Episode 102. The Controversy of Cefdinir in UTIs

The Pharm So Hard Podcast: An Emergency Medicine and Hospital Pharmacy Podcast

https://youtu.be/3BxzFe09pag

Show Notes: Episode 102 – The Controversy of Cefdinir in UTIs

In this episode, we dive into the hot topic of using cefdinir, a third-generation oral cephalosporin antibiotic, in treating urinary tract infections (UTIs). Despite its low urine concentrations, cefdinir has shown clinical efficacy in treating UTIs, sparking a controversy that we explore in depth.

Key Topics:

Background on Cefdinir: We discuss the role of cefdinir in treating UTIs and why its use is controversial.

Review of Literature: We delve into several clinical trials and studies that have been conducted on the use of cefdinir for UTIs:
Cardinale et al: High efficacy and safety of cefdinir in UTI treatment.
Sader et al., 2005: Cefdinir showed high activity against common UTI pathogens.
Bonsu et al., 2006: High susceptibility of urinary pathogens to cefdinir.
Oishi et al., 2011: Prophylactic cefdinir could prevent recurrent UTIs in pediatric patients.
Leigh et al., 2000: Clinical cure rates and microbiologic response rates for cefdinir and cefaclor were statistically equivalent.
Kim et al., 2014: Cefdinir has low urine concentrations, which could potentially affect its efficacy in treating UTIs.
Davis et al., 2022: The study found that despite high resistance rates to some antibiotics in the U.S.-Mexico border region, cefdinir, along with amoxicillin/clavulanate, cefuroxime, and nitrofurantoin, showed lower resistance rates and could be effective for outpatient UTI treatment.

Clinical Pearls: We share some key takeaways from the studies and discussions, including the role of cefazolin as the susceptibility surrogate for oral cephalosporins.

Discussion of Twitter Comments and Retweets: We discuss the results of a Twitter poll and the interesting discussions it sparked among healthcare professionals.

Check out the Twitter Poll on this topic: https://twitter.com/pharmso_hard/status/1667205066615410690

Announcements:

EMPoweRx Conference Homestudy Release: The EMPoweRx Conference Homestudy is now available! This is a great opportunity to learn from experts in the field at your own pace. Check it out at empowerx-conference.com.

PACUPrep BCEMP Question Bank Version 2.1 Release: The new version of the PACUPrep BCEMP Question Bank is now available at pharmacy-acutecareuniversity.com. This is a valuable resource for anyone preparing for the BCEMP exam.

References

2. Cardinale B, et al. Retrospective Comparison of Cefdinir, Cephalexin, and Sulfamethoxazole-Trimethoprim in the Treatment of Outpatient Pediatric Urinary Tract Infections. Clin Pediatr (Phila). 2023 Jan;62(1):47-54. PMID: 35861216.

3. Sader HS, et al. Antimicrobial activity of cefdinir (FK482), an orally administered cephalosporin, against pathogens isolated from respiratory tract and skin and soft tissue infections. Diagn Microbiol Infect Dis. 2005;51(1):27-33. Link

4. Bonsu BK, et al. Susceptibility of recent bacterial isolates to cefdinir and selected antibiotics among children with urinary tract infections. Pediatr Emerg Care. 2006;22(1):18-21. Link

5. Oishi T, et al. Prophylactic cefdinir for pediatric cases of complicated urinary tract infection. Pediatr Int. 2011;53(1):57-61. Link

6. Leigh AP, et al. Cefdinir versus cefaclor in the treatment of uncomplicated urinary tract infection. Clin Ther. 2000;22(7):818-825. Link

7. Kim YC, et al. Effects of 1α,25-dihydroxyvitamin D3, the natural vitamin D receptor ligand, on the pharmacokinetics of cefdinir and cefadroxil, organic anion transporter substrates, in rat. J Pharm Sci. 2014;103(11):3793-3805. Link

8. Nguyen HM, et al. Cefazolin as a class representative for oral cephalosporins and uncomplicated urinary tract infections caused by indicated Enterobacteriaceae. Diagn Microbiol Infect Dis. 2013;77(4):350-352. Link

9. https://www.fda.gov/drugs/development-resources/rationale-fdas-position-use-cefazolin-breakpoints-surrogate-determining-breakpoints-oral.

10. Gupta K,; Infectious Diseases Society of America; European Society for Microbiology and Infectious Diseases. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011 Mar 1;52(5):e103-20. PMID: 21292654.

11. Coleman A et al. Antibiotic Utilization and Efficacy Associated With Treating Pediatric Urinary Tract Infections in Texas Medicaid Patients in the First Year of Life. Pediatr Infect Dis J. 2021 Nov 1;40(11):993-996. PMID: 34321440.

12. Davis WH, Magee MR, Monks SM, Geno KA, Crawford SB. Assessment of nationally recommended antibiotics for treatment of UTI in U.S.-Mexico border emergency departments. Am J Emerg Med. 2022 Nov;61:12-17. 14. PMID: 36027632

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