Cefdinir Versus Cephalexin for the Treatment of Uncomplicated Urinary Tract Infections.

Background: Due to its low bioavailability and poor urinary penetration, there are concerns that cefdinir is a suboptimal agent for the treatment of urinary tract infections (UTIs). Limited available literature examining cefdinir's use for UTIs has not shown worse outcomes compared with other oral beta-lactams; however, these studies are limited by small sample size or lack of symptom assessment as a measure of clinical cure. Methods: This retrospective, multicenter cohort study included adult female patients who received either cefdinir or cephalexin for 5-7 days for symptomatic uncomplicated UTI (uUTI). The primary objective was to compare treatment failure, defined as recurrent or continued urinary symptoms necessitating re-treatment within 30 days, between patients treated with oral cefdinir 300 mg twice daily (cefdinir group) and cephalexin 500 mg twice daily (cephalexin group) in the outpatient setting. Results: Three hundred sixty-seven patients were included (cefdinir n = 167; cephalexin, n = 200). Patients treated with cefdinir experienced a significantly higher rate of treatment failure (23.4% vs 12.5%, Conclusions: Cefdinir was independently associated with treatment failure with nearly twice as high of failure rate compared with cephalexin for the treatment of outpatient uUTI. Patients who failed treatment with cefdinir were more likely to demonstrate cephalosporin resistance on subsequent urine culture.