From the Research
Cefixime is not the preferred antibiotic choice for a urinary tract infection (UTI) potentially caused by Group B Streptococcus (GBS). For GBS UTIs, penicillin or ampicillin remains the first-line treatment, with amoxicillin 500 mg three times daily for 3-7 days being a common outpatient regimen 1. If the patient has a penicillin allergy, clindamycin 300 mg four times daily or cephalexin 500 mg four times daily for 3-7 days are better alternatives. While cefixime has good gram-negative coverage for typical UTI pathogens like E. coli, it has less reliable activity against GBS compared to other options. GBS is naturally susceptible to beta-lactam antibiotics, particularly penicillins, which provide more targeted and effective treatment.
Some key points to consider when treating UTIs potentially caused by GBS include:
- The diversity of GBS serotypes that can cause UTIs, with serotypes V, Ia, and III being the most common 1
- The importance of susceptibility testing to guide treatment, especially in cases of penicillin allergy or resistance
- The need for intrapartum antibiotic prophylaxis in pregnant women with GBS bacteriuria to prevent neonatal GBS disease
In terms of the effectiveness of cefixime for UTIs, studies have shown that it is a suitable alternative to other antibiotics for uncomplicated UTIs, with a broad spectrum of activity against gram-negative bacteria 2, 3, 4, 5. However, its use in GBS UTIs is not recommended due to its less reliable activity against this pathogen.
Overall, the choice of antibiotic for a UTI potentially caused by GBS should be guided by the most recent and highest quality evidence, with a focus on minimizing morbidity, mortality, and improving quality of life. Penicillin or ampicillin remains the first-line treatment for GBS UTIs, and cefixime should not be used as a first-line agent for this indication.