Cephalexin Twice Daily vs Four Times Daily for UTI Treatment in the ED

Cephalexin Twice Daily vs Four Times Daily for UTI Treatment in the ED

Abigail Rath et al.
 American Journal of Emergency Medicine, March 2025
 PMID: 40184663

šŸ©ŗ Clinical Implications

  • No statistically significant difference in treatment failure between BID and QID regimens

  • BID dosing is reasonable for both uUTI and cUTI in the ED outpatient setting

  • Potential benefits of BID:

    • Improved patient adherence

    • Lower cost

    • Simplified regimen without compromising efficacy

šŸ“Œ Study Overview

  • Design: Retrospective, single-center cohort study (2016ā€“2023)

  • Population: Adults (ā‰„18 y/o) discharged from the ED with:

    • A UTI diagnosis

    • Cephalexin 500 mg BID or QID

    • Positive urine culture for E. coli, Klebsiella, or Proteus susceptible to cefazolin

  • Primary Outcome: Treatment failure within 30 days

    • Defined as return visit for similar/worsening UTI symptoms or antibiotic change

šŸ“Š Key Results

  • Total patients: 214 (50% BID group, 50% QID group)

  • Overall failure rates:

    • BID: 18.7%

    • QID: 15.0% (P = 0.465) ā†’ Not significant

  • By UTI type:

    • Uncomplicated UTI: 14.9% (BID) vs 8.1% (QID) (P = 0.197)

    • Complicated UTI: 27.3% (BID) vs 30.3% (QID) (P = 0.786)

Rath, A., Morrisette, T., Hamby, A., Burgoon, R. and Billups, K., 2025. Cephalexin twice daily versus four times daily for the treatment of urinary tract infections diagnosed in the emergency department. The American Journal of Emergency Medicine, 93, pp.80-85.

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