Efficacy, safety and cost of cefuroxime compared with cephradine in the treatment of acute pyelonephritis during pregnancy

Background: Second generation cephalosporins (CFPs) are more active in the treatment of acute pyelonephritis during pregnancy but their cost in consid erably higher than their predecessors. Cefuroxime, a second generation CFP with oral and parenteral presentations, might offer significant advantages and become a first choice antimicrobial in this setting. Aim: To compare th e efficacy, safety and cost of cefuroxime and cephradine in the treatment o f acute pyelonephritis in pregnancy. Patients and methods: Hospitalized wom en with 12 to 34 weeks of pregnancy, with clinical and bacteriological diag nosis of acute pyelonephritis, were randomly assigned to receive cefuroxime (Curocef (r), Glaxo Wellcome) 750 mg t.i.d, i.v. or cephradine 1 g q.i.d., i.v. If the isolated organism was resistant to the assigned drug the patie nt was excluded. Once patients were afebrile, they were switched to an oral form of the same antimicrobial. They were discharged according to the clin ical status and treated for a total of 14 days. Laboratory tests, including urine culture were requested during controls and at the end of follow-up a t 28 days. Results: One hundred and one patients were randomized: 49 to rec eive cephradine and 52 to receive cefuroxime. Patients in the cefuroxime gr oup had fewer febrile days (mean 1.7 vs 2.2, p<0.05), faster clinical recov ery (mean 2.7 vs 3.1 days, p<0.05), a higher rate of bacteriological cure a t 28 days (78.8% and 59.2%, p<0.05) and lower rate of failure (21.2% vs 40. 8 % p<0.05). The rate of resistance of isolated uropathogens was 14% to cep hradine and 1% to cefuroxime. Conclusions: Cefuroxime can be considered as a first choice option in the treatment of acute pyelonephritis during pregn ancy due to its tolerance, microbiological activity and efficacy.