Rath Abigail, Morrisette Taylor, Hamby Aaron, Burgoon Rachel, Billups Kelsey
Department of Pharmacy, Medical University of South Carolina, Charleston, SC, United States.
Department of Pharmacy, Medical University of South Carolina, Charleston, SC, United States; Department of Clinical Pharmacy and Outcome Sciences, College of Pharmacy, Medical University of South Carolina, Charleston, SC, United States.
Am J Emerg Med. 2025 Jul;93:80-85. doi: 10.1016/j.ajem.2025.03.058. Epub 2025 Mar 24.
Cephalexin is an oral cephalosporin approved for the treatment of urinary tract infections (UTIs). Data regarding the optimal dosing interval for cephalexin in UTIs, including uncomplicated UTIs (uUTI) and complicated UTIs (cUTI), remains limited.
The primary objective of this study was to compare the rates of treatment failure between patients prescribed cephalexin twice daily versus four times daily for the management of uUTIs and cUTIs once discharged from the emergency department (ED).
This retrospective, single-center cohort study conducted between July 31st, 2016 and July 31st, 2023, included patients who were ≥ 18 years of age, discharged from the ED with a diagnosis of UTI, prescribed cephalexin 500 mg twice or four time daily, and a urine culture positive for Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis susceptible to cefazolin. Treatment failure was defined as return to the ED or outpatient clinic with similar or worsening UTI symptoms or change in antibiotic therapy within 30 days of the initial ED visit. Sub-group analyses were performed for both uUTI and cUTIs.
In total, 214 patients were included in this analysis (50.0 % in each group). Treatment failure rates between the twice daily and four times daily dosing groups were 18.7 % versus 15.0 % (P = 0.465). Treatment failure rates in those with uUTI were 14.9 % versus 8.1 % (P = 0.197) and those with cUTI were 27.3 % versus 30.3 % (P = 0.786).
For patients with UTIs, there was no statistically significant difference in treatment failure rates between patients prescribed cephalexin twice daily versus four times daily. These findings suggest cephalexin dosed twice daily may be a reasonable option for the outpatient management of UTIs diagnosed in the ED, thus increasing adherence and decreasing cost without statistically compromising effectiveness.
头孢氨苄是一种口服头孢菌素，被批准用于治疗尿路感染（UTIs）。关于头孢氨苄在UTIs（包括单纯性UTIs（uUTI）和复杂性UTIs（cUTI））中的最佳给药间隔的数据仍然有限。
本研究的主要目的是比较急诊科（ED）出院后，每日两次与每日四次服用头孢氨苄治疗uUTIs和cUTIs的患者的治疗失败率。
这项回顾性、单中心队列研究于2016年7月31日至2023年7月31日进行，纳入了年龄≥18岁、因UTI诊断从ED出院、每日两次或四次服用500mg头孢氨苄且尿培养对头孢唑林敏感的大肠埃希菌、肺炎克雷伯菌或奇异变形杆菌呈阳性的患者。治疗失败定义为在首次ED就诊后30天内，因类似或恶化的UTI症状返回ED或门诊，或抗生素治疗发生改变。对uUTI和cUTI均进行了亚组分析。
本分析共纳入214例患者（每组50.0%）。每日两次给药组和每日四次给药组的治疗失败率分别为18.7%和15.0%（P = 0.465）。uUTI患者的治疗失败率分别为14.9%和8.1%（P = 0.197），cUTI患者的治疗失败率分别为27.3%和30.3%（P = 0.786）。
对于UTI患者，每日两次与每日四次服用头孢氨苄的患者治疗失败率无统计学显著差异。这些发现表明，每日两次给药的头孢氨苄可能是ED诊断的UTI门诊管理的合理选择，从而提高依从性并降低成本，而在统计学上不影响疗效。
