Randomized comparison of aztreonam and cefuroxime in gram-negative upper urinary tract infections.
In order to evaluate the efficacy and safety of aztreonam in hospitalized patients with upper urinary tract infections (UTI), a comparative clinical study with cefuroxime was performed. 62/60% (aztreonam/cefuroxime) of the patients had a complicating factor, mostly obstructive uropathy. I.v. bolus injections were used at a dose of 1 g aztreonam or 1.5 g cefuroxime t.i.d., for a mean of 8.2 days (range: five to 14 days) except in patients with bacteraemia, who received a mean of 10.3 days (range: seven to 13 days) of therapy. 89% of the patients treated with aztreonam and 87% of those who received cefuroxime showed clinical cure and the bacteriological cure rate at one week post-therapy was 70% and 73% in the respective groups. The relapse/reinfection rate was high with both drugs; bacteriological cure at one month post-therapy was only 43% after aztreonam and 40% after cefuroxime. This suggests that these infections may need longer treatment times. Superinfections, mostly asymptomatic urinary colonization, occurred in 7% and 3%, respectively, and adverse reactions in 23% and 12%, respectively, of the patients treated with aztreonam or cefuroxime, the majority being mild and reversible and only 3% and 3%, respectively, requiring discontinuation of the therapy. The t 1/2 for aztreonam following a 1 g i.v. bolus was 2.0 h in six patients with creatinine clearance above 80 ml/min and 3.0 h in seven patients with creatinine clearance between 35-75 ml/min.
Friman
G
G
Department of Infectious Diseases, Uppsala University Hospital, Akademiska sjukhuset, Sweden.
Cars
O
O
Bäck
E
E
Beckman
H
H
Carlsson
M
M
Forssell
J
J
Fredlund
H
H
Neringer
R
R
Odenholt-Tornqvist
I
I
Rydén
C
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001398:Aztreonam / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002444:Cefuroxime / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use*; D006801:Humans; D007275:Injections, Intravenous; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D014552:Urinary Tract Infections / Q000188:drug therapy*
D002511:Cephalosporins; D001398:Aztreonam; D002444:Cefuroxime