scholarly journals Preferential Use of Nitrofurantoin Over Fluoroquinolones for Acute Uncomplicated Cystitis and Outpatient Escherichia coli Resistance in an Integrated Healthcare System

2017 ◽  
Vol 38 (4) ◽  
pp. 461-468 ◽  
Author(s):  
Rebecca L. Pedela ◽  
Katherine C. Shihadeh ◽  
Bryan C. Knepper ◽  
Michelle K. Haas ◽  
William J. Burman ◽  
...  
Keyword(s):  
Healthcare System ◽  
First Line ◽  
Integrated Healthcare ◽  
Acute Cystitis ◽  
E Coli ◽  
First Line Therapy ◽  
System A ◽  
Line Therapy ◽  
Acute Uncomplicated Cystitis ◽  
Uncomplicated Cystitis

OBJECTIVESTo evaluate changes in outpatient fluoroquinolone (FQ) and nitrofurantoin (NFT) use and resistance among E. coli isolates after a change in institutional guidance to use NFT over FQs for acute uncomplicated cystitis.DESIGNRetrospective preintervention–postintervention study.SETTINGUrban, integrated healthcare system.PATIENTSAdult outpatients treated for acute cystitis.METHODSWe compared 2 time periods: January 2003–June 2007 when FQs were recommended as first-line therapy, and July 2007–December 2012, when NFT was recommended. The main outcomes were changes in FQ and NFT use and FQ- and NFT-resistant E. coli by time-series analysis.RESULTSOverall, 5,714 adults treated for acute cystitis and 11,367 outpatient E. coli isolates were included in the analysis. After the change in prescribing guidance, there was an immediate 26% (95% CI, 20%–32%) decrease in FQ use (P<.001), and a nonsignificant 6% (95% CI, −2% to 15%) increase in NFT use (P=.12); these changes were sustained over the postintervention period. Oral cephalosporin use also increased during the postintervention period. There was a significant decrease in FQ-resistant E. coli of −0.4% per quarter (95% CI, −0.6% to −0.1%; P=.004) between the pre- and postintervention periods; however, a change in the trend of NFT-resistant E. coli was not observed.CONCLUSIONSIn an integrated healthcare system, a change in institutional guidance for acute uncomplicated cystitis was associated with a reduction in FQ use, which may have contributed to a stabilization in FQ-resistant E. coli. Increased nitrofurantoin use was not associated with a change in NFT resistance.Infect Control Hosp Epidemiol 2017;38:461–468

scholarly journals Fosfomycin: A First-Line Oral Therapy for Acute Uncomplicated Cystitis

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
George G. Zhanel ◽  
Andrew J. Walkty ◽  
James A. Karlowsky
Keyword(s):  
Clinical Trials ◽  
Safety Profile ◽  
Cross Resistance ◽  
Adult Women ◽  
First Line ◽  
Favorable Safety Profile ◽  
E Coli ◽  
Acute Uncomplicated Cystitis ◽  
Uncomplicated Cystitis ◽  
Favorable Safety

Fosfomycin is a new agent to Canada approved for the treatment of acute uncomplicated cystitis (AUC) in adult women infected with susceptible isolates ofE. coliandEnterococcus faecalis. We reviewed the literature regarding the use of oral fosfomycin for the treatment of AUC. All English-language references from 1975 to October 2015 were reviewed. In Canada, fosfomycin tromethamine is manufactured as Monurol® and is available as a 3-gram single dose sachet. Fosfomycin has a unique chemical structure, inhibiting peptidoglycan synthesis at an earlier site compared toβ-lactams with no cross-resistance with other agents. Fosfomycin displays broad-spectrum activity against ESBL-producing, AmpC-producing, carbapenem-non-susceptible, and multidrug-resistant (MDR)E. coli. Resistance to fosfomycin inE. coliis rare (<1%). Fosfomycin is excreted unchanged in the urine by glomerular filtration with peak urinary concentration ~4000 µg/mL and remains at concentrations >100 µg/mL for 48 hours after a single 3-gram oral dose. No dosage adjustments are required in elderly patients, in pregnant patients, or in either renal or hepatic impairment. Fosfomycin demonstrates a favorable safety profile, and clinical trials have demonstrated efficacy in AUC that is comparable to ciprofloxacin, nitrofurantoin, and trimethoprim-sulfamethoxazole. Fosfomycin’s in vitro activity against common uropathogens, including MDR isolates, its favorable safety profile including pregnancy patients, drug interactions, and clinical trials data demonstrating efficacy in AUC, has resulted in Canadian, US, and European guidelines/authorities recommending fosfomycin as a first line agent for the treatment of AUC.

scholarly journals Cefaclor as a first-line treatment for acute uncomplicated cystitis

2020 ◽  
Author(s):  
Dai Koguchi ◽  
Yasukiyo Murakami ◽  
Masaomi Ikeda ◽  
Masato Dobashi ◽  
Junichiro Ishii
Keyword(s):  
Treatment Failure ◽  
Success Rate ◽  
Clinical Efficacy ◽  
Wide Spectrum ◽  
White Blood Cells ◽  
Resistant Bacteria ◽  
First Line ◽  
E Coli ◽  
Acute Uncomplicated Cystitis ◽  
Uncomplicated Cystitis

Abstract Background: Wide-spectrum antibiotics have been favored to treat acute uncomplicated cystitis (AUC) for a long time, leading to the emergence of multi-drug resistant bacteria. We hypothesize that narrow-spectrum antibiotics might mitigate the issue and aim to investigate the clinical efficacy of cefaclor in patients with AUC.Methods: We retrospectively reviewed the clinical data of female outpatients with AUC treated with cefaclor and evaluated the safety and clinical efficacy. Clinical cure was defined as the elimination of clinical symptom under 4 white blood cells (WBCs) per high power field on microscopy.Results: Overall, 223 women with AUC were enrolled. Escherichia coli was the dominant pathogen (n=160; 68.6%), followed by Klebsiella species and E. coli-extended spectrum β-lactamase (ESBL) (n=19; 8.1% and n=18; 7.7%). Overall success rate was 94.0% (n=219) and susceptibility rate of cefazolin was 84.1%, which was close to that of levofloxacin (82.9%). Ampicillin showed the lowest rate of 63.7% with a significantly greater resistance rate of 35.3% among all antibiotics (P<0.001). In the subgroup analysis, the success rate in patients with resistance to levofloxacin or cefazolin was 100% (n=24) or 93.3% (n=14). The rate in patients with resistance to both antibiotics was 60.0% (n=9), and the pathogens in the other 40.0% (n=6) of patients with treatment failure were E. coli-ESBL.Conclusion: Cefaclor showed an excellent efficacy in AUC patients, even in those with resistance to cefazolin or levofloxacin. Cefaclor has the potential to be the first-line and second-line therapies for patients with levofloxacin treatment failure.

scholarly journals Cefaclor as a first-line treatment for acute uncomplicated cystitis: a retrospective single-center study

2020 ◽  
Author(s):  
Dai Koguchi ◽  
Yasukiyo Murakami ◽  
Masaomi Ikeda ◽  
Masato Dobashi ◽  
Junichiro Ishii
Keyword(s):  
Treatment Failure ◽  
Success Rate ◽  
Clinical Efficacy ◽  
Wide Spectrum ◽  
White Blood Cells ◽  
Resistant Bacteria ◽  
First Line ◽  
E Coli ◽  
Acute Uncomplicated Cystitis ◽  
Uncomplicated Cystitis

Abstract Background: Wide-spectrum antibiotics have been favored to treat acute uncomplicated cystitis (AUC) for a long time, leading to the emergence of multi-drug resistant bacteria. We hypothesize that narrow-spectrum antibiotics might mitigate the issue and aim to investigate the clinical efficacy of cefaclor in patients with AUC. Methods : We retrospectively reviewed the clinical data of female outpatients with AUC treated with cefaclor and evaluated the safety and clinical efficacy. Clinical cure was defined as the elimination of clinical symptom under 4 white blood cells (WBCs) per high power field on microscopy. Results : Overall, 223 women with AUC were enrolled. Escherichia coli was the dominant pathogen (n=160; 68.6%), followed by Klebsiella species and E. coli -extended spectrum β-lactamase (ESBL) (n=19; 8.1% and n=18; 7.7%). Overall success rate was 94.0% (n=219) and susceptibility rate of cefazolin was 84.1%, which was close to that of levofloxacin (82.9%). Ampicillin showed the lowest rate of 63.7% with a significantly greater resistance rate of 35.3% among all antibiotics (P<0.001). In the subgroup analysis, the success rate in patients with resistance to levofloxacin or cefazolin was 100% (n=24) or 93.3% (n=14). The rate in patients with resistance to both antibiotics was 60.0% (n=9), and the pathogens in the other 40.0% (n=6) of patients with treatment failure were E. coli -ESBL. Conclusion : Cefaclor showed excellent efficacy in AUC patients, even in those with in vitro resistance to cefazolin or levofloxacin. Cefaclor may be considered as a first-line option in patients with AUC and a second-line option for those with levofloxacin treatment failure.

scholarly journals Cefaclor as a first-line treatment for acute uncomplicated cystitis

2020 ◽  
Author(s):  
Dai Koguchi ◽  
Yasukiyo Murakami ◽  
Masaomi Ikeda ◽  
Masato Dobashi ◽  
Junichiro Ishii
Keyword(s):  
Treatment Failure ◽  
Success Rate ◽  
Clinical Efficacy ◽  
Wide Spectrum ◽  
White Blood Cells ◽  
Resistant Bacteria ◽  
First Line ◽  
E Coli ◽  
Acute Uncomplicated Cystitis ◽  
Uncomplicated Cystitis

Abstract Background: Wide-spectrum antibiotics have been favored to treat acute uncomplicated cystitis (AUC) for a long time, leading to the emergence of multi-drug resistant bacteria. We hypothesize that narrow-spectrum antibiotics might mitigate the issue and aim to investigate the clinical efficacy of cefaclor in patients with AUC. Methods : We retrospectively reviewed the clinical data of female outpatients with AUC treated with cefaclor and evaluated the safety and clinical efficacy. Clinical cure was defined as the elimination of clinical symptom under 4 white blood cells (WBCs) per high power field on microscopy. Results : Overall, 223 women with AUC were enrolled. Escherichia coli was the dominant pathogen (n=160; 68.6%), followed by Klebsiella species and E. coli -extended spectrum β-lactamase (ESBL) (n=19; 8.1% and n=18; 7.7%). Overall success rate was 94.0% (n=219) and susceptibility rate of cefazolin was 84.1%, which was close to that of levofloxacin (82.9%). Ampicillin showed the lowest rate of 63.7% with a significantly greater resistance rate of 35.3% among all antibiotics (P<0.001). In the subgroup analysis, the success rate in patients with resistance to levofloxacin or cefazolin was 100% (n=24) or 93.3% (n=14). The rate in patients with resistance to both antibiotics was 60.0% (n=9), and the pathogens in the other 40.0% (n=6) of patients with treatment failure were E. coli -ESBL. Conclusion : Cefaclor showed excellent efficacy in AUC patients, even in those with in vitro resistance to cefazolin or levofloxacin. Cefaclor may be considered as a first-line option in patients with AUC and a second-line option for those with levofloxacin treatment failure.

scholarly journals The Management of Acute Uncomplicated Cystitis in Adult Women by Family Physicians in Canada

2008 ◽  
Vol 19 (4) ◽  
pp. 287-293 ◽  
Author(s):  
Warren J McIsaac ◽  
Preeti Prakash ◽  
Susan Ross
Keyword(s):  
Primary Care Physicians ◽  
Urine Culture ◽  
Family Physicians ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Adult Women ◽  
First Line ◽  
Acute Cystitis ◽  
Acute Uncomplicated Cystitis ◽  
Uncomplicated Cystitis

INTRODUCTION: There are few Canadian studies that have assessed prescribing patterns and antibiotic preferences of physicians for acute uncomplicated cystitis. A cross-Canada study of adult women with symptoms of acute cystitis seen by primary care physicians was conducted to determine current management practices and first-line antibiotic choices.METHODS: A random sample of 2000 members of The College of Family Physicians of Canada were contacted in April 2002, and were asked to assess two women presenting with new urinary tract symptoms. Physicians completed a standardized checklist of symptoms and signs, indicated their diagnosis and antibiotics prescribed. A urine sample for culture was obtained.RESULTS: Of the 418 responding physicians, 246 (58.6%) completed the study and assessed 446 women between April 2002 and March 2003. Most women (412 of 420, for whom clinical information about antibiotic prescriptions was available) reported either frequency, urgency or painful urination. Physicians would have usually ordered a urine culture for 77.0% of the women (95% CI 72.7 to 80.8) and prescribed an antibiotic for 86.9% of the women (95% CI 83.3 to 90.0). The urine culture was negative for 32.8% of these prescriptions. The most commonly prescribed antibiotic was trimethoprim/sulfamethoxazole (40.8%; 95% CI 35.7 to 46.1), followed by fluoroquinolones (27.4%; 95% CI 22.9 to 32.3) and nitrofurantoin (26.6%; 95% CI 22.1 to 31.4).CONCLUSION: Empirical antibiotic prescribing is standard practice in the community, but is associated with high levels of unnecessary antibiotic use. While trimethoprim/sulfamethoxazole is the first-line empirical antibiotic choice, fluoroquinolone antibiotics have become the second most commonly prescribed empirical antibiotic for acute cystitis. The effect of current prescribing patterns on community levels of quinolone-resistantEscherichia colimay need to be monitored.

scholarly journals Pharmacoeconomic aspects of using enzalutamide for treatment of patients with nonmetastatic castration-resistant prostate cancer

2020 ◽  
Vol 16 (2) ◽  
pp. 82-96
Author(s):  
N. A. Avxentyev ◽  
M. Yu. Frolov ◽  
Yu. V. Makarova
Keyword(s):  
Prostate Cancer ◽  
Cost Effectiveness ◽  
Markov Model ◽  
Healthcare System ◽  
Castration Resistant Prostate Cancer ◽  
First Line ◽  
First Line Therapy ◽  
Castration Resistant ◽  
Line Therapy ◽  
Life Years

Background. Prostate cancer is one of the most common malignant diseases among men. Until recently, the most common treatment of nonmetastatic castration-resistant prostate cancer (nmCRPC) in Russia was to continue previously started hormonal therapy. Enzalutamide is a second-generation anti-androgen indicated for treatment of CRPC, regardless of a patient’s metastatic status, which significantly increases metastasis-free survival in nmCRPC compared with androgen deprivation therapy (ADT).Objective: to evaluate the incremental cost-effectiveness ratio (ICER) of enzalutamide use in patients with nmCRPC and the ICER of abiraterone as the first-line therapy for mCRPC from the Russian healthcare system perspective.Materials and methods. Standard ADT regimens for nmCRPC were used as a comparator as it was the only approved treatment for nmCRPC in Russia. We proposed a Markov model of CRPC progression on enzalutamide plus ADT (hereinafter enzalutamide) or ADT based on PROSPER trial data. Model was used to calculate progression-free life years and costs of nmCRPC and post-progression CRPC treatment. Simulation period was 5 years with one cycle of 1 month. In the “cost–effectiveness” analysis, we calculated enzalutamide ICER compared to ADT. In addition, we calculated ICER for abiraterone plus ADT and prednisolone (hereinafter abiraterone) vs ADT + prednisolone in the first-line therapy of metastatic CRPC (mCRPC) as a benchmark. In both cases, time to disease progression over a 5-year period was used as an efficacy criteria.Results. According to the Markov model, progression-free life-years gained for enzalutamide were 3.12 years compared to 1.79 for ADT within a 5-year period. The average enzalutamide therapy costs were 7,989,475.8 rubles/1 patient for 5 years, which were 5,716,983.5 rubles higher than when using ADT (2,272,492.3 rubles). ICER for enzalutamide (vs ADT) was 4,307,136.3 rubles per one progression-free life-year gained. ICER for abiraterone in the first line of mCRPC treatment (vs ADT + prednisolone) was 6,191,617.4 rubles per one progression-free life-year gained.Conclusion. In the Russian healthcare system, ICER for enzalutamide in nmCRPC was 4,307,136.3 rubles and the ICER for abiraterone in mCRPC was 6,191,617.4 rubles. 

1904: Outcomes of Large Renal Calculi (>2-Cm) Treated with ESWL as First Line Therapy

2004 ◽  
Vol 171 (4S) ◽  
pp. 503-503
Author(s):  
Richard Vanlangendock ◽  
Ramakrishna Venkatesh ◽  
Jamil Rehman ◽  
Chandra P. Sundaram ◽  
Jaime Landman
Keyword(s):  
Renal Calculi ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy
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