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EFFICACY OF CEFIXIME IN THE TREATMENT OF URINARY TRACT INFECTION

Article  in  WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES · January 2015

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 WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES
Mukesh et al. World Journal of Pharmacy and Pharmaceutical Sciences
SJIF Impact Factor 2.786

Volume 4, Issue 04, 987-994. Research Article ISSN 2278 – 4357

EFFICACY OF CEFIXIME IN THE TREATMENT OF URINARY

TRACT INFECTION

Mukesh Kumar Chaudhary*, Ghyanshyam Pandey, Mahendra Godar,

Ramesh Gautam and Subash Gurung

Crimson College of Technology, Butwal-13, Devinagar, Rupandehi, Lumbini, Nepal.

Article Received on ABSTRACT

21 Jan 2015, Introduction: A urinary tract infection (UTI) (also known as acute
Revised on 15 Feb 2015, cystitis or bladder infection) is an infection that affects part of the
Accepted on 11 Mar 2015
urinary tract. When it affects the lower urinary tract it is known as a
simple cystitis (a bladder infection) and when it affects the upper
*Correspondence for
urinary tract it is known as pyelonephritis (a kidney infection).
Author
Mukesh Kumar Symptoms from a lower urinary tract include painful urination and
Chaudhary either frequent urination or urge to urinate (or both), while those of
Crimson College of pyelonephritis include fever and flank pain in addition to the symptoms
Technology, Butwal-13,
of a lower UTI. Bacteria are the main cause for UTI. Cefixime is an
Devinagar, Rupandehi,
antibiotic useful for the treatment of a number of bacterial infections. It
Lumbini, Nepal.
is a third generation cephalosporin. Cefixime, when given orally is
well absorbed and has a long plasma half life (3-4 hrs) and a good therapeutics index in a
variety of infection. Objective: The aim of this study was to determine the Efficacy of
Cefixime in Urinary Tract Infection in the different hospitals and polyclinic of Rupandehi
districts of Nepal. Methodology: A prospective study was conducted in Crimson Hospital,
Manigram, Rupandehi, Grace Polyclinic, Bhalwari, Rupandehi and Aaram Polyclinic,
Kotihawa, Rupandehi. Patient information was obtained by interviewing the patient and from
their lab report. Result: Out of 65 patients, 3 patients did not arrive during the follow up
procedure while 61 patients recovered completely with Cefixime showing efficacy of
98.38%. Conclusion: Cefixime was effective in the treatment of UTI.

KEYWORDS: Urinary Tract Infection, Cefixime, Urine culture, E.coli.

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INTRODUCTION
Urinary tract infection (UTI) may involve only the lower urinary tract or both the upper and
the lower tracts. The term cystitis has been used to describe the syndrome involving dysuria,
frequency, and occasionally suprapubic tenderness. Acute pyelonephritis describes the
clinical syndrome characterized by flank pain or tenderness, or both, and fever, often
associated with dysuria, urgency, and frequency.[1] UTI is caused by pathogenic invasion of
the urinary tract which leads to an inflammatory response of the urothelium. The main causal
agent of both types is E. coli, though other bacteria, viruses or fungi may rarely be the
cause.[2] UTIs are among the most common bacterial infections in women. In most women,
these infections are limited to the lower urinary tract and are manifest by asymptomatic
bacteriuria. Cystitis is the most common symptomatic infection and is characterized by
dysuria, urgency, and frequency concomitant with pyuria and bacteriuria. Although cystitis is
usually uncomplicated, the upper urinary tract may become involved by ascending infection.
Pyelonephritis is defined as infection of the renal parenchyma and pelvicaliceal system, and it
arises either de novo from asymptomatic renal bacteriuria or from ascending bladder
infection.[3] Treatment of UTI focuses on the site of infection, presence of fever, and the
pathogen causing the infection.

Ampicillin and gentamicin continue to be the mainstay of empirical treatment of

pyelonephritis. The use of a third-generation cephalosporin may be considered with the
knowledge that its coverage will not include Enterococcus and that there is emerging
extended-spectrum beta-lactam resistance.[4] Cefixime was quickly established in the western
countries as a potent broad-spectrum antibiotic with a variety of indications. A multinational,
worldwide study has confirmed the excellent efficacy of Cefixime in children and adults.
Some authors recommend Cefixime as a first line antibiotic in community-acquired URTI.
Other studies present good clinical efficacy of Cefixime in URTI and AOM, where
community acquired infections present a very high resistance to Macrolides and high
sensitivity to Cefixime.[5] Although there are drug utilization study conducted on the various
therapeutic classes of the UTI drugs, due to the emergence of MDR E. coli in endemic areas,
there is development of resistance for the drugs used. So there is requirement of alternative
drugs for the treatment of UTI. Thus the aim was to observe the therapeutic effectiveness of
one of the alternative drug, Cefixime in treatment of UTI in selected hospital and polyclinics
in Rupandehi district. The objective of this study was to find the efficacy and tolerability of
Cefexime in the treatment of UTI.

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MATERIALS AND METHODS

Before conducting the study ethical issue was taken into consideration. The proposal was
submitted to department of pharmacy Crimson College of Technology affiliated to Pokhara
University. After its approval study was designed and conducted at three different hospitals
from October 2014 to December 2014. The study was a non-randomized, open, non-
comparative, multi centric study. Informed consent was obtained from the patients and the
study was in accordance with the clinical principles laid down in declaration of Helsinki.

Inclusion criteria
1. Patients of either gender.
2. Patients with major symptom of UTI.
3. Patient not suffering from other disease (cardiovascular disorder, peptic ulcer, liver
disorder).

Exclusion criteria
1. Patient with cephalosporin allergy.
2. Patient with impaired renal and hepatic function.
3. Pregnancy and lactation.
4. Patient less than 10 years of age.

After informed consent was obtained, adult patient received 200 mg every 12 hrs for 7-10
days. At the time of entry into the study, base line data were recorded. Patients were observed
on 0 (start of day), 3rd, 7th and 10th day after enrollment into the study for assessment of
symptoms.

Bacteriological responses were defined as followings

1. Eradication- Negative culture of the initial pathogen obtained at the end of therapy,
maintained to the 5-10 days post-therapy follow-up.
2. Persistent- Positive culture of the initial pathogen obtained at the end of therapy.
3. Superinfection- Isolation of one or more new pathogens at the end of therapy.

Clinical responses were defined as followings

Cure- Symptoms resolved at the evaluation 5-10 days post-therapy.
Relapse- Symptoms initially improved or resolved, but recurred either late in the therapeutic
course or during the 5-10 days post-therapy period.

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Failure- No evident response to therapy.

Statistical analysis
Results were analyzed using Microsoft word 2007 spreadsheet. The Statistical Package of
Social Sciences (SPSS) version 16 was used to carry out descriptive statistics. The results
were expressed in the form of pie-charts, bar-diagrams, tables etc. Value of P<0.05 were
considered significant.

RESULT
Age wise distribution of UTI patients
The age distributions of patient with UTI are shown below. Majority of the UTI patient were
in the age group 20-55 years. The mean ± standard deviation of the age of the patient was
40.29 ± 20.06 years.

Figure1: Age-wise distribution of UTI patients.

Gender-wise distribution of UTI Patients

Gender wise distribution of patients is as shown in the figure. The study reflected that out of
65 patients, 24 were males and 41 were females.

Figure 2: Gender distribution of patients

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Occupation wise distribution of UTI patients

UTI patients can be distributed according to occupation status as shown in figure. Highest
numbers of patients were found to be housewife (26.15%).

Table 1: Table for occupational distribution of UTI patients

Occupation Frequency Percentage
Student 17 26.15
Housewife 18 27.70
Employee 14 21.53
Farmer 16 24.62
Total 65 100

Follow up of UTI patients during drug therapy

During the treatment, patients were suggested to follow up on 3rd, 5th and 7th day. And most
patient preferred to follow up on 5th and 7th day of treatment. The detail information of follow
up data is as shown below.

Table 2: Follow up of UTI patient during drug therapy

Days (within) Frequency Percentage
3 5 7.70
4 3 4.60
5 17 26.15
6 2 3.08
7 20 30.77
8 and after 15 23.08
Does not follow 3 4.62
Total 65 100

Improvement in condition of UTI patient after treatment

After the administration of Cefixime, among 65 patients, 61 patients (93.85%) recovered
completely after drug therapy. Overall Cefixime in the treatment of UTI is effective with the
efficacy of 93.85%.

Table 3: Improvement in condition of UTI patient after treatment

Condition
Frequency Percentage
Improved/ not
Yes 61 93.85
No 4 6.15
Total 65 100

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Side effects of Cefixime in UTI

Some of the side effects seen during the treatment of UTI were Nausea, Gastritis, Rashes and
Drowsiness. But these side effects were in minor amount.

Table 4: Side effects of Cefixime in UTI

Side Effect Frequency Percentage
Nausea 1 1.54
Gastritis 2 3.08
Rashes 2 3.08
Drowsiness 1 1.54
No complication 59 90.76
Total 65 100

DISCUSSION
UTI are some of the most common infections experienced by humans, exceeded in frequency
among ambulatory patients only by respiratory and gastrointestinal infections.[6] In our
research patient of all age group (except <10 yrs) were randomly selected and our study
showed that age group from 20-55 yrs were mostly affected. Moreover elderly patients (post
menopausal women) were highly susceptible to UTI. This can be explained by the fact that in
postmenopausal women, the intravaginal pH is high which is associated with a change in
colonising organisms and increased bacterial adherence to the uroepithelium. Increased
instrumentation and decreased host defence mechanisms also contribute to the increased risk
of elderly patients developing sepsis originating from the urinary tract.[7]

Women are more prone to UTIs than men.[8] This is probably because in females, urethra is
much shorter and closer to the anus as per.[9] Our study also support the above mention fact
where out of 65 UTI patients who were selected randomly, 41 were females while the
remaining 24 patients were males.

These patients were diagnosed with UTI by urinalysis followed by Urine Culture. The gold
standard for the diagnosis of a urinary tract infection is the detection of the pathogen in the
presence of clinical symptoms. The pathogen is detected and identified by urine culture
(using midstream urine).[10]

Urinalysis showed that out of 65 patients, urine of 36 patients were clear while remaining 29
patients were found to be slightly turbid. The cause of turbidity was presence of small amount
of precipitated phosphate crystal.[11] Moreover out of 65 patients pH of only 3 patients were

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found to be alkaline whereas of remaining 62 patients were found to be acidic which further
confirms the diagnosis of UTI.[10] Urine culture of all these patients showed growth of E.coli
and hence was found to be major causative organism for UTI.[12]

In our study Cefixime does not show any severe side effects or adverse effect in majority of
the patients. Out of 65 patients, there was incidence of nausea (1 patient), gastritis (2 patient),
rashes (2 patients) and drowsiness (1 patient). No such adverse effect was reported in
remaining 59 patients. Thus our study not only shows that Cefixime was effective in the
treatment of UTI but was also well tolerated by the patients receiving the drug.[13]
Furthermore patient were suggested to follow up on 3rd, 5th and 7th day of the treatment and
most patient preferred on 5th and 7th day. Out of 65 patients 3 patients did not arrive on the
follow up procedure while the conditions of remaining patient were evaluated on the basis of
routine urine examination (urine R/E).

Following the administration of Cefixime in 65 patients, 61 patients recovered completely

(on the basis of symptoms and urine R/E). Out of remaining 4 patients, 3 patients does not
arrive during the follow up procedure and in remaining 1 patient Cefixime does not show the
expected therapeutic effect. Overall Cefixime in treatment of UTI was found to be highly
effective with efficacy of 93.85%. Hence, Cefixime can be used as alternatives for treatment
of UTI.[14]

CONCLUSION
Cefixime is a 3rd generation cephalosporin which is used in the treatment of many bacterial
infection like bronchitis, gonorrhea, ear infection, tonsillitis, throat infection and pneumonia.
Cefixime is active against a very wide spectrum of bacteria such as E. coli, Staphylococcus
aureus, Streptococcus pneumoniae, Streptococcus pyogenes, Hemophilus influenzae,
Salmonella, Shigella, and Neisseria gonorrhoeae. In our study Cefixime was administered
twice a day for 7-10 days in the treatment of 65 patients suffering from UTI. Not only the
study evaluates the efficacy of Cefixime in the treatment of UTI but also showed its safety
and tolerability in majority of the patient therefore can be used as an alternate drug for the
treatment of UTI.

REFERENCES
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ed., Churchill Livingstone, 2005; 957-986.

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2. Arul Prakasam K.C., K. G. Dileesh Kumar and M. Vijayan. A Cross Sectional Study on
Distribution of Urinary Tract Infection and Their Antibiotic Utilization Pattern In Kerala.
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Gynecology, 2005; 106(5): 1085-92
4. Clark CJ, Kennedy WA and Shortliffe LD. Urinary Tract Infection in Children: When to
Worry. Urol Clin N Am, 2010; 37: 229-41.
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American Journal of Life Sciences, 2014; 2(2): 46-52.
9. Jaiswal et al. Bacteriological Study of Urinary Tract Infection in Male Patients
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10. Franz M and Horl W. H. Common Errors in Diagnosis and Management of Urinary Tract
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11. Tjale M. C. The Prevalence of Abnormal Urine Component as Detected by Routine
Dipstick Urinalysis: A Survey at a Primary Health Care Clinic in Mankweng Hospital;
University of Limpopo, 2009.
12. Amin et al. Study of Bacteria Isolated From Urinary Tract Infections and Determination
of Their Susceptibility to Antibiotics. Jundishapur Journal of Microbiology, 2009; 2(3):
118-23.
13. Adam D. Overview of the Clinical Features of Cefixime. Chemotherapy, 1998; 44: 1-5.
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Medical Science, 1993; 13: 159-64.

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