Cefpodoxime Versus Ciprofloxacin for Acute Uncomplicated Cystitis

A randomized, double-blind trial of women aged 18 to 55 years with acute uncomplicated cystitis compared ciprofloxacin (n = 150) with cefpodoxime (n = 150).⁴ Study subjects were randomized to receive either 250 mg of ciprofloxacin orally twice daily for 3 days or 100 mg of cefpodoxime proxetil orally twice daily for 3 days. The primary end point was overall clinical cure (defined as not requiring antimicrobial treatment during follow-up) at the 30-day follow-up visit.

The study demonstrated that the overall clinical cure rate at the 30-day visit with the intent-totreat approach in which patients lost to follow-up were considered as having clinical cure was 93% for ciprofloxacin compared with 82% for cefpodoxime (difference of 11%; 95% CI, 3%-18%). For the intent-to-treat approach, in which patients lost to follow-up were considered as having not responded to treatment, the clinical cure rate was 83% for ciprofloxacin compared with 71% for cefpodoxime (difference of 12%; 95% CI, 3%-21%).

The authors concluded that the use of cefpodoxime as a first-line fluoroquinolone-sparing antimicrobial for acute uncomplicated cystitis cannot be supported by this trial.

Dr. Reed received her doctor of pharmacy degree from the University of the Sciences in Philadelphia, Pennsylvania, and currently works as a medical editor in the greater Philadelphia area.

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