Treatment of Acute Pyelonephritis in Emergency Department; Comparison of the Efficacy of Ciprofloxacin and 3rd Generation Cephalosporin / 감염과화학요법

ABSTRACT

BACKGROUND: The resistance rate of Escherichia coli (E.coli) against ciprofloxacin is reported as high as 30% in Korea. The purpose of this study was to evaluate the clinical outcome of two empirical antibiotics, ciprofloxacin and cefotaxime, in patients with acute pyelonephritis (APN). MATERIAL AND METHODS: We retrospectively reviewed medical records of APN patients who were prescribed with ciprofloxacin or cefotaxime as empirical antibiotics from November 2004 and June 2006. The Successful treatment (ST) was defined as the condition that a patient maintained body temperature below 37.7degrees C for more than 48 hours after treatment. RESULTS: A total of 64 patients were enrolled (31 in the ciprofloxacin and 33 in the cefotaxime group). Average age was 58.9 (+/-15.8) years and 58 (90.6%) patients were women. Comparing WBC count and CRP level before treatment with those after 48 hours of treatment, significant improvements were found only in the cefotaxime group. After 48 hours, the cefotaxime group had more patients with ST, but the difference was not significant [19 (58%) vs. 12 (39%), P=0.131]. After 72 and 120 hours, the cefotaxime group showed significantly higher ST rate than the ciprofloxacine group [72 hours; 30 (91%) vs. 19 (61%), P=0.016 and 120 hours; 32 (97%) vs. 23 (74%), P=0.009]. Even after adjusting demographic factors, the cefotaxime group showed higher ST rate. CONCLUSION: Cefotaxime can be considered as a better option for empirical treatment for APN in aspects of improvement of acute phase reactants and clinical cure, especially in endemic area of highly resistant E. coli.