Summary: United States, January-December 1985. Hyattsville, Maryland: National Center for Health Statistics, Department of Health, Education and Welfare 1: 62 (1978). [Vital and Health Statistics series 13, No. 33. DHEW publications No. (PHS) 78-1784.]Google Scholar
  34. Kunin, C.M.: Duration of treatment of urinary tract infections. American Journal of Medicine 71: 849 (1981).PubMedCrossRefGoogle Scholar
  35. MacAuley, M. and Charles, D.: Placental transfer of cephalothin. American Journal of Obstetrics and Gynecology 100:940 (1968).Google Scholar
  36. MacDonald, P.; Alexander, D.; Catz, C. and Edelman, R.: Summary of a workshop on maternal genitourinary infection and the outcome of pregnancy. Journal of Infectious Disease 147: 596 (1983).CrossRefGoogle Scholar
  37. McCabe, W.R. and Jackson, G.G.: Treatment of pyelonephritis: Bacterial, drug and host factors in success or failure among 252 patients. New England Journal of Medicine 272: 1037 (1965).CrossRefGoogle Scholar
  38. McFadyen, I.R.; Eykyn, S.J.; Gardner, N.H.N.; Vanier, T.M.; Bennett, A.E.; Mayo, M.E. and Lloyd-Davies, R.W.: Bacteriuria in pregnancy. Journal of Obstetrics and Gynaecology of the British Empire 80: 85 (1973).Google Scholar
  39. Morrow, S.; Palmisano, P. and Gasady, G.: The placental transfer of cephalothin. Journal of Pediatrics 73: 262 (1968).PubMedCrossRefGoogle Scholar
  40. Philipson, A. and Stierastedt, G.: Pharmacokinetics of cefuroxime in pregnancy. American Journal of Obstetrics and Gynecology 142: 823 (1982).PubMedGoogle Scholar
  41. Pontzer, R.E.; Krieger, R.E.; Boscia, J.A.; McNamee, W.; Levison, M.E. and Kaye, D.: Single-dose cefonicid therapy for urinary tract infections. Antimicrobial Agents and Chemotherapy 23: 814 (1983).PubMedCrossRefGoogle Scholar
  42. Ronald, A.R.; Boutros, P. and Mourtada, H.: Bacteriuria localization and response to single-dose therapy in women. Journal of the American Medical Association 235: 1854 (1976).PubMedCrossRefGoogle Scholar
  43. Rubin, R.H.; Fang, L.S.T. and Jones, S.R.: Single-dose amoxicillin therapy for urinary tract infection: Multicenter trial using antibody-coated bacteria localization technique. Journal of the American Medical Association 244: 561 (1980).PubMedCrossRefGoogle Scholar
  44. Sandberg, T.; Henning, C.; Paulsen, O. and Iwarson, S.: Cefadroxil once daily for three days versus one week therapy in uncomplicated urinary tract infections. 23rd Interscience Conference on Antimicrobial Agents and Chemotherapy, Las Vegas, Oct. 24–26, 1983. Abstract No. 528 (1983).Google Scholar
  45. Sande, M.: Pharmacokinetics of cefoperazone in normal volunteers and subjects with renal insufficiency. Antimicrobial Agents and Chemotherapy 19: 821 (1981).PubMedCrossRefGoogle Scholar
  46. Savard-Fenton, M.; Fenton, B.W.; Reller, L.B.; Lauer, B.A. and Byyny, R.L.: Single-dose amoxycillin therapy with follow-up urine culture: Effective initial management for acute uncomplicated urinary tract infections. American Journal of Medicine 73: 808 (1982).PubMedCrossRefGoogle Scholar
  47. Schwarz, R.H.: Consideration of antibiotic therapy during pregnancy. Obstetrics and Gynecology 58 (Suppl.): 955 (1981).Google Scholar
  48. Seddon, M.; Wise, R.; Gillett, A. and Livingston, R.: Pharmacokinetics of RO-139904, a broad spectrum cephalosporin. Antimicrobial Agents and Chemotherapy 18: 240 (1980).PubMedCrossRefGoogle Scholar
  49. Shaw, P.G.; Fairley, K.F. and Whitworth, J.A.: Treatment of urinary tract infection with a single-dose intramuscular administration of cephamandole. Medical Journal of Australia 1: 489 (1980).PubMedGoogle Scholar
  50. Souney, P. and Polk, B.F.: Single-dose antimicrobial therapy for urinary tract infections in women. Reviews of Infectious Diseases 4: 29 (1982).PubMedCrossRefGoogle Scholar
  51. Stamey, T.A. (Ed.): Urinary tract infection in women; in Pathogenesis and Treatment of Urinary Tract Infections, p. 164 (Williams and Wilkins, Baltimore 1980).Google Scholar
  52. Stamey, T.A.; Fair, W.R.; Timothy, M.M.; Millar, M.A.; Mihara, G. and Lowery, Y.C.: Serum versus urinary antimicrobial concentrations in cure of urinary-tract infections. New England Journal of Medicine 291: 1159 (1974).PubMedCrossRefGoogle Scholar
  53. Stamm, W.E.; Wagner, K.F.; Amsel, R.; Alexander, E.R.; Turch, M.; Couts, G.W. and Holmes, K.K.: Causes of the acute urethral syndrome in women. New England Journal of Medicine 303: 409 (1980).PubMedCrossRefGoogle Scholar
  54. Stamm, W.E.; Koutsky, L.A.; Benedetti, J.K.; Jourden, J.L.; Brunham, R.C. and Holmes, K.K.: Chlamydia trachomatis urethral infections in men. Annals of Internal Medicine 100: 47 (1984).PubMedGoogle Scholar
  55. Stewart, K.S.: Bacterial infections. Clinics in Obstetrics and Gynecology 8: 315 (1981).Google Scholar
  56. Swape, W.E.; Hajj, S.N. and Kass, E.H.: Demographic and prognostic characteristics of bacteriuria in pregnancy. Medicine 46: 385 (1967).CrossRefGoogle Scholar
  57. Takase, Z.: Experience with cefotaxime in gynecology and obstetrics. Clinical Therapeutics 4(Suppl. A): 25 (1981).PubMedGoogle Scholar
  58. Thomas, V.; Shelokov, A. and Forland, M.: Antibody-coated bacteria in the urine and the site of urinary-tract infection. New England Journal of Medicine 290: 588 (1974).PubMedCrossRefGoogle Scholar
  59. Tolkoff-Rubin, N.E.; Weber, D.; Fang, L.S.T.; Kelly, M.; Wilkinson, R. and Rubin, R.H.: Single-dose therapy with trimethoprim-sulfamethoxazole for urinary tract infection in women. Reviews of Infectious Diseases 4: 444 (1982).PubMedCrossRefGoogle Scholar
  60. Williams, J.D.; Reeves, D.S.; Condie, A.P.; Leigh, D.A.; Franklin, I.S.N. and Brumfitt, W.: The treatment of bacteriuria in pregnancy; in O’Grady and Brumfitt (Eds) Urinary Tract Infection, p. 160 (Oxford University Press, London 1968).Google Scholar
  61. Williams, K.L.; Hebblethwaite, E.M.; Brown, G.W.; Cox, D.M.; Plested, S.J.: Cefuroxime axetil in the treatment of uncomplicated UTI: a comparison with cefaclor and augmentin. Drugs Under Experimental and Clinical Research 13: 95 (1987).PubMedGoogle Scholar

Copyright information

© ADIS Press Limited 1987

Authors and Affiliations

  • Layne O. Gentry
    • 1
  1. 1.St Luke’s Episcopal HospitalHoustonUSA

Personalised recommendations