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Danish Medical Journal Apr 2014Uncomplicated urinary tract infection (uUTI) is a common reason for seeing a GP. In Denmark, it is debated if sulfamethizole or pivmecillinam should be recommended for...
INTRODUCTION
Uncomplicated urinary tract infection (uUTI) is a common reason for seeing a GP. In Denmark, it is debated if sulfamethizole or pivmecillinam should be recommended for empirical treatment of uUTIs. We evaluated sulfamethizole and pivmecillinam use in the five Danish regions from 2007 to 2011 and explored if the choice of antibiotic in primary care was in accordance with the regional recommendations for uUTI.
MATERIAL AND METHODS
Regional drug use data on pivmecillinam and sulfamethizole from 2007 to 2011 were retrieved from the Registry of Medicinal Product Statistics. Regional recommendations from the same period were identified. We calculated differences in consumption based on defined daily doses per 1,000 inhabitants per day (DID) of pivmecillinam and sulfamethizole between the five regions, and intraregional developments.
RESULTS
Four regions had recommendations on uUTI in 2011. From 2007 to 2009, sulfamethizole was the only antibiotic recommended. Pivmecillinam was recommended along with sulfametizole in one of four regions from 2010, which increased to two regions in 2011. During the five-year period, sulfamethizole consumption decreased in all regions. The absolute decrease ranged from 0.4 to 0.6 DID. Pivmecillinam consumption increased steadily; the absolute increase ranged from 1.5 to 2.5 DID. During the whole period, the total pivmecillinam consumption was higher than the total sulfamethizole consumption.
CONCLUSION
Pivmecillinam dominated the treatment of uUTIs, whereas sulfamethizole prevailed in the regional recommendations, which suggests a lack of adherence to regional recommendations.
FUNDING
not relevant.
TRIAL REGISTRATION
not relevant.
Topics: Adolescent; Adult; Amdinocillin Pivoxil; Anti-Infective Agents, Urinary; Female; General Practitioners; Guideline Adherence; Humans; Male; Middle Aged; Practice Patterns, Physicians'; Sulfamethizole; Urinary Tract Infections; Young Adult
PubMed: 24814591
DOI: No ID Found -
Antimicrobial Agents and Chemotherapy Sep 2010An increase in extended-spectrum-beta-lactamase (ESBL)-producing Escherichia coli has been observed in outpatient settings. Consequently, 100 ESBL-positive E. coli...
An increase in extended-spectrum-beta-lactamase (ESBL)-producing Escherichia coli has been observed in outpatient settings. Consequently, 100 ESBL-positive E. coli isolates from ambulatory patients with clinically confirmed urinary tract infections were collected by a single laboratory between October 2004 and January 2008. Antimicrobial susceptibility testing was carried out using the oral antibiotics fosfomycin, pivmecillinam, and nitrofurantoin and the parenteral antibiotic ertapenem. Susceptibility rates indicate that fosfomycin (97%), nitrofurantoin (94%), and pivmecillinam (85%) could be considered important oral treatment options.
Topics: Amdinocillin Pivoxil; Anti-Bacterial Agents; Escherichia coli; Escherichia coli Infections; Fosfomycin; Humans; Microbial Sensitivity Tests; Nitrofurantoin; Urinary Tract Infections; beta-Lactamases
PubMed: 20585127
DOI: 10.1128/AAC.01760-09 -
Antimicrobial Agents and Chemotherapy Apr 2006Similar changes in the periurethral and vaginal microflora were observed in 19 women with recurrent urinary tract infection following treatment with norfloxacin (NOR) or... (Randomized Controlled Trial)
Randomized Controlled Trial
Similar changes in the periurethral and vaginal microflora were observed in 19 women with recurrent urinary tract infection following treatment with norfloxacin (NOR) or pivmecillinam (PIV). Escherichia coli strains were suppressed by both treatments. Staphylococcus spp. and enterococci colony counts increased following PIV treatment in the periurethral flora but remained stable with NOR.
Topics: Adolescent; Adult; Amdinocillin Pivoxil; Bacteria; Double-Blind Method; Female; Humans; Middle Aged; Norfloxacin; Recurrence; Urethra; Urinary Tract Infections; Vagina
PubMed: 16569875
DOI: 10.1128/AAC.50.4.1528-1530.2006 -
Scandinavian Journal of Primary Health... Mar 2020
Topics: Adolescent; Adult; Amdinocillin Pivoxil; Anti-Bacterial Agents; Denmark; Escherichia coli; Humans; Male; Middle Aged; Nitrofurantoin; Prescriptions; Retrospective Studies; Trimethoprim; Urinary Tract Infections; Young Adult
PubMed: 31997687
DOI: 10.1080/02813432.2020.1718301 -
BMC Infectious Diseases Dec 2016Uncomplicated lower urinary tract infections (LUTI) are very common, and presumably around 200,000 female patients are treated for this annually in Denmark. The current... (Randomized Controlled Trial)
Randomized Controlled Trial
The efficacy of pivmecillinam: 3 days or 5 days t.i.d against community acquired uncomplicated lower urinary tract infections - a randomized, double-blinded, placebo-controlled clinical trial study protocol.
BACKGROUND
Uncomplicated lower urinary tract infections (LUTI) are very common, and presumably around 200,000 female patients are treated for this annually in Denmark. The current Danish national clinical practice guidelines recommend pivmecillinam as a first-line drug (i.e., 400 mg t.i.d. for 3 days). Pivmecillinam is also one of the first-line drugs recommended in the international guidelines for LUTIs (i.e., 400 mg b.i.d. for 5 days). The international recommended duration is based on evidence saying that a 7-day regimen is better than a 3-day regimen. However, no data says that a 5-day regimen is superior to a 3-day regimen. With this study we aim to identify and to compare the efficacy of pivmecillinam 400 mg t.i.d in a 3-day respectively 5-day regimen, against community acquired uncomplicated LUTI, i.e., in women at the age of 18-70 year old.
METHOD/DESIGN
The general practitioner will at consultation give a suitable patient the opportunity to participate in the study. If the patient will give her consent, a double-blinded kit (i.e., the antibiotic with/without placebo, questionnaires and self-urinary samples) will be given to the patient. We aim for 161 evaluable patients in each arm.
DISCUSSION
Pivmecillinam is an excellent choice against urinary tract infections and we believe this study will fill in the gaps and strengthen the evidence on the treatment against one of the most common infections in our society. Thus, aiming to provide a more rational and ecological beneficial antimicrobial therapy.
TRIAL REGISTRATION
EudraCTno.: 2014-001321-32 .
Topics: Adolescent; Adult; Aged; Amdinocillin Pivoxil; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Denmark; Double-Blind Method; Drug Administration Schedule; Female; Humans; Middle Aged; Prospective Studies; Urinary Tract Infections; Young Adult
PubMed: 27905884
DOI: 10.1186/s12879-016-2022-0 -
Antimicrobial Agents and Chemotherapy Mar 2009During a 9-year study period from 1997 through 2005, the association between antimicrobial resistance rates in Escherichia coli and outpatient antimicrobial consumption...
During a 9-year study period from 1997 through 2005, the association between antimicrobial resistance rates in Escherichia coli and outpatient antimicrobial consumption was investigated in 20 hospital districts in Finland. A total of 754,293 E. coli isolates, mainly from urine samples, were tested for antimicrobial resistance in 26 clinical microbiology laboratories. The following antimicrobials were studied: ampicillin, amoxicillin-clavulanate, cephalosporins, fluoroquinolones, trimethoprim, trimethoprim-sulfamethoxazole, pivmecillinam, and nitrofurantoin. We applied a protocol used in earlier studies in which the level of antimicrobial consumption over 1 year was compared with the level of resistance in the next year. Statistically significant associations were found for nitrofurantoin use versus nitrofurantoin resistance (P < 0.0001), cephalosporin use versus nitrofurantoin resistance (P = 0.0293), amoxicillin use versus fluoroquinolone resistance (P = 0.0031), and fluoroquinolone use versus ampicillin resistance (P = 0.0046). Interestingly, we found only a few associations between resistance and antimicrobial consumption. The majority of the associations studied were not significant, including the association between fluoroquinolone use and fluoroquinolone resistance.
Topics: Ambulatory Care Facilities; Amdinocillin Pivoxil; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Infective Agents; Cephalosporins; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Finland; Fluoroquinolones; Hospitals, Community; Humans; Microbial Sensitivity Tests; Nitrofurantoin; Retrospective Studies; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination
PubMed: 19104012
DOI: 10.1128/AAC.00856-08 -
Journal of Clinical Microbiology May 2006The primary infecting Escherichia coli strains from 156 women with community-acquired uncomplicated urinary tract infection (UTI) randomized to pivmecillinam or placebo... (Randomized Controlled Trial)
Randomized Controlled Trial
Pulsed-field gel electrophoresis typing of Escherichia coli strains from samples collected before and after pivmecillinam or placebo treatment of uncomplicated community-acquired urinary tract infection in women.
The primary infecting Escherichia coli strains from 156 women with community-acquired uncomplicated urinary tract infection (UTI) randomized to pivmecillinam or placebo and the E. coli strains causing UTI at two follow-up visits were typed using pulsed-field gel electrophoresis (PFGE). In the pivmecillinam treatment group PFGE showed that among patients having a negative urine culture at the first follow-up 77% (46/60) had a relapse with the primary infecting E. coli strain and 23% (14/60) had reinfection with a new E. coli strain at the second follow-up. Among patients having E. coli at the first follow-up PFGE showed that 80% (32/40) had persistence with the primary infecting E. coli strain, 15% (6/40) had reinfection with a new E. coli strain, and 5% (2/40) had different E. coli strains at the two follow-up visits (one had reinfection followed by relapse, and the other had persistence followed by reinfection). In the placebo group the majority had E. coli at the first follow-up. PFGE showed that among these patients 96% (50/52) had persistence with the primary infecting E. coli strain and 4% (2/50) had different E. coli strains at the two follow-up visits (both had persistence followed by reinfection). The finding that the majority of UTIs at follow-up are caused by the primary infecting E. coli strain supports the theory of a vaginal and rectal reservoir but could also support the recent discovery that E. coli strains are able to persist in the bladder epithelium despite appropriate antibiotic treatment, constituting a reservoir for recurrent UTI.
Topics: Adult; Amdinocillin Pivoxil; Anti-Bacterial Agents; Bacterial Typing Techniques; Community-Acquired Infections; DNA, Bacterial; Double-Blind Method; Electrophoresis, Gel, Pulsed-Field; Escherichia coli; Escherichia coli Infections; Female; Humans; Recurrence; Species Specificity; Urinary Tract Infections
PubMed: 16672406
DOI: 10.1128/JCM.44.5.1776-1781.2006 -
Scandinavian Journal of Primary Health... 2009To investigate whether short-term treatment with pivmecillinam was more effective than sulfamethizole in patients with acute uncomplicated urinary tract infection (UTI). (Comparative Study)
Comparative Study Randomized Controlled Trial
OBJECTIVE
To investigate whether short-term treatment with pivmecillinam was more effective than sulfamethizole in patients with acute uncomplicated urinary tract infection (UTI).
DESIGN
Randomized controlled trial.
SETTING
General practice, Denmark.
SUBJECTS
Patients (n = 167) with uncomplicated UTI confirmed by positive urine phase-contrast microscopy.
MAIN OUTCOME MEASURES
Drug efficacy based on clinical and bacteriological cure.
RESULTS
Urinary symptoms disappeared first in patients treated with pivmecillinam, but after five days there was no significant difference in clinical cure rate between the two antibiotics. At the follow-up visit 7-10 days after initiation of treatment, 95.4% of patients treated with pivmecillinam and 92.6% of patients treated with sulfamethizole had no persistent cystitis symptoms (difference 2.8%, CI -4.5%; 10.0%). Bacteriological cure was observed in 68.8% of patients randomized to pivmecillinam and in 77.9% randomized to sulfamethizole (difference -9.2%, CI -24.7%; 6.3%). Some 26.8% of patients randomized to pivmecillinam experienced a new UTI within 6 months after treatment compared with 18.4% of patients randomized to sulfamethizole (difference 8.4%, CI -4.5%;21.4%). No patients developed septicaemia with urinary pathogens within one year after initial treatment.
CONCLUSION
Patients treated with a three-day regime of pivmecillinam experienced faster relief of symptoms compared with patients treated with a three-day regime of sulfamethizole. Five days after initiation of treatment there was no significant difference in clinical and bacteriological cure between the two antibiotic regimes.
Topics: Adolescent; Adult; Amdinocillin Pivoxil; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Cystitis; Drug Administration Schedule; Female; Humans; Middle Aged; Sulfamethizole; Treatment Outcome; Urinary Tract Infections; Young Adult
PubMed: 18991182
DOI: 10.1080/02813430802535312 -
Hinyokika Kiyo. Acta Urologica Japonica Mar 1984The therapeutic efficacy of Pivmecillinam (PMPC) against urinary tract infections after prostatectomy was investigated. PMPC was orally administered at the dose of 300...
The therapeutic efficacy of Pivmecillinam (PMPC) against urinary tract infections after prostatectomy was investigated. PMPC was orally administered at the dose of 300 mg/day for 2-14 weeks after initial intravenous postoperative chemotherapy with other antibiotics for 0-24 days (average 5.7 days). Thirty patients underwent retropubic prostatectomy and the other 59 patients received TUR-P. The chemotherapeutic efficacy for 19 patients who had over 10(3) CFU/ml of microorganisms was as follows: The effective rate was 48.4% after 2 weeks, 53.8% after 4 weeks, 66.7% after 5-6 weeks and 100% after 7-9 weeks. The prophylactic efficacy for 70 patients who had no or less than 10(3) CFU/ml of microorganisms was 64.3% after 2 weeks, 79.6% after 4 weeks, 86.7% after 5-6 weeks and 90.0% after 7-9 weeks. The overall clinical efficacy of PMPC for 89 patients was 60.7% after 2 weeks, 74.2% after 4 weeks, 83.3% after 5-6 weeks, 90.0% after 7-9 weeks and 100% after 10-14 weeks. No severe side effects were found in these 89 cases. In conclusion, PMPC is a useful drug for the long term treatment after prostatectomy.
Topics: Administration, Oral; Aged; Amdinocillin Pivoxil; Humans; Male; Middle Aged; Penicillanic Acid; Postoperative Complications; Premedication; Prostatectomy; Prostatic Hyperplasia; Prostatic Neoplasms; Urinary Tract Infections
PubMed: 6205570
DOI: No ID Found -
Antimicrobial Agents and Chemotherapy Mar 2008Activity of simulated cefditoren urinary concentrations was determined against seven Escherichia coli isolates. Bactericidal activity was obtained from 4 to 24 h against...
Urine bactericidal activity against Escherichia coli isolates exhibiting different resistance phenotypes/genotypes in an in vitro pharmacodynamic model simulating urine concentrations obtained after oral administration of a 400-milligram single dose of cefditoren-pivoxil.
Activity of simulated cefditoren urinary concentrations was determined against seven Escherichia coli isolates. Bactericidal activity was obtained from 4 to 24 h against TEM-1 (penicillinase production/hyperproduction), TEM-34 (IRT-6), and TEM-116 (extended-spectrum beta-lactamase [ESBL]) and from 6 to 8 h against SHV/TEM-116 (ESBL) but never against SHV/TEM-1 (ESBL). Extension of bactericidal activity depended on the resistance genotype/phenotype tested.
Topics: Amdinocillin Pivoxil; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Cephalosporins; Escherichia coli; Escherichia coli Infections; Genotype; Humans; Microbial Sensitivity Tests; Models, Biological; Phenotype; Urinary Tract Infections; Urine; beta-Lactamases
PubMed: 18160517
DOI: 10.1128/AAC.01247-07