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Mecillinam resistance and outcome of pivmecillinam treatment in uncomplicated lower urinary tract infection in women
Author(s) -
Monsen Tor J,
Holm Stig E,
Ferry Björn Magnus,
Ferry Sven A
Publication year - 2014
Publication title -
apmis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.909
H-Index - 88
eISSN - 1600-0463
pISSN - 0903-4641
DOI - 10.1111/apm.12147
Subject(s) - mecillinam , medicine , placebo , urinary system , staphylococcus saprophyticus , antimicrobial , antibiotics , clinical trial , microbiology and biotechnology , biology , staphylococcus , bacteria , escherichia coli , pathology , enterobacteriaceae , biochemistry , genetics , alternative medicine , gene , staphylococcus aureus
Pivmecillinam ( PIV ) is a first‐line antimicrobial for treatment of lower urinary tract infection in women ( LUTIW ). Mecillinam, the active substance of PIV , is bactericidal mainly against gram‐negative uropathogens, whereas gram‐positive species are considered intrinsically resistant. However, successful treatment of LUTIW caused by S taphylococcus saprophyticus has been reported, but more rarely for other gram‐positive species. The aim of this study was to compare clinical and bacteriological outcome of PIV vs placebo treatment among uropathogens with special focus on mecillinam‐resistant isolates. We analysed data from a prospective, multicentre, placebo‐controlled, primary health care, therapy study performed in S weden in 1995–1998 that included 1143 women with symptoms suggestive of LUTIW . Urine cultures were collected and symptoms registered at inclusion and at follow‐up visits. Overall, the efficacy of PIV was superior to that of placebo. Clinical and bacteriological outcomes of PIV treatment were similar for S . saprophyticus , E scherichia coli as for most other uropathogens irrespective of their susceptibility to mecillinam. However, the occurrence of enterococci increased nearly fivefold shortly post PIV treatment, although with mild symptoms and a high spontaneous eradication. As susceptibility to mecillinam in vitro did not predict bacteriological and clinical outcome of PIV treatment, we suggest that the present breakpoints for mecillinam should be revised.