What antibiotic can be used to treat a urinary tract infection (UTI) in a patient allergic to Ceftin (Cefuroxime)?

From the Guidelines

For a patient allergic to Ceftin (cefuroxime) who has a urinary tract infection, nitrofurantoin (Macrobid) 100 mg twice daily for 5-7 days is a good alternative treatment option. Other effective choices include trimethoprim-sulfamethoxazole (Bactrim) DS tablet twice daily for 3 days, fosfomycin (Monurol) as a single 3-gram dose, or ciprofloxacin (Cipro) 250-500 mg twice daily for 3-7 days depending on infection severity 1. Since the patient has a cephalosporin allergy, it's essential to avoid other cephalosporins due to potential cross-reactivity, as suggested by the study on drug allergy published in the Journal of Allergy and Clinical Immunology 1. The choice of antibiotic should consider local resistance patterns, patient factors like kidney function, and infection severity. Nitrofurantoin works by damaging bacterial DNA and is concentrated in the urine, making it particularly effective for uncomplicated UTIs while having minimal impact on gut flora. Patients should complete the full course of antibiotics even if symptoms improve and should increase fluid intake to help flush the infection.

Some key points to consider when choosing an antibiotic for a patient with a UTI and a cephalosporin allergy include:

• Avoiding cephalosporins with similar side chains to the culprit drug, as recommended by the Dutch Working Party on Antibiotic Policy guideline 1
• Considering non-beta-lactam antibiotics, such as fluoroquinolones, aminoglycosides, imidazol derivatives, macrolides, and lincosamides, as alternative treatment options
• Evaluating the patient's antibiotic allergy history and performing a thorough allergy work-up to determine the best course of treatment
• Handling the patient's care according to the advice provided by an allergist, if necessary

It's also important to note that the true prevalence of fluoroquinolone allergy in the general population is unknown, but it is the most frequently reported non-beta-lactam antibiotic allergy, with moxifloxacin posing the highest risk of anaphylaxis compared to other frequently used fluoroquinolones, such as levofloxacin and ciprofloxacin 1.

From the FDA Drug Label

To reduce the development of drug-resistant bacteria and maintain the effectiveness of sulfamethoxazole and trimethoprim tablets and other antibacterial drugs, sulfamethoxazole and trimethoprim tablets should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria Urinary Tract Infections For the treatment of urinary tract infections due to susceptible strains of the following organisms: Escherichia coli, Klebsiella species, Enterobacter species, Morganella morganii, Proteus mirabilis and Proteus vulgaris It is recommended that initial episodes of uncomplicated urinary tract infections be treated with a single effective antibacterial agent rather than the combination

For a patient allergic to Ceftin (Cefuroxime), trimethoprim-sulfamethoxazole can be used to treat a urinary tract infection (UTI) caused by susceptible strains of certain bacteria, including:

• Escherichia coli
• Klebsiella species
• Enterobacter species
• Morganella morganii
• Proteus mirabilis
• Proteus vulgaris 2

From the Research

Alternatives to Ceftin for UTI Treatment

If a patient is allergic to Ceftin (Cefuroxime), there are several alternative antibiotics that can be used to treat a urinary tract infection (UTI).

• First-line options:
  • Nitrofurantoin 3, 4, 5
  • Fosfomycin tromethamine 3, 5, 6
  • Pivmecillinam 3, 5, 6
• Second-line options:
  • Oral cephalosporins such as cephalexin or cefixime 3, 7
  • Fluoroquinolones 3, 5, 6
  • β-lactams, such as amoxicillin-clavulanate 3, 5, 6
• Treatment options for specific types of UTIs:
  • UTIs due to AmpC-β-lactamase-producing Enterobacteriales: nitrofurantoin, fosfomycin, pivmecillinam, fluoroquinolones, cefepime, piperacillin-tazobactam, and carbapenems 3
  • UTIs due to ESBLs-E coli: nitrofurantoin, fosfomycin, pivmecillinam, amoxicillin-clavulanate, finafloxacin, and sitafloxacin 3
  • UTIs due to ESBLs-Klebsiella pneumoniae: pivmecillinam, fosfomycin, finafloxacin, and sitafloxacin 3
  • UTIs due to carbapenem-resistant Enterobacteriales (CRE): ceftazidime-avibactam, meropenem/vaborbactam, imipenem/cilastatin-relebactam, colistin, fosfomycin, aztreonam, and cefiderocol 3
  • UTIs caused by multidrug-resistant (MDR)-Pseudomonas spp.: fluoroquinolones, ceftazidime, cefepime, piperacillin-tazobactam, carbapenems, ceftolozane-tazobactam, ceftazidime-avibactam, aminoglycosides, aztreonam, and cefiderocol 3