Pivmecillinam Treatment of Uncomplicated Lower Urinary Tract Infections in Adult Women

DOI: 10.3238/zfa.2020.0243-0245

german translation / full article

Martin Cichocki, Andreas Sönnichsen

QuestionCurrent guidelines recommend Fosfomycin, Nitrofurantoin, Nitroxolin, Pivmecillinam or Trimethoprim for the antibiotic treatment of uncomplicated lower urinary tract infections in adult women. The increasing development of bacterial resistance makes it necessary to carefully reflect upon the choice and dosage of the selected antibiotic. Pivmecillinam is said to be associated with low rates of bacterial resistance and a low rate of adverse events. We therefore investigated in a non-systematic literature search the effectiveness of Pivmecillinam as well as optimum dosage and duration of treatment. AnswerThe presently available evidence from studies shows Pivmecillinam to be highly effective in the treatment of uncomplicated lower urinary tract infections in adult women. Especially the risk for pyelonephritis as a complication is significantly reduced compared to placebo. Regarding optimum dosing and duration, current evidence from studies is inconclusive. Longer duration of treatment or higher dosing does not seem to associated with significant clinical benefits. Therefore, lower doses like 3 x 200 mg daily with an initial dose of 400 mg or 2–3 x 400 mg daily for three days appear to be sufficient.

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