Fluoroquinolones for cystitis
Cefpodoxime is inferior to ciprofloxacin for short-course treatment of acute uncomplicated cystitis in women, according to new study. In a randomized, double-blind trial, 300 women ages 18-55 with uncomplicated cystitis were randomized to ciprofloxacin 250 mg orally twice daily for 3 days or cefpodoxime 100 mg twice daily for 3 days. The overall clinical cure rate with the intent-to-treat approach in which patients lost to follow-up were considered as having a clinical cure was 93% for ciprofloxacin compared to 82% for cefpodoxime. For the intent-to-treat approach in which patients lost to follow-up were considered as not having responded to treatment, the clinical cure rate was 83% for ciprofloxacin compared to 71% for cefpodoxime. The microbiological cure rate was 96% for ciprofloxacin compared with 81% for cefpodoxime. At follow-up, 16% of women in the ciprofloxacin group had vaginal Escherichia coli colonization compared with 40% in the cefpodoxime group. The authors conclude that cefpodoxime did not meet criteria for non-inferiority to ciprofloxacin for treating uncomplicated cystitis in women (JAMA 2012;307:583-589). The study is somewhat disappointing given the increasing rates of fluoroquinolone resistance in the community and the need for effective alternatives.