Work

Cefdinir Versus Cephalexin for the Treatment of Uncomplicated Urinary Tract Infections

Year: 2025

Type: article

Abstract: Background Due to its low bioavailability and poor urinary penetration, there are concerns that cefdinir is a suboptimal agent for the treatment of urinary tract infections (UTIs). Limited available literature examining cefdinir's use for UTIs has not shown worse outcomes compared with other oral beta-lactams; however, these studies are limited by small sample size or lack of symptom assessment as a measure of clinical cure. Methods This retrospective, multicenter cohort study included adult female patients who received either cefdinir or cephalexin for 5–7 days for symptomatic uncomplicated UTI (uUTI). The primary objective was to compare treatment failure, defined as recurrent or continued urinary symptoms necessitating re-treatment within 30 days, between patients treated with oral cefdinir 300 mg twice daily (cefdinir group) and cephalexin 500 mg twice daily (cephalexin group) in the outpatient setting. Results Three hundred sixty-seven patients were included (cefdinir n = 167; cephalexin, n = 200). Patients treated with cefdinir experienced a significantly higher rate of treatment failure (23.4% vs 12.5%, P = .006), and cefdinir was independently associated with treatment failure (odds ratio: 1.9 [95% CI: 1.1–3.4]). Additionally, patients who experienced treatment failure with cefdinir had a higher incidence of cefazolin nonsusceptible pathogens (cefdinir 37.5% vs cephalexin 0%; P = .024) and ceftriaxone nonsusceptible pathogens (cefdinir 31.2% vs cephalexin 0%; P = .053) on repeat culture. Conclusions Cefdinir was independently associated with treatment failure with nearly twice as high of failure rate compared with cephalexin for the treatment of outpatient uUTI. Patients who failed treatment with cefdinir were more likely to demonstrate cephalosporin resistance on subsequent urine culture.

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofaf501

Authors: Tyler M Mitzner, Kristen M Eid, Destiny M Hughson, Andrew P Jameson, Lisa E Dumkow

Institutions: Trinity Health Grand Rapids, Michigan State University

Language: English

Topic: Urinary Tract Infections Management

Subfield: Epidemiology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $4,053