A Comparison of Cefpodoxime Proxetil and Cefaclor in the Treatment of Acute Exacerbation of COPD in Adults

Phillips, H. L.; Hook, C.J. Van; Butler, Thomas; Todd, Wesley Mark

doi:10.1378/chest.104.5.1387

Cited by 22 publications

(7 citation statements)

References 16 publications

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“…Cefaclor has also been shown to be as effective as cefpodoxime proxetil in the treatment of acute exacerbations of chronic obstructive pulmonary disease. 30 The current study is consistent with these results and demonstrates that cefaclor continues to be an effective agent in the treatment of AECB.…”

Section: Discussionsupporting

confidence: 90%

Cefaclor Af Versus Amoxycillin/Clavulanate in Acute Bacterial Exacerbations of Chronic Bronchitis: A Randomised Multicentre Study

Bandak

Bolzon

Turnak

et al. 1999

Int J Clinical Practice

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SUMMARYCefaclor and amoxycillin/clavulanate are active against Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis and Staphylococcus aureus ‐ pathogens commonly associated with acute exacerbations of chronic bronchitis (AECB). This randomised, parallel‐group, single‐blind, multicentre study investigated the comparative efficacy and safety of 7‐day treatment regimens of cefaclor AF (750 mg b.d. [n=73]) and amoxycillin/clavulanate (875/125 mg b.d. [n=72]) in AECB. A favourable clinical response was obtained in 95.9% of patients on cefaclor AF and 97.2% of patients on amoxycillin/clavulanate. There were no statistically significant differences between the groups for improvement in clinical response measured by pulmonary peak expiratory flow (PPEF), or for common symptoms associated with AECB. Both agents were well tolerated, with no statistically significant differences in overall safety; however, nausea and vomiting, and abdominal pain, the most frequently occurring adverse events in the amoxycillin/clavulanate group, were not reported in the cefaclor group. In conclusion, cefaclor AF and amoxycillin/clavulanate have similar efficacy and safety profiles in the treatment of AECB.

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Section: Discussionsupporting

confidence: 90%

Cefaclor Af Versus Amoxycillin/Clavulanate in Acute Bacterial Exacerbations of Chronic Bronchitis: A Randomised Multicentre Study

Bandak

Bolzon

Turnak

et al. 1999

Int J Clinical Practice

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“…A study showed that with the most potent broad-spectrum antibiotics, the patients are likely to get the best benefit from early treatment, such as amoxicillin/clavulanate and respiratory fluoroquinolones [24]. Philips et al [25] studied either cefpodoxime proxetil (200 mg, bid) or cefaclor (250 mg, tid) regimen for 10 days in acute bacterial exacerbations of COPD and found that there were no statistically significant differences between the two drug regimens in the eradication of the initial pathogen (cefpodoxime, 91%; cefaclor, 92%) or end-of-therapy clinical response (cure and proved; cefpodoxime, 99%; cefaclor, 92%) rates for the evaluable patients.…”

Section: Discussionmentioning

confidence: 99%

Inappropriate Utilization of Antibiotics in COPD Exacerbations

Varol¹,

Karakurt²,

Çırak³

et al. 2019

Monitoring Airway Disease

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OBJECTIVE:Most exacerbations are mild to moderate, and antibiotic treatment for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is recommended for patients with severe exacerbations or severe underlying chronic obstructive pulmonary disease (COPD). Therefore, we aimed to investigate the patient factors that are associated with the prescription of antibiotics for inappropriate indication in AECOPD. MATERIAL AND METHODS:This study was an observational cross-sectional study conducted in an outpatient clinic. The patients diagnosed with AECOPD and prescribed an antibiotic by a pulmonary physician were enrolled in the study. These prescriptions were documented by the pharmacist who asked the patient about the three cardinal symptoms. Appropriate and inappropriate prescription groups were defined by the types of exacerbations, as defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) COPD report.RESULTS: There were 138 patients, predominantly male (83%), with a mean age of 64 (±9) years. A total of 64% of the prescriptions were appropriate; however, there were 50 (36%) patients with inappropriate antibiotic prescription according to the mentioned criteria. When we compared the patient factors between the appropriate and inappropriate antibiotic prescriptions, there was no statistically significant difference in terms of age, Forced expiratory volume in first second % (FEV1%) predicted, FEV1 ml, forced vital capacity (FVC) ml, FEV1/ FVC, and amount (packs/year) of smoking (p>0.05 for all parameters). FVC% was statistically significantly lower in the appropriate antibiotic prescription group compared with that in the inappropriate antibiotic prescription group (p=0.049). CONCLUSION:This study shows that most pulmonary physicians have a tendency to prescribe antibiotics for AECOPD according to the defined GOLD criteria. However, some of the physicians also prefer to prescribe antibiotics self-directedly, irrespective of the GOLD criteria. A physician-based questionnaire can be completed for future studies to define the underlying reasons for antibiotic prescription demands for cases of mild AECOPD.

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“…Unfortunately, they generally suffer from such debilitating deficiencies that they are nearly uninterpretable, as a review of some relatively recent, but representative, trials reveals. [72][73][74][75][76][77][78][79][80][81] They typically define the cause of an exacerbation by the presence, in any amount, of a potential "pathogen" in sputum cultures, rather than demanding that it achieve a certain concentration or predominance as assessed by quantitative (eg, colonies per milliliter of sputum) or semiquantitative (eg, heavy, medium, or light growth) criteria. Accordingly, a bacterium could be considered the "cause" of an exacerbation even if only a single colony of it grew.…”

Section: Trials Comparing Antibioticsmentioning

confidence: 99%