Cephalexin, a cephalosporin, and ciprofloxacin, a fluoroquinolone, are effective and well tolerated as prophylaxis against urinary tract infection (UTI) in patients who are unable to receive sulfamethoxazole-trimethoprim, investigators reported at the 2022 American Transplant Congress (ATC 2022) in Boston, Massachusetts.
The finding is from a single-center retrospective analysis of 78 patients who received cephalexin 500 mg or ciprofloxacin 500 mg daily for UTI prophylaxis following receipt of a kidney transplant. Each group had 39 patients. All patients were either intolerant or allergic to sulfamethoxazole-trimethoprim. The primary outcome was prophylaxis failure, which investigators defined as development of a clinically relevant UTI.
The proportion of patients who experienced UTIs was numerically higher in the cephalexin than ciprofloxacin groups (36% vs 18%), but the difference was not statistically significant, investigators Nicholas Pauley, PharmD, of Transplant Institute at Henry Ford Hospital in Detroit, Michigan, and colleagues reported.
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Significantly more patients in the cephalexin than ciprofloxacin group had postoperative complications (15 vs 7 patients), a finding that potentially could explain the higher incidence of UTIs, according to the investigators.
Dr Pauley and colleagues observed a significantly lower creatinine clearance level among ciprofloxacin than cephalexin recipients at day 180 (48.3 vs 60.5 mL/min), but found no significant difference in change from baseline to day 180. They also observed no significant difference in the occurrence of adverse events. Although a higher proportion of ciprofloxacin than cephalexin recipients discontinued treatment (15% vs 5%), the difference was not statistically significant.
The authors concluded that both antibiotics were effective at providing UTI prophylaxis following kidney transplantation and that cephalexin is a suitable alternative that avoids unnecessary exposure to fluoroquinolones.
Reference
Pauley NA, Fizmaurice M, Poparad-Stezar A, Summers B, Jantz A. Comparison of cephalexin and ciprofloxacin prophylaxis for urinary tract infection in kidney transplant recipients. Presented at: ATC 2022; June 4-8, 2022, Boston, Massachusetts. Abstract 1007.
