Pyelonephritis in pregnancy: once-a-day ceftriaxone versus multiple doses of cefazolin. A randomized, double-blind trial.
OBJECTIVE
The purpose of this study was to compare the efficacy of a single daily dose of intravenous ceftriaxone with that of multiple-dose cefazolin in the treatment of acute pyelonephritis in pregnancy.


METHODS
This was a double-blind, randomized, clinical trial. Patients admitted to the hospital with the diagnosis of acute pyelonephritis in pregnancy were enrolled and randomized according to a computer-generated randomization schedule. The study group received a single daily 1 gm dose of ceftriaxone intravenously along with two additional doses of normal saline solution. The comparison group received three daily 2 gm doses of cefazolin intravenously. All infusions were given on an 8-hour schedule. Treatments were continued until the patient became afebrile. Each patient was discharged from the hospital on a regimen of appropriate oral antibiotics as directed by urine culture and sensitivities. At follow-up visits test-of-cure cultures were obtained.


RESULTS
During the 2-year study period, 178 patients were randomized: 88 received cefazolin and 90 ceftriaxone. Patient demographics and presenting signs and symptoms were similar in both groups. No differences were noted between the groups regarding days of febrile morbidity, length of hospital stay, or treatment failures.


CONCLUSIONS
Daily single-dose intravenous ceftriaxone is as effective as multiple-dose cefazolin in the treatment of patients with acute pyelonephritis during pregnancy.
Sanchez-Ramos
L
L
Department of Obstetrics and Gynecology, University of Florida Health Science Center, Jacksonville 32209-6561.
McAlpine
K J
KJ
Adair
C D
CD
Kaunitz
A M
AM
Delke
I
I
Briones
D K
DK
D000328:Adult; D002437:Cefazolin / Q000008:administration & dosage* / Q000627:therapeutic use; D002443:Ceftriaxone / Q000008:administration & dosage* / Q000627:therapeutic use; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D011704:Pyelonephritis / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome
D002443:Ceftriaxone; D002437:Cefazolin