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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.
The Food and Drug Administration recently approved Pivya (pivmecillinam) to treat uncomplicated UTIs in female adults. Clinical trials show that Pivya is effective and side effects are limited.
When methenamine was first introduced in the late 1800s and early 1900s, doses of 15 to 30 g per day were commonly employed and doses of up to 60 to 180 g per day were tried in some cases. [42] Toxic effects of such high doses included urinary tract and bladder irritation, frequent urination, strangury, and hematuria. [42]
Nitrofurantoin, sold under the brand name Macrobid among others, is an antibacterial medication of the nitrofuran class used to treat urinary tract infections (UTIs), although it is not as effective for kidney infections. [16] It is taken by mouth. [16] Common side effects include nausea, loss of appetite, diarrhea, and headaches. [16]
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Its use as a prophylactic treatment is supported by one clinical trial involving children with acute lymphoblastic leukaemia. [59] Other than this and one other clinical trial into its efficacy as a treatment for pneumocystis pneumonia, [ 60 ] data on its use in both the treatment and prevention of pneumocystis pneumonia is significantly lacking.