CEFIXIME VERSUS AMOXICILLIN PLUS NETILMICIN IN THE TREATMENT OF COMMUNITY-ACQUIRED NONCOMPLICATED ACUTE PYELONEPHRITIS

BACKGROUND: Community-acquired non-complicated acute pyelonephritis (A PN) is a frequent, ocasionally serious infection (around 20% of the ca ses are bacteremic) that usually requires hospital admission. The thir d generation oral cephalosporins wich are active against more than 95% of E. coli strains should allow the outpatient management of these pa tients. OBJECTIVE: To evaluate the bacteriological and clinical effica cy of oral cefixime in comparison to amoxicilin plus netilcilin in the treatment of APN. PATIENTS AND METHODS: Patients older than 18 years affected by APN were included in a fourteen month prospective study. A ccording to a random numbers chart, the patients received cefixime (40 0 mg/24 h in a single daily dose for 12 days) or amoxicilin (1 g/8 h p er os) plus netilmicin (4 mg/kg/24 h in a single intramuscular daily d ose) during five days followed by 7 days of an oral tretament chosen a ccording to the susceptibility pattern of isolated microorganism. RESU LTS: Sixty-one patients received cefixime and 65 amoxicillin plus reti lmicin. There were no significant differences between both groups of p atients. Thirty-two patients presented bacteremia (25.4%). The mean (S D) eak and trough concentrations of netilmicin were 11.4 (2.8) mg/l an d 0.38 (0.4) mg/l, respectively. Clinical response was favorable in 97 % of patients treated with cefixime and in 98% of those treated with a moxicilin plus netilmicin (p = NS). The infection recurred in 10 out o f 59 patients (16.9%) in the cefixime arm of the study and in 9 out of 64 patients (14%) treated with amoxicillin plus netilmicin (p = NS). Tolerance to the study drugs was good in both arms of the study, and r enal function remained normal. CONCLUSION: Cefixime seems to be an acc eptable alternative to the regimens containing an aminopenicillin and an aminoglycoside for the treatment of community-acquired non-complica ted APN.