Comparing ceftriaxone and cefazolin for treatment of adult acute pyelonephritis; A clinical trial

Background: Urinary tract infection (UTI) is a major health concern worldwide. The present study was aimed to compare drug resistance to ceftriaxone and cefazolin in adult patients with acute pyelonephritis. Patients and methods: For this clinical trial, patients with fever plus either dysuria, frequency, flank pain or flank tenderness were enrolled. Having performed urinalysis (U/A), urine culture (U/C) and antibiogram, they were randomly assigned in two groups: ceftriaxone 1gr twice a day or cefazolin 1gr trice a day. Three days later, urine was re-evaluated and patients were categorized as clinical and microbiological responders. Chi-square test and Fisher’s exact tests were used, when appropriate. Statistical significance was defined as p < 0.05. Results: Study population included 59 females and 27 males. Escherichia coli was the most frequent isolated pathogen (86.0%). Dysuria, flank pain and flank tenderness was more frequent among non-E. coli-infected than E. coli-infected subjects, however, the difference was solely significant for flank tenderness (p=0.008). Clinical response was observed in 86.1%, 11.6%, and 2.3% of patients 3, 4, and 5 days following the therapy, respectively, however, there was no significant difference between ceftriaxone and cefazolin group. Totally, 93% of patients became culture negative. Rate of microbiological response did not differ significantly between groups. Conclusion: The results demonstrated that clinical and microbiological responses of patients with acute pyelonephritis are not always compatible. Meanwhile, first and third generation cephalosporins have similar efficacy for treatment of uncomplicated patients