Cephalexin BD as Effective as QID for UTIs in the ED

TOPLINE:

Cephalexin administered twice vs four times daily showed comparable treatment failure rates for urinary tract infections (UTIs) diagnosed in the emergency department (ED), potentially offering a more convenient option without compromising effectiveness, a new study showed.

METHODOLOGY:

• Researchers conducted a retrospective, single-center cohort study of 214 adults diagnosed with either uncomplicated UTIs (uUTIs; 69.2%) or complicated UTIs (cUTIs; 30.8%) in the ED between 2016 and 2023.
• Participants were prescribed 500 mg cephalexin twice daily (n = 107) or four times daily (n = 107), and their urine cultures were positive for cefazolin-susceptible isolates of Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis.
• The primary outcome was treatment failure within 30 days of an ED visit, and the secondary outcomes were a Clostridioides difficile infection within 30 days and side effects within 7 days of cephalexin initiation.

TAKEAWAY:

• Overall treatment failure rates were comparable between the twice-daily and four-times-daily dosing groups (18.7% and 15.0%, respectively; P = .465).
• C difficile infections within 30 days and reported side effects within 7 days of treatment initiation did not significantly differ between the groups.
• Subgroup analysis showed that treatment failure rates were not significantly different between the groups for both uUTIs (P = .197) and cUTIs (P = .786).

IN PRACTICE:

“These findings suggest cephalexin dosed twice daily may be a reasonable option for the outpatient management of UTIs diagnosed in the ED, thus increasing adherence and decreasing cost without statistically compromising effectiveness,” the authors wrote.

SOURCE:

The study was led by Abigail Rath, PharmD, Medical University of South Carolina, Charleston, South Carolina. It was published online on March 24, 2025, in The American Journal of Emergency Medicine.

LIMITATIONS:

This retrospective, single-center study had several limitations, including reliance on electronic medical record documentation, a manual chart review for follow-up visits, a small sample size, and the inability to confirm medication adherence. Some patients who sought care elsewhere may have been lost to follow-up. Additionally, microbiological failure was not assessed.

DISCLOSURES:

Information on study funding was not provided. Two authors reported having various ties with various sources. Details are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.