AMINOGLYCOSIDES DO NOT IMPROVE THE EFFICACY OF CEPHALOSPORINS FOR TREATMENT OF ACUTE PYELONEPHRITIS IN WOMEN

A prospective, coordinated, randomized multicentre trial was conducted to determine whether tobramycin 160 mg intravenously (i.v.) once dail y for 2 days would improve the efficacy of cefotaxime Ig i.v. twice da ily for 2 days followed by a 10-day course of oral cefadroxil 1 g twic e daily, in the treatment of community-acquired acute pyelonephritis i n women. Of 73 patients enrolled in the study, 51 could be evaluated a ccording to the protocol. There were no significant differences in bac teriological cure rates between the combined treatment with tobramycin /cefotaxime and cefotaxime alone, either at short-term follow-up (63.0 % vs 59.1%; 95% confidence interval (CI) for difference in proportions -23.4% to 31.2%), or up to 7 weeks after cessation of treatment (42.9 % vs 52.2%; 95% CI, -18.0% to 36.6%). A modified intention-to-treat an alysis showed no difference in clinical efficacy between the two regim ens (68.6% vs 69.2%; 95% CI, -22.9% to 24.1%), Tobramycin seemed to en hance the resolution of inflammation by a more rapid decline in C-reac tive protein levels. The high recurrence rates after treatment with be ta-Iactam antibiotics in this and previous studies of acute pyelonephr itis may be explained by adverse ecological effects rather than failur e to eradicate the infection.