Ann Emerg Med

Pyelonephritis: Are oral cephalosporins as good as fluroquinolones and TMP-SMX?

February 21, 2025

Oral cephalosporins showed similar treatment failure rates—and similar appropriateness of empiric therapy based on culture results—compared with Infectious Diseases Society of America (IDSA) guideline-recommended drugs ciprofloxacin and trimethoprim/sulfamethoxazole (TMP-SMX) for treatment of adult women with pyelonephritis who were discharged home from the emergency department (ED).

Study details: This retrospective observational cohort study at 11 U.S. EDs included 851 women aged 18+ years with pyelonephritis who were discharged to home. Primary outcome: treatment failure at 14 days, defined as the composite of (1) urinary symptom recurrence, (2) repeat ED visit or hospitalization for UTI, (3) receiving a new antibiotic prescription for UTI. Secondary outcome: appropriateness of empiric therapy based on urine culture susceptibilities.

Results: Of the 851 women treated, 647 were prescribed a cephalosporin while 204 were prescribed an IDSA guideline-recommended first-line antibiotic (fluroquinolone or TMP-SMX). Treatment failure rates weren’t significantly different between cephalosporin and fluroquinolone/TMP-SMX groups: 17.2% for cephalosporin vs. 22.5% for fluroquinolone/TMP-SMX, even after adjusting for potential confounders. Appropriateness of empiric therapy compared with culture results also didn’t differ between groups.

Source:

Koehl J, et al. (2024, November 19). Ann Emerg Med. Cephalosporins for Outpatient Pyelonephritis in the Emergency Department: COPY-ED Study. https://pubmed.ncbi.nlm.nih.gov/39570254/