Pivmecillinam is a
beta-lactam antimicrobial marketed almost two decades ago. It has been used widely for the treatment of acute
cystitis in selected areas of the world, particularly in Scandinavia. With increasing resistance of community Escherichia coli isolates to
trimethoprim and
trimethoprim/
sulphamethoxazole, as previously observed for
ampicillin and sulphonamides, reassessment of empiric antimicrobial regimens for acute uncomplicated urinary
infection is necessary. Thus, it is timely to revisit the role of
pivmecillinam for the treatment of acute
cystitis. Clinical studies document the efficacy of this antimicrobial with short course
therapy for acute
cystitis, and clinical practice in countries where it has been used for many years confirms its efficacy and tolerability. If this agent were more widely used for empiric treatment for acute
cystitis, use of antimicrobials such as the
quinolones might be avoided. Further trials to define the comparative efficacy of
pivmecillinam with other antimicrobials, and further studies of community resistance in E. coli isolates to this agent are needed.