Comparative Efficacy of 3-Day and 7-Day Chemotherapy with Pivmecillinam in Urinary Tract Infections in General Practice

Abstract

Large numbers of patients, mostly women, consult their general practitioners every year complaining of symptoms of urinary tract infection. Antibiotics are prescribed in the majority of cases, even though it has been established that only about one-half of these women will have significant bacteriuria (Gallagher, Montgomerie & North 1965). In addition, there is no general consensus of opinion on the duration of antibiotic treatment for acute cystitis. Treatment may be continued for 7, 10 or even 14 days. Administration of antibacterial agents may have an adverse effect on the environment by increasing the pool of multi-resistant bacteria. This suggests that antibiotics should be administered only to patients with proven infection. However, it has been shown that antibacterial therapy of non-infected women does appear to be more effective than placebo in alleviating symptoms and may also help to delay subsequent infection (Brooks, Garrett & Hollihead 1972). If it could be established that a short course of treatment with an antibiotic that does not select for multi-resistant bacteria was effective, then there may be less theoretical concern at administering therapy to all patients with acute cystitis. In addition, there would be a considerable benefit in terms of cost and probably in patient compliance, since symptoms usually subside after 3 to 4 days of active treatment. Pivmecillinam (Selexid®) is the orally administered form of the amidinopenicillin mecillinam, which exerts high activity against the majority of urinary tract pathogens (Brumfitt & Hamilton-Miller 1978). It has been shown to be more effective than esters of ampicillin (Aaraas, Skarsten and Neess 1977, Bentzen et aI1975), amoxycillin (Bresky 1977, Ishigami 1977), and comparable in efficacy to co-trimoxazole (Verrier Jones & Asscher 1975, Guttmann 1977). Furthermore, unlike ampicillin, pivmecillinam does not have an adverse effect on the bacterial ecology (Anderson et al 1976). Therefore pivmecillinam seems ideally suited for the treatment of acute cystitis, particularly if a short course of therapy could be employed. Recent in vitro evidence (Anderson et al 1977) indicates that just 3 days therapy with this antibiotic may be effective. To investigate this, the efficacy of a 3-day course of pivmecillinam was compared with the more conventional 7-day regimen in women presenting to their general practitioner with symptoms of acute cystitis.