Do first-generation cephalosporins (1st gen ceph) cover lactose-positive coliform (E. coli) urine cultures?

From the Research

First-generation cephalosporins are not the preferred choice for treating lactose-positive coliform (E. coli) urine cultures due to increasing resistance rates, as reported in the most recent study 1. The study published in 2020 in Postgraduate medicine highlights the growing concern of antibiotic-resistant Gram-negative bacteria, including E. coli, and the need for alternative treatment options. Some key points to consider:

• The recommended first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females is a 5-day course of nitrofurantoin, a 3-g single dose of fosfomycin tromethamine, or a 5-day course of pivmecillinam, as stated in the study 1.
• High rates of resistance to trimethoprim-sulfamethoxazole and ciprofloxacin preclude their use as empiric treatment of UTIs in several communities, particularly if patients who were recently exposed to them or in patients who are at risk of infections with extended-spectrum β-lactamases (ESBLs)-producing Enterobacteriales, as mentioned in the study 1.
• Second-line options include oral cephalosporins such as cephalexin or cefixime, fluoroquinolones, and β-lactams, such as amoxicillin-clavulanate, according to the study 1. However, the study also notes that increasing resistance rates are a concern, and urine culture and susceptibility testing are recommended, especially for complicated infections or in areas with high resistance prevalence. It's worth noting that other studies, such as the one published in 2019 in Microbial drug resistance, suggest that combination therapy with oral cephalosporins and amoxicillin/clavulanate may be an effective treatment option for ESBL-producing E. coli, but this is not a first-generation cephalosporin 2. In conclusion, while first-generation cephalosporins may have been effective in the past, the most recent evidence suggests that they are not the preferred choice for treating lactose-positive coliform (E. coli) urine cultures due to increasing resistance rates.