From the Guidelines
For a complicated urinary tract infection (UTI) that has failed cefuroxime treatment, the best approach is to use an intravenous third-generation cephalosporin as empirical treatment, especially if the patient has systemic symptoms, as recommended by the European Association of Urology guidelines 1. When considering treatment options, it's essential to take into account the potential for antibiotic resistance and the need to manage any underlying urological abnormalities.
- The European Association of Urology guidelines suggest using a combination of antibiotics, such as amoxicillin plus an aminoglycoside or a second-generation cephalosporin plus an aminoglycoside 1.
- However, given the failure of cefuroxime, a broader-spectrum antibiotic like an intravenous third-generation cephalosporin may be more effective 1.
- It's also crucial to note that ciprofloxacin should only be used if the local resistance rate is <10% and the patient does not require hospitalization 1.
- Additionally, managing any urological abnormality and/or underlying complicating factors is strongly recommended 1.
- The treatment approach should be tailored to the individual patient's needs, taking into account the severity of the infection, the presence of any underlying conditions, and the results of urine cultures and sensitivity testing.
From the FDA Drug Label
Complicated Urinary Tract Infections Including Pyelonephritis Ertapenem was evaluated in adults for the treatment of complicated urinary tract infections including pyelonephritis in two randomized, double-blind, non-inferiority clinical trials Both trials compared ertapenem (1 g parenterally once a day) with ceftriaxone (1 g parenterally once a day) and enrolled a total of 850 patients. The microbiological success rates (combined trials) at 5 to 9 days posttherapy (test-of-cure) were 89. 5% (229/256) for ertapenem and 91. 1% (204/224) for ceftriaxone.
Treatment Option: Ertapenem is a possible treatment option for complicated UTI after treatment with cefuroxime, with a microbiological success rate of 89.5% at 5 to 9 days posttherapy 2.
- Key Points:
- Ertapenem was compared to ceftriaxone in two clinical trials
- The trials enrolled a total of 850 patients
- Ertapenem had a microbiological success rate of 89.5% at 5 to 9 days posttherapy
- Ceftriaxone had a microbiological success rate of 91.1% at 5 to 9 days posttherapy
From the Research
Treatment Options for Complicated UTI
After treatment with cefuroxime, the following options can be considered for complicated UTI:
- Carbapenems, such as meropenem/vaborbactam, imipenem/cilastatin-relebactam, and sulopenem 3
- Piperacillin-tazobactam, ceftazidime-avibactam, ceftolozane-tazobactam, and aminoglycosides, including plazomicin 3, 4
- Cefepime + enmetazobactam, which has shown efficacy in treating complicated UTI, including acute pyelonephritis 5
- Fosfomycin, which can be used as an alternative treatment option for lower complicated UTIs 3, 4
Considerations for Treatment
When selecting a treatment option, consider the following factors:
- Local resistance patterns 3, 4
- Patient-specific factors, including anatomic site of infection and severity of disease 4
- Pharmacokinetic and pharmacodynamic principles 6
- Cost and potential for development of antimicrobial resistance 3, 7
Alternative Treatment Options
Other treatment options that may be considered include: