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Within the penicillin class, pivmecillinam is considered the first-line empiric treatment for acute cystitis due to its wide spectrum of activity against gram-negative bacteria and its specific efficacy in the urinary tract. It has consistently demonstrated a high cure rate of over 85% for UTIs and a low resistance rate among E. coli strains.
Cefixime is a broad spectrum cephalosporin antibiotic and is commonly used to treat bacterial infections of the ear, urinary tract, and upper respiratory tract. The following represents MIC susceptibility data for a few medically significant microorganisms: [15] Escherichia coli: 0.015 μg/mL – 4 μg/mL
Trimethoprim (TMP) is an antibiotic used mainly in the treatment of bladder infections. [1] Other uses include for middle ear infections and travelers' diarrhea. [1] With sulfamethoxazole or dapsone it may be used for Pneumocystis pneumonia in people with HIV/AIDS.
Antibiotic sensitivity can also be tested with these cultures, making them useful in the selection of antibiotic treatment. However, women with negative cultures may still improve with antibiotic treatment. [4] As symptoms can be vague and without reliable tests for urinary tract infections, diagnosis can be difficult in the elderly. [11]
Nitrofurantoin and the quinolone antibiotics are mutually antagonistic in vitro. It is not known whether this is of clinical significance. [9] Resistance to nitrofurantoin may be chromosomal or plasmid-mediated and involves inhibition of nitrofuran reductase. [55] Acquired resistance in E. coli continues to be rare.
Mecillinam or amdinocillin is an extended-spectrum penicillin antibiotic of the amidinopenicillin class that binds specifically to penicillin binding protein 2 (PBP2), [2] and is only considered to be active against Gram-negative bacteria.
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However, E. coli are extremely sensitive to such antibiotics as streptomycin or gentamicin. Recent research suggests treatment of enteropathogenic E. coli with antibiotics may significantly increase the chance of developing haemolytic-uremic syndrome. [12]