A review on recently approved drugs to treat urinary tract infection

Abstract

Urinary tract infection is one of the commonest infections to affect humans. Uncomplicated infections occur most commonly in  healthy women .when uropathogenic bacteria, usually Escherichia coli, ascend from the perineum into the bladder and overcome host innate immunity. Complicated infections occur in patients with an anatomical or functional abnormality of the urinary tract. The diagnosis is made on the basis of symptoms and diagnostic precision is improved by urinalysis. Urine culture is important with severe, recurrent or complicated infection and when the diagnosis is unclear, for example, in children and the elderly. Most women with symptoms that resolve quickly do not require further investigation but in children, men and patients with recurrent or severe infection, imaging of the renal tract, functional testing and cystoscopy should be considered to exclude an underlying abnormality. Pivmecillinam is the pro-drug of mecillinam, a ?-lactam antibiotic with a novel site of action and with specific and high activity against Gram-negative organisms such as Escherichia coli and other Enterobacteriaceae. Since its introduction, it has been widely used for the treatment of acute lower urinary tract infections (UTI), primarily in the Nordic countries. In contrast to the increasing resistance of urinary pathogens to other ?-lactams particularly ampicillin/amoxicillin and to other UTI antibiotics such as trimethoprim and trimethoprim/sulphamethoxazole (TMP/SMX), the level of resistance has remained on a low level. Less than 2% of E. coli community isolates are resistant to mecillinam. This paper reviews the clinical data on Pivmecillinam with a special focus on the safety aspects. Exblifep is a novel ?-lactam/?-lactamase inhibitor combination and a potential empirical therapy for resistant gram-negative infections. Exblifep noninferior to piperacillin/tazobactam for the primary outcome of treatment efficacy in patients with complicated urinary tract infections (UTIs) or acute pyelonephritis.