[Prospective, randomized, comparative study of the efficacy, safety and cost of cefuroxime versus cephradine in acute pyelonephritis during pregnancy].
BACKGROUND
Second generation cephalosporins (CFPs) are more active in the treatment of acute pyelonephritis during pregnancy but their cost is considerably higher than their predecessors. Cefuroxime, a second generation CFP with oral and parenteral presentations, might offer significant advantages and become a first choice antimicrobial in this setting.


OBJECTIVE
To compare the efficacy, safety and cost of cefuroxime and cephradine in the treatment of acute pyelonephritis in pregnancy.


METHODS
Hospitalized women with 12 to 34 weeks of pregnancy, with clinical and bacteriological diagnosis of acute pyelonephritis, were randomly assigned to receive cefuroxime (Curocef(r), Glaxo Wellcome) 750 mg t.i.d, i.v. or cephradine 1 g q.i.d., i.v. If the isolated organism was resistant to the assigned drug the patient was excluded. Once patients were afebrile, they were switched to an oral form of the same antimicrobial. They were discharged according to the clinical status and treated for a total of 14 days. laboratory tests, including urine culture were requested during controls and at the end of follow-up at 28 days.


RESULTS
One hundred and one patients were randomized: 49 to receive cephradine and 52 to receive cefuroxime. Patients in the cefuroxime group hed fewer febrile days (mean 1.7 vs 2.2, p < 0.05), faster clinical recovery (mean 2.7 vs 3.1 days, p < 0.05), a higher rate of bacteriological cure at 28 days (78.8% and 59.2%, p < 0.05) and lower rate of failure (21.2% vs 40.8% p < 0.05). The rate of resistance of isolated uropathogens was 14% to cephradine and 1% to cefuroxime.


CONCLUSIONS
Cefuroxime can be considered as a first choice option in the treatment of acute pyelonephritis during pregnancy due to its tolerance, microbiological activity and efficacy.
Ovalle
A
A
Servicio de Obstetricia, Ginecología y Neonatología, Hospital Clínico San Borja Arriarán, Santiago, Chile. aovalle@hotmail.com
Martínez
M A
MA
Wolff
M
M
Cona
E
E
Valderrama
O
O
Villablanca
E
E
Lobos
L
L
D000208:Acute Disease; D000704:Analysis of Variance; D002444:Cefuroxime / Q000191:economics / Q000627:therapeutic use*; D002511:Cephalosporins / Q000191:economics / Q000627:therapeutic use*; D002515:Cephradine / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000191:economics; D011446:Prospective Studies; D011704:Pyelonephritis / Q000188:drug therapy* / Q000191:economics; D018709:Statistics, Nonparametric
D002511:Cephalosporins; D002515:Cephradine; D002444:Cefuroxime