From the Guidelines
For patients with urinary tract infections (UTIs) who have cephalosporin allergies, the most effective alternative antibiotic option is Azithromycin, which can be used as a first-line treatment, as suggested by the European Association of Urology guidelines 1. When considering treatment options for UTIs in patients with cephalosporin allergies, it's crucial to prioritize alternatives that are both effective and safe.
- The European Association of Urology guidelines 1 provide a comprehensive overview of suggested antimicrobial therapy regimens for various pathogens, including those causing UTIs.
- For non-gonococcal infections, Doxycycline (100 mg twice daily for 7 days) is a recommended first-line treatment 1, while Azithromycin (500 mg on day 1, followed by 250 mg for 4 days) is an alternative option.
- In cases of cephalosporin allergy, Gentamicin (240 mg intramuscularly as a single dose) plus Azithromycin (2 g orally as a single dose) is a suggested regimen 1.
- Other alternatives, such as Gemifloxacin (320 mg orally as a single dose) plus Azithromycin (2 g orally as a single dose), Spectinomycin (2 g intramuscularly as a single dose), or Fosfomycin trometamol (3 g orally on days 1,3, and 5), may also be considered 1.
- The choice of antibiotic should be guided by local resistance patterns, patient-specific factors, and ideally by urine culture results.
From the FDA Drug Label
CLINICAL STUDIES Complicated Urinary Tract Infection and Pyelonephritis – Efficacy in Pediatric Patients: ... Ciprofloxacin, administered I. V. and/or orally, was compared to a cephalosporin for treatment of complicated urinary tract infections (cUTI) and pyelonephritis in pediatric patients 1 to 17 years of age ...
Treatment options for UTI in patients with an allergy to Cephalosporins:
- Ciprofloxacin (PO) is a potential treatment option for complicated urinary tract infections (cUTI) and pyelonephritis in patients with an allergy to Cephalosporins, as it has been compared to a cephalosporin in clinical trials and shown to have similar clinical success and bacteriological eradication rates 2.
- However, it is essential to note that ciprofloxacin is not a drug of first choice in the pediatric population due to an increased incidence of adverse events compared to controls.
- The decision to use ciprofloxacin should be made on a case-by-case basis, considering the patient's age, medical history, and the severity of the infection.
From the Research
Treatment Options for UTI in Patients with Cephalosporins Allergy
- For patients allergic to Cephalosporins, alternative treatment options for Urinary Tract Infections (UTIs) include:
- Nitrofurantoin 3
- Fosfomycin tromethamine 3, 4
- Pivmecillinam 3
- Fluoroquinolones (such as ciprofloxacin, but use is precluded in some communities due to high resistance rates) 3, 4
- Amoxicillin-clavulanate 3
- Finafloxacin 3
- Sitafloxacin 3
- Piperacillin-tazobactam (for ESBL-E coli only) 3
- Carbapenems (including meropenem/vaborbactam, imipenem/cilastatin-relebactam, and sulopenem) 3
- Ceftazidime-avibactam 3
- Ceftolozane-tazobactam 3
- Aminoglycosides (including plazomicin) 3
- Cefiderocol 3
- Colistin 3
- Aztreonam 3
- Tigecycline 3
Considerations for Treatment
- The choice of treatment should be based on local susceptibility patterns and the specific type of UTI (e.g. uncomplicated vs. complicated, ESBL-producing vs. non-ESBL producing) 3, 4
- It is essential to use the new antimicrobials wisely to avoid resistance development 3
- Pharmacokinetic characteristics of the molecule should be considered to optimize clinical benefit and minimize the risk of antibacterial resistance 4