Pivmecillinam treatment for community-acquired urinary tract infections (UTIs) caused by extended spectrum beta-lactamase (ESBL)-producing Escherichia coli is a reasonable option, according to new findings published in the Journal of Antimicrobial Chemotherapy.

Resistance to antibiotics is a global issue and new options are needed, but clinical studies investigating the efficacy of pivmecillinam for treating community-acquired UTIs caused by ESBL-producing Enterobacteriaceae have been limited, with small sample sizes. In the current study, the investigators compared clinical outcomes of pivmecillinam used to treat community-acquired UTIs caused by ESBL-producing E. coli in 88 women vs a control group of 74 cases of UTIs caused by non-ESBL-producing E. coli in an outpatient setting.

In the ESBL group, 37 participants (42.5%) were treated with 200 mg of pivmecillinam administered 3 times daily vs 48 (65.8%) non-ESBL control participants; the remaining participants received 400 mg of pivmecillinam 3 times daily (doses for 2 patients were not registered). Median time from beginning treatment to symptom resolution was 5 days in the ESBL group vs 3 days in the non-ESBL group (P =.01). A greater percentage of patients in the ESBL group needed a second antibiotic prescription during the follow-up period (30/88 [34.1%] vs 10/72 [13.9%]; P =.01). Persistent bacteriuria was more common in the ESBL group, although it was non-significant (15/81 [18.5%], vs 6/67 [9.0%], P =.10). The 200-mg dose was associated with treatment failure (odds ratio [OR] 4.77; 95% CI, 1.40-19.44; P =.03) in the ESBL E. coli group, but comparable rates of bacteriologic cure were observed in the ESBL group and non-ESBL controls with the 400-mg dose.

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“Comparable rates of bacteriological cure for ESBL cases and non-ESBL controls can be expected,” with a 400-mg dose given 3 times daily for >5 days, the investigators concluded.

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Bollestad M, Grude N, et al. Clinical and bacteriological efficacy of pivmecillinam treatment for uncomplicated urinary tract infections caused by ESBL-producing Escherichia coli: a prospective, multicentre, observational cohort study [published online 2018 Jun 29]. J Antimicrob Chemother. doi:10.1093/jac/dky230