This study was performed to compare the therapeutic efficacy of
cefuroxime with that of
cefotaxime as initial antimicrobial
therapies in women with complicated nonobstructive acute
pyelonephritis (APN) caused by
Enterobacteriaceae infections. The clinical characteristics and outcomes of a
cefuroxime-treated group (n = 156) were compared with those of a
cefotaxime-treated group (n = 166). Of these 322 women, 90 from each group were matched by propensity scores. The defervescence rates were not significantly different in the
cefuroxime and
cefotaxime groups at 72 h after the start of antimicrobial
therapy (81.1% versus 78.9%, P = 0.709). The clinical and microbiological cure rates during the follow-up visits that were 4 to 14 days after the end of the antimicrobial
therapies were not significantly different in the
cefuroxime versus
cefotaxime groups, which were 97.8% (87/89) versus 97.8% (87/89) (P > 0.999) and 89.5% (68/76) versus 90.7% (68/75) (P = 0.807), respectively. The median
hospital stay duration and the median times to defervescence in the
cefuroxime versus
cefotaxime groups were 8 days (interquartile range [IQR], 7 to 10 days) versus 9 days (IQR, 7 to 11 days), respectively, and 55 h (IQR, 37 to 70 h) versus 55 h (IQR, 35 to 69 h), respectively.
Bacteremia, extended-spectrum-β-lactamase-producing Enterobacteriaceae,
C-reactive protein levels of ≥ 15 mg/dl, and white blood cell counts of ≥ 15,000/mm(3) of blood had independent effects on the rates of early clinical failure. Our data suggest that the effects of
cefuroxime are not different from those of
cefotaxime when they are used as an initial antimicrobial treatments for community-onset complicated nonobstructive APN in women.