Urinary tract infections (UTIs) are among the most common bacterial infections in humans. is by far the leading cause of community-acquired UTIs. Pivmecillinam, the oral prodrug of the penicillin derivative mecillinam (amdinocillin), was re-introduced in Germany in March 2016 for first-line treatment of acute uncomplicated cystitis. This study aimed to evaluate the prevalence of resistance to mecillinam in comparison to nine other antibiotics used for oral treatment in urine isolates after the re-introduction of pivmecillinam. A total of 460 isolates were collected at 23 laboratories of clinical microbiology between October 2019 and March 2020. Forty-six isolates (10.0%) produced an extended-spectrum β-lactamase (ESBL) of the CTX-M family. Resistance to amoxicillin (43.3%) was most widespread, followed by resistance to trimethoprim-sulfamethoxazole (27.0%), amoxicillin-clavulanic acid (18.0%), cefuroxime (11.3%), and ciprofloxacin (11.1%). Twenty-four isolates (5.2%) were resistant to mecillinam. The concentrations of mecillinam needed to inhibit 50/90% of the ESBL-producing isolates and the remaining isolates were 1/4 mg/L and 0.5/4 mg/L, respectively. The findings support the recommendation to regard pivmecillinam as a first-line option for the treatment of uncomplicated lower UTIs.
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| http://dx.doi.org/10.3390/antibiotics11060751 | DOI Listing |
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Article Synopsis
- - The review highlights the efficacy and safety of pivmecillinam in treating uncomplicated acute cystitis, based on data from six randomized controlled trials showing effectiveness at doses of 200 to 400 mg taken three times daily for 3 to 7 days.
- - Higher doses (400 mg) and longer treatment durations resulted in better clinical and bacteriologic outcomes, while pivmecillinam is particularly beneficial for populations not commonly approved by the FDA, like men or pregnant women.
- - As antibiotic resistance increases, pivmecillinam offers a new, potentially effective outpatient treatment option for uncomplicated acute cystitis in the U.S., with a focus on cost and its low resistance profile in managing uropathogens. *
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