Cefpodoxime fails test in uncomplicated cystitis

When compared with ciprofloxacin, cefpodoxime failed to meet criteria for noninferiority in women with uncomplicated bladder infections, according to the findings of a randomized, double-blind trial.

The study involved 300 women aged 18 to 55 years with acute uncomplicated cystitis. The researchers gave the women either 250 mg ciprofloxacin orally twice daily for 3 days or 100 mg of cefpodoxime proxetil orally twice daily for 3 days.

The researchers predicted that cefpodoxime would be noninferior to ciprofloxacin by a 10% margin. Using an intent-to-treat approach in which they considered women lost to follow-up as having been cured, they calculated an overall cure rate at 30 days of 93% (139/150) in the women who received ciprofloxacin versus 82% (123/150) in the women receiving cefpodoxime (difference of 11%; 95% CI, 3%-18%).

At the first follow-up visit, scheduled for 5 to 9 days after completion of treatment, more than twice as many women in the cefpodoxime group as in the ciprofloxacin group had vaginal colonization with Escherichia coli (40% vs 16%, respectively).

Experts had hoped that cefpodoxime would prove to be an effective alternative to ciprofloxacin so that clinicians could reserve use of ciprofloxacin for more severe, recalcitrant infections, thus helping to minimize antimicrobial resistance to fluoroquinolones.

But the authors concluded, "Our findings . . . do not support the use of cefpodoxime as a first-line fluoroquinolone-sparing antimicrobial for acute uncomplicated cystitis."

Hooton TM, Roberts PL, Stapleton AE. Cefpodoxime vs ciprofloxacin for short-course treatment of acute uncomplicated cystitis: a randomized trial. JAMA. 2012;307(6):583-589.