ArticleEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology2026
Comparison of oral third- versus first-/ second-generation cephalosporins for acute uncomplicated cystitis: a nationwide retrospective cohort study.
Article in European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeOral cephalosporins are frequently prescribed for uncomplicated cystitis. Although cephalexin and cefaclor (first- and second-generation oral cephalosporins) exhibit favorable pharmacokinetic properties, third-generation agents demonstrate lower and more variable bioavailability, potentially resulting in reduced clinical effectiveness. This study compared oral third-generation cephalosporins with cephalexin and cefaclor in treating uncomplicated cystitis.
methodsWe conducted a retrospective cohort study using a nationwide claims database in Japan (2006-2022). We included adult women aged ≥ 18 years who newly received oral third-generation (cefdinir, cefpodoxime proxetil, cefditoren pivoxil, or cefcapene pivoxil) or first-/second-generation cephalosporins (cephalexin or cefaclor) for acute uncomplicated cystitis, with a prescription duration of 5-7 days. The primary outcome was a composite of pyelonephritis diagnosis or additional antibiotic use within 7 days. Secondary outcomes included the individual primary outcome components, all-cause hospitalization, and adverse events. We conducted propensity-score overlap weighting to adjust for possible confounders and stratified analyses by age (< 50 or ≥ 50 years).
resultsAmong 40,003 eligible patients, 90.7% received third-generation cephalosporins. The proportion of the primary outcome was significantly higher in the third-generation group than in the first-/second-generation group (8.4% vs. 6.5%; risk difference, 1.9%; 95% confidence interval, 1.0%-2.7%). Among the secondary outcomes, additional antibiotic treatment was more frequent in the third-generation group, whereas the proportions of pyelonephritis diagnosis and other outcomes were similar between the groups. Subgroup analyses showed consistent results across age strata.
conclusionsOral third-generation cephalosporins may be associated with more frequent additional antibiotic treatment compared with cephalexin or cefaclor in the management of uncomplicated cystitis.
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