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Mecillinam (Amdinocillin) and Pivmecillinam
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Oral pivmecillinam seems comparable to ampicillin for the treatment of shigella dysentery, and it may also prove to be effective for the treatment of this disease caused by ampicillin-resistant strains (Kabir et al., 1984; Prado et al., 1993). Cure rates > 99% were reported with pivmecillinam in the literature for the treatment of dysentery in children (Traa et al., 2010). The combination of pivampicillin and pivmecillinam also eradicates the organism from most Shigella spp. carriers (Ekwall and Svenungsson, 1990).
Urinary Tract Infections
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Oral treatment of uncomplicated cystitis caused by multidrug-resistant Gram-negative Enterobacterales (resistant to at least three different antibiotic classes): First-line options are fosfomycin trometamol 3 g PO with repeat dose on day 3 OR high dose pivmecillinam 400 mg 8-hourly for 7 days OR co-amoxiclav 625 mg 8-hourly for 7 days.Alternative options: Oral third-generation cephalosporins: Cefixime or ceftibuten if strain is NOT producing ESBL or AmpC.Oral ciprofloxacin 500 mg PO 12-hourly.Consider combination of co-amoxiclav 625 mg PO 8-hourly with pivmecillinam 400 mg PO 8-hourly if significant proportion of ESBLs are CTX-M-15 type.Cautions: If nitrofurantoin is the only oral option but the eGFR of 30–44 mL/min/1.73 m2, a short course (3–7 days) may be used with caution.Some ESBL CTX-M-15 strains co-produce OXA-1, which is not inhibited by clavulanic acid. OXA-1 has no effect on pivmecillinam, however pivmecillinam 200 mg 8-hourly PO is inadequate against CTX-M-15. Pivmecillinam at 400 mg 8-hourly PO may be more effective, in combination with amoxicillin/clavulanic acid 625 mg 8-hourly.Consider doxycycline 100 mg PO 12-hourly. Only CLSI has breakpoints for tetracyclines and Enterobacterales, with an MIC of ≤4 mg/L considered sensitive.
Antibiotic prescribing in Danish general practice in the elderly population from 2010 to 2017
Published in Scandinavian Journal of Primary Health Care, 2021
Maria Louise Veimer Jensen, Rune Munck Aabenhus, Barbara Juliane Holzknecht, Lars Bjerrum, Jette Nygaard Jensen, Volkert Siersma, Gloria Córdoba
Throughout the study period, pivmecillinam and phenoxymethylpenicillin were the most prescribed antibiotic agents. In Denmark, pivmecillinam is generally first choice treatment for UTIs and phenoxymethylpenicillin for most RTIs. As UTI and RTI was the most common indications, this indicate that the choice of antibiotic type is based on current guidelines. Furthermore, the top three antibiotic agents prescribed for UTI, RTI and SSTI accounted for 73.7%, 80.1% and 82.4% of the total amount of prescriptions respectively, indicating that GPs tend to prescribe the same type of antibiotics for the same indications. Fluoroquinolones are decreasingly used in Danish general practice and made up only approximately 5% of the total use. Worryingly, a slight increase in prescription of amoxicillin with beta-lactamase inhibitor was noted, as this is on the watch list in WHO AWaRe index.
Different antibiotic regimes in men diagnosed with lower urinary tract infection – a retrospective register-based study
Published in Scandinavian Journal of Primary Health Care, 2020
Helena Kornfält Isberg, Katarina Hedin, Eva Melander, Sigvard Mölstad, Olof Cronberg, Sven Engström, Heidi Lindbäck, Thomas Neumark, Gunilla Stridh Ekman, Anders Beckman
The recommended treatment duration for the first-line antibiotics in lower UTI in men (pivmecillinam or nitrofurantoin) is seven days. In our study, median treatment duration for nitrofurantoin was five days, and for pivmecillinam, it was seven days. This indicates that treatment duration differs from treatment guidelines. The minimum duration of antibiotic treatment for lower UTI in men has not yet been determined [3] but a recent Danish retrospective study showed no significant difference in treatment failure between five- or seven-day regimens with pivmecillinam in men [21]. In a review article, the researchers could only identify one RCT [22] and one observational study [23] since the year 2000 addressing male UTI [24]. Concluding these studies, duration of therapy for acute UTI in men should be limited to seven to 14 days [24].
Antibiotic switch after treatment with UTI antibiotics in male patients
Published in Infectious Diseases, 2020
Marius A. H. Skow, Ingvild Vik, Sigurd Høye
During the study period, the total number of prescriptions of UTI antibiotics decreased from 70.3 prescriptions per 1000 male inhabitants in 2008 to 62.9 prescriptions per 1000 male inhabitants in 2018. The frequency of fluoroquinolone prescriptions decreased from 23.4 to 14.0 prescriptions per 1000 men from 2008 to 2018, while usage of cotrimoxazole increased from 10.0 to 21.0 prescriptions per 1000 men (Figure 1). Pivmecillinam, nitrofurantoin and cefalexin usage marginally decreased. In 2018, cotrimoxazole, pivmecillinam and fluoroquinolones were the most frequently prescribed UTI antibiotics.