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The following is a summary of “Cephalosporins for Outpatient Pyelonephritis in the Emergency Department: COPY-ED Study,” published in the November 2024 issue of Emergency Medicine by Koehl et al.
Researchers conducted a retrospective study to compare the effectiveness of oral cephalosporins vs fluoroquinolones and trimethoprim/sulfamethoxazole (TMP-SMX) in treating patients with pyelonephritis discharged from the emergency department (ED).
They analyzed data from 11 geographically diverse EDs in the United States and included patients aged 18 years or older diagnosed with pyelonephritis and discharged home from the ED between January 1, 2021, and October 31, 2023. The primary outcome at 14 days was treatment failure, defined as a composite of recurrence of urinary symptoms, repeat ED visits or hospitalizations for urinary tract infection, or initiation of a new antibiotic prescription for urinary tract infection. The secondary outcome assessed the appropriateness of empiric antibiotic therapy based on urine culture susceptibility.
The results showed among 851 patients meeting inclusion criteria, 647 received cephalosporins, while 204 were treated with guideline-endorsed first-line therapies TMP-SMX. Baseline characteristics were the same across the 2 groups. Treatment failure rates were comparable, with 17.2% in the cephalosporin group vs 22.5% in the TMP-SMX group (difference = 5.3%, 95% confidence interval [CI] –0.118 to 0.01). After adjusting for confounders, cephalosporin use did not increase treatment failure risk (odds ratio = 0.22, 95% CI 0.03 to 1.95). Rates of appropriate empiric treatment based on urine culture susceptibility were also similar.
Investigators concluded that oral cephalosporins were effective as guideline-endorsed treatments for patients with pyelonephritis in ED discharged home.
Source: annemergmed.com/article/S0196-0644(24)01140-5/abstract
