2026 Eastern States Conference

Eastern States Abstract
Nadine Haidar, PharmD
Preceptors: Nicholas Pugliese, PharmD, BCCCP; Olubusola Fowowe, PharmD, BCIDP; Sarah Graziose, PharmD, BCPS, BCIDP
Title
Cefpodoxime versus cefdinir for the treatment of urinary tract infections in the emergency department: a retrospective cohort study
Learning Objective
Identify differences in treatment failure between cefpodoxime and cefdinir in emergency department patients with urinary tract infections.
Background/Objective
Cefpodoxime has more favorable pharmacokinetic properties than cefdinir, yet both are used for urinary tract infections. This study evaluates differences in treatment failure between these agents in emergency department patients.
Methods
This retrospective, single-center cohort study included adult emergency (ED) patients with uncomplicated or complicated urinary tract infections (UTIs) discharged on oral cefpodoxime or cefdinir (with or without a single IV dose) and able to tolerate oral therapy. Patients were excluded if they were admitted to the hospital, had catheter-associated infections, were pregnant, had concurrent infections, or received multiple antibiotics. The primary outcome was treatment failure within 14 days, defined as return visit to a medical facility (ED, urgent care, telehealth, or outpatient clinic) for worsening urinary symptoms or antibiotic change due to persistent or worsening urinary symptoms and secondary outcomes included treatment failure at 28 and 90 days, as well as adverse drug reactions.
Results
Among 415 patients, 210 received cefpodoxime and 205 received cefdinir. Fourteen-day treatment failure was similar between groups (4.3% vs 4.4%; p=1.000), with no significant differences at 28 days (2.9% vs 3.9%; p=0.597) or 90 days (6.2% vs 10.2%; p=0.154). Cefpodoxime patients had more SIRS ≥2 (22.4% vs 14.6%; p=0.042), complicated UTI (42.9% vs 30.7%; p=0.010), and ED ceftriaxone administration (63.8% vs 52.2%; p=0.017).
Conclusion
Cefpodoxime and cefdinir demonstrated similar return-to-care outcomes after ED discharge for UTI, with no statistically significant differences in treatment failure at 14, 28, or 90 days. Despite greater baseline illness severity in the cefpodoxime group, outcomes remained comparable to cefdinir, suggesting cefpodoxime may be a reasonable oral option for ED UTI discharge. Additional studies with larger sample sizes are needed to better define its role in higher-risk UTI populations.
Self-Assessment Question
Based on the findings of this study, what conclusions can be drawn regarding cefpodoxime compared to cefdinir in ED patients with UTIs? (Select all that apply)
a) Comparable treatment failure at 14 days
b) Superior short-term efficacy of cefdinir
c) Potential differences in longer-term outcomes
d) Increased adverse drug reactions with cefpodoxime
Answer: A, C