Pivmecillinam for the treatment of acute uncomplicated urinary infection

Pivmecillinam is a beta-lactam antimicrobial marketed almost two decades ag o. It has been used widely for the treatment of acute cystitis in selected areas of the world, particularly in Scandinavia. With increasing resistance of community Escherichia coli isolates to trimethoprim and trimethoprim/su lphamethoxazole, as previously observed for ampicillin and sulphonamides, r eassessment of empiric antimicrobial regimens for acute uncomplicated urina ry infection is necessary. Thus, it is timely to revisit the role of pivmec illinam for the treatment of acute cystitis. Clinical studies document the efficacy of this antimicrobial with short course therapy for acute cystitis , and clinical practice in countries where it has been used for many years confirms its efficacy and tolerability. If this agent were more widely used for empiric treatment for acute cystitis, use of antimicrobials such as th e quinolones might be avoided. Further trials to define the comparative eff icacy of pivmecillinam with other antimicrobials, and further studies of co mmunity resistance in E. coli isolates to this agent are needed.