Treating urinary tract infection is still a major health challenge in developing countries. Cephalosporins are one of the mainstays of therapy and third generation among these are the first line agents for treatment of complicated UTIs including those of nosocomial origin.
However the indiscriminate use of third generation cephalosporins and increasing reports of bacterial resistance especially Klebsiella, Pseudomonas and many strains of E. coli make it necessary to investigate new compounds. For infections caused by ESBL-producing E. coli or Klebsiella species, Cefepime and piperacillin-tazobactam have been successful.
The present open and comparative study compared the efficacy and tolerability of parentral cefotaxime/sulbactam and cefepime/ tazobactam in patients of urinary tract infections. Well, while conducting this study, many challenges were posed as not many patients were being recruited for group B (where a long term parentral therapy was planned in the protocol) . Long duration of therapy was not usually required in majority of patients. Neurotoxic reports from Cefepime too posed further concerns. High cost of therapy for group B, further restrained patients from inclusion in the group B. Hence small number of study subject is a limitation of this study. In lots of other patients (admitted in urology wards but not enrolled in our study) Cephalosporins alone without addition of a beta lactmase inhibitors were found to be effectively controlling UTI. Well, a practise of prescribing a combination of a cephalosporin along with a beta lactmase inhibitor without evaluating the drug sensitivity of the isolated organism in the culture was another thing highlighted to be very prevalent and needs to be rectified at root level to prevent further the emerging problem of resistance. Subjective parameters like urgency inclusion in calculation of clinical cure rates make bacteriological cure rates a more reliable index for efficacy. However the clinical rates post five days of therapy were indicative of a good quality of life of the patient.
A judicious use of antibiotics which includes prescription after drug sensitivity testing , avoiding the combinations with beta lactamase inhibitors when not needed and hence rationalisation of the therapy is the need of the hour.
Written by:
Dr. Kamalpreet Kaur
Department of Pharmacology, GGS Medical College, Faridkot, Punjab, India.