New Antibiotic for Bladder Infection Disappoints in Trial

But other drugs can still get the job done, experts say

TUESDAY, Feb. 7, 2012 (HealthDay News) -- New antibiotics are needed to help treat bladder infections, but the drug cefpodoxime, once thought promising, doesn't appear to be up to the task, a new study indicates.

Bladder infections, more common in women than men, are usually treated with a short course of antibiotics. But overuse of mainstay medications, such as ciprofloxacin, has led to increasing rates of antibiotic resistance.

"We do have antibiotics to treat bladder infections, but due to increasing rates of resistance, we wanted to see if this other drug [cefpodoxime] was comparable to the gold standard, but it wasn't," said Dr. Thomas Hooton, a professor of clinical medicine at the University of Miami Miller School of Medicine.

"It didn't perform as well as we thought it should to be considered a ciprofloxacin alternative," he said. "This drug should not be considered a first-line treatment of bladder infections in women."

Ciprofloxacin belongs to a class of antibiotics known as fluoroquinolones. Because of concerns about their continued effectiveness, efforts are being made to restrict their use and to find safe and effective alternatives.

Symptoms of bladder infections include frequent or urgent urination, burning and pain during urination and cloudy or blood-tinged urine.

The new study, published Feb. 8 in the Journal of the American Medical Association, included 300 women aged 18 to 55 with uncomplicated bladder infections. They received either 250 milligrams (mg) of ciprofloxacin orally twice a day for three days or 100 mg of cefpodoxime proxetil orally twice a day for three days.

Ciprofloxacin bested cefpodoxime in terms of cure rates at both the five-day mark and the 30-day mark, the study showed. The study was funded by grants from the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

Currently, the first-line antibiotic treatments for bladder infections in the United States should include a short course of trimethoprim-sulfamethoxazole (Bactrim, Cotrim, Septra), nitrofurantoin or fosfomycin. These drugs should still be chosen before ciprofloxacin and cefpodoxime, the researchers said.

Dr. Elizabeth Kavaler, a urologist at Lenox Hill Hospital in New York City, said that most women with uncomplicated bladder infections can be safely and effectively treated with a short course of antibiotics.

"They usually do not need any testing or evaluation, and respond very well to the antibiotics that we use," Kavaler said. Women who have had a series of bladder infections may need additional measures, but even then, she said, the antibiotic in the new study would not have been on her radar.

More information

Learn more about the signs and symptoms of bladder infections at the U.S. National Institutes of Health.

SOURCES: Elizabeth Kavaler, M.D., urologist, Lenox Hill Hospital, New York City; Thomas M. Hooton, M.D., professor, clinical medicine, University of Miami Miller School of Medicine; Feb. 8, 2012, Journal of the American Medical Association
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