Niimura Takahiro, Goda Mitsuhiro, Nakano Satoshi, Kajihara Toshiki, Yahara Koji, Hirabayashi Aki, Miyata Koji, Ikai Marie, Shinohara Motoko, Minato Yusuke, Suzuki Masato, Ishizawa Keisuke
Department of Clinical Pharmacology and Therapeutics, University of Tokushima Graduate School of Biomedical Sciences, Tokushima, Japan.
Clinical Research Center for Developmental Therapeutics, Tokushima University Hospital, Tokushima, Japan.
BMC Med. 2025 Jul 1;23(1):396. doi: 10.1186/s12916-025-04130-x.
Flomoxef and cefmetazole have been reported to be effective against broad-spectrum β-lactamase-producing bacteria and have gained attention as a potential alternative to carbapenems. This study aimed to compare the efficacy of these two drugs in treating urinary tract infection (UTI) by integrating in vitro data and two real-world databases.
The susceptibility rates of third-generation cephalosporin-resistant Escherichia coli and Klebsiella pneumoniae to flomoxef and cefmetazole were compared using comprehensive national antimicrobial resistance surveillance data. Combined antimicrobial activities against an extended-spectrum beta-lactamase (ESBL)-producing multidrug-resistant bacterial strain were tested by diagonal measurement of n-way drug interactions. The effectiveness of the two drugs in treating UTIs was compared using hospital stay duration data obtained from the Japan Medical Data Center (JMDC) Claims Database.
Third-generation cephalosporin-resistant E. coli and K. pneumoniae, including ESBL-producing strains, were similarly susceptible to flomoxef and cefmetazole. In vitro assessment against an ESBL-producing multidrug-resistant strain revealed similar antimicrobial interaction patterns. JMDC Claims data analysis showed that the median hospital stay was 11 (95% confidence interval [CI]: 11-11) and 4 (95% CI: 3-5) days in the cefmetazole and flomoxef groups, respectively (log-rank test, P < 0.001). Moreover, the flomoxef group demonstrated a significantly lower frequency of adverse events such as C. difficile infection and renal failure.
The effectiveness of flomoxef is comparable to that of cefmetazole in treating UTIs without major complications. Thus, flomoxef is a viable treatment option for UTIs in locales with a high prevalence of ESBL-producing strains.
据报道，氟氧头孢和头孢美唑对产广谱β-内酰胺酶的细菌有效，作为碳青霉烯类药物的潜在替代品受到关注。本研究旨在通过整合体外数据和两个真实世界数据库，比较这两种药物治疗尿路感染（UTI）的疗效。
使用全国综合抗菌药物耐药性监测数据，比较第三代头孢菌素耐药的大肠埃希菌和肺炎克雷伯菌对氟氧头孢和头孢美唑的药敏率。通过n维药物相互作用的对角线测量，测试对产超广谱β-内酰胺酶（ESBL）的多重耐药菌株的联合抗菌活性。使用从日本医疗数据中心（JMDC）索赔数据库获得的住院时间数据，比较这两种药物治疗UTI的有效性。
第三代头孢菌素耐药的大肠埃希菌和肺炎克雷伯菌，包括产ESBL菌株，对氟氧头孢和头孢美唑的敏感性相似。对产ESBL的多重耐药菌株的体外评估显示出相似的抗菌相互作用模式。JMDC索赔数据分析表明，头孢美唑组和氟氧头孢组的中位住院时间分别为11天（95%置信区间[CI]：11 - 11）和4天（95%CI：3 - 5）（对数秩检验，P < 0.001）。此外，氟氧头孢组艰难梭菌感染和肾衰竭等不良事件的发生率显著较低。
在治疗无重大并发症的UTI方面，氟氧头孢的有效性与头孢美唑相当。因此，在产ESBL菌株高流行地区，氟氧头孢是UTI的一种可行治疗选择。
