Twice-daily cephalexin safe, effective for women with uncomplicated UTI
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Key takeaways:
- Cephalexin given twice daily is as effective as four times daily for women with uncomplicated UTIs.
- Rates of reported adverse events were similar between the two regimens.
Cephalexin given twice daily is as effective as a regimen of four daily doses for treating women with uncomplicated UTIs, researchers reported.
“Due to rising resistance rates of common uropathogens and safety concerns of several common antimicrobials including fluoroquinolones and trimethoprim-sulfamethoxazole, there is a critical need to evaluate the efficacy and safety of beta-lactam therapies for the treatment of uncomplicated urinary tract infections (uUTIs),” Aidan Yetsko, PharmD, pharmacy resident in the department of pharmacy at Trinity Health Grand Rapids, told Healio.
Uncomplicated UTIs (uUTIs) can decrease quality of life, work productivity and worsen mental and physical health, previous research has shown, and a high percentage of uUTIs do not respond to first-line treatments because of high rates of antimicrobial resistance.
“Cephalexin is a potential alternative therapy for uUTI treatment. However, conflicting data exist regarding optimal dosing, with most reference material historically listing four times daily regimens while pharmacokinetic data support twice-daily dosing,” Yetsko said.
According to Yetsko, because there is minimal published clinical outcomes data supporting twice-daily dosing, he and colleagues aimed to compare a regimen of cephalexin 500 mg twice daily (BID group) to a four times daily dosing regimen (QID group) for the treatment of uUTI in women.
To do so, they conducted a retrospective, multicenter, cohort study during which they assessed adult women who received 5 to 7 days of cephalexin for symptomatic uUTI with a cefazolin-susceptible urine culture.
The primary objective was to compare uUTI treatment failure between patients treated with the two treatment options, whereas secondary outcomes included time to treatment failure, reported adverse events within 7 days of treatment and occurrence of Clostridioides difficile within 30 days of treatment.
A total of 261 patients were included in the study — 173 in the BID group and 88 in the QID group — with Escherichia coli being the most commonly detected pathogen (85.4%). According to the study, there was no difference in treatment failure observed between groups (BID group 12.7% vs. QID group 17%; P = .343), including failure while on therapy (BID group 2.3% vs. QID group 5.7%; P = .438) or recurrence within 30 days (BID group 10.4% vs. QID group 11.3%; P = .438).
Additionally, the researchers found no significant difference in reported adverse events (BID group 4.6% vs. QID group 5.6%; P = .103) between the two treatment groups.
Based on these results, Yetsko concluded that cephalexin dosed 500 mg twice daily is as safe and effective as four times daily dosing for the treatment of uUTI in women, although he added that less frequent dosing may improve patient adherence and satisfaction with treatment.
“The twice-daily dosing strategy may also help prompt prescribers to select cephalexin over more broad-spectrum oral cephalosporins which may have historically been selected due to less frequency dosing recommendations,” he said.
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