>>>Keflex for UTI?
Keflex is a first generation ceph, making it more appropriate for gram positives, not gram negatives.
Am I missing something?<<<<
I have found about 80-85% sensitivities in first and second-time UTI's with Keflex. I would be less likely to use it in anyone with a complicated medical history...
Working in a small community hospital with rather favorable antibiogram patterns may explain the difference in practice patterns.
My thinking (please correct any erroneous assumptions) is that Keflex still covers many E. Coli, and some sp of Klebsiella and Proteus, as well as some gm positives (the latter of which make up about 10% of UTI's.) It is much more affordable than many of the newer agents.
Keflex is one of my first choices pending cultures in some pregnant women and some children for UTI's, especially if they are sulfa allergic, and more so if Pen allergic. I still hesitate to use quinolones under age 18, and am not a big fan of nitrofurantoin as it gets no coverage north of the bladder. I see the 'macrodantin misses' from the PMD's offices who come in with their fever, chills, and back pain. . .
Nice thing about cephalosporins (and penicillins) is the relative lack of harm in pregnancy and absence of drug interactions (even more impt in older folks on Coumadin or oral hypoglycemics, where quinolones can lead to elevated INR's [along with TMP-sulfa] or drops in blood sugar.) I have seen plenty of patients who had an INR above 6 from a week of Septra DS for UTI or CA-MRSA.
So, in sulfa-allergic kids who are not particularly ill but have dysuria and a positive urinanalysis, I feel that my main choices are Augmentin or Keflex.
I am open to other suggestions. What do you all recommend in these cases - a second generation cephalosporin, or something else?
Take good care,
Bruce Nayowith MD
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