Antimicrobial susceptibility of Haemophilus influenzae, Haemophilus parainfluenzae and Moraxella catarrhalis isolated from adult patients with respiratory tract infections in four southern European countries

Soriano, Francisco; Granizo, Juan-José; Coronel, Pilar; Gimeno, Mercedes; Ródenas, E.; Gracia, Matilde; García, Claudia María; Fernández-Roblas, R.; Esteban, Jaime; Gadea, Ignacio

doi:10.1016/j.ijantimicag.2003.07.018

Cited by 36 publications

(26 citation statements)

References 12 publications

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“…In these situation, physicians should consider, in addition to the patient's condition, local epidemiology of AECB-related pathogens and their in vitro susceptibility to interpret the results of a study (30). Both of the oral cephalosporins used in this study exhibited very good activity against H. influenzae (20,26), the main AECB isolate, against which a clinical response (84% versus 82.5% for CDN versus CXM, respectively) was obtained as shown in Table 6. The lower rate of S. pneumoniae susceptibility to CXM (20) than to CDN (27) is not reflected in this clinical trial since only 5.4% (29 out of 541) of the patients presented an S. pneumoniae isolate.…”

Section: Discussionmentioning

confidence: 95%

“…For ␤-lactam antibiotics, the time that drug con-centrations in serum exceed the MIC for the pathogen is the key indicator of bacteriological efficacy, 35 to 40% of the time between two doses being the predictive value for maximal bacteriological efficacy (6,25). When plotting mean concentrations of CDN in serum (29) against the MICs for the main AECB isolates, CDN covers all H. influenzae Spanish isolates (MIC range, Յ0.03 to 0.12 g/ml; MIC 90 , Ͻ0.03 g/ml) (26) for Ն63% of the dosing interval and 94.1% of the S. pneumoniae isolates in Spain (MIC range, Ͻ0.03 to 4 g/ml; MIC 90 , 0.5 g/ml) (27) for at least Х40% of the dosing interval.…”

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confidence: 99%

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Clinical and Bacteriological Efficacy in Treatment of Acute Exacerbations of Chronic Bronchitis with Cefditoren-Pivoxil versus Cefuroxime-Axetil

Alvarez-Sala

Kardos

Martı́nez-Beltrán

et al. 2006

Antimicrob Agents Chemother

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A randomized, double-blind, double-dummy trial was performed comparing 200 mg of cefditoren-pivoxil twice daily for 5 days versus standard cefuroxime-axetil treatment (250 mg twice daily for 10 days) of Anthonisen type I or II acute exacerbations of chronic bronchitis. The modified intention-to-treat population included 541 patients. Patients were assessed during therapy, at the end of therapy (visit 3; primary evaluation time point), and at follow-up. Clinical success was obtained in 79.9% of the 264 patients included in the cefditoren-pivoxil group and in 82.7% of the 277 patients in the cefuroxime-axetil group (treatment difference, 95% confidence interval [CI]: ؊2.8, ؊9.7 to 3.6%). Treatment clinical effects were more clearly seen in sputum signs (decreasing volume and purulence from approximately 80% to approximately 10% of the patients). At the end of treatment, exploratory analysis of the per-pathogen bacteriological response showed 72.8% (of 103 isolates) in the cefditoren-pivoxil arm versus 67.0% (of 94 isolates) in the cefuroxime-axetil group (treatment difference; 95% CI: 5.8, ؊7.0 to 18.6%). Globally, the per-pathogen bacteriological response correlated well with clinical success: 83.5% of 164 baseline isolates from patients with a clinical success were eradicated or presumably eradicated, in contrast to only 3% of 33 isolates from patients with a clinical failure. Clinical success in patients infected with Haemophilus influenzae, the most frequent isolate, was 84% (of 50) and 82.5% (of 40) (treatment difference; 95% CI: 1.5, ؊14 to 17%) in the cefditoren-pivoxil versus the cefuroxime-axetil group. Although this study does not prove that either drug is better than a placebo, cefditoren-pivoxil and the standard 10-day cefuroxime-axetil course had similar point estimates of success in acute exacerbations of chronic bronchitis.Feelings related to acute exacerbations of chronic bronchitis (AECB), such as embarrassment about symptoms, are identified factors reducing patients' perceived quality of life (17). Although there is not a uniform definition of AECB episodes (15), they are characterized by the following main symptoms: increase in baseline dyspnea, increase in sputum volume, and/or appearance of purulent expectoration (28). According to the presence of these symptoms, exacerbations are classified by Anthonisen as types I (three symptoms), II (two symptoms), and III (one symptom) (1). At least half of AECB cases are presumably caused by bacterial infection (4, 13), which may respond primarily to antibiotics. Despite the fact that many of these patients are treated with antibiotics, the efficacy of this approach has been questioned (11) because previous trials have not shown a benefit over placebo administration (14). Nevertheless, other studies (1, 22) have described small but statistically significant improvements of clinical outcomes in ambulatory patients with type I and type II exacerbations treated with broad-spectrum antibiotics.Sputum purulence is strongly associated with the presence of bact...

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Section: Discussionmentioning

confidence: 95%

mentioning

confidence: 99%

Clinical and Bacteriological Efficacy in Treatment of Acute Exacerbations of Chronic Bronchitis with Cefditoren-Pivoxil versus Cefuroxime-Axetil

Alvarez-Sala

Kardos

Martı́nez-Beltrán

et al. 2006

Antimicrob Agents Chemother

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“…Several studies, including the multicenter ARISE project, demonstrated that the PK/PD aspects of cefditoren, mainly at a dosage of 400 mg/12 h, can produce adequate and effective concentrations for a time-dependent antibiotic, making this cephem derivative an antimicrobial agent of choice against both AECB and CAP. 7,33,34 As far as adverse events and safety of antibiotics are concerned, macrolides have a quite high incidence of adverse events at gastrointestinal level, also due to the stimulatory effect on peristalsis and variable degrees of hepatotoxicity within the class. 35 Moreover, both macrolides and fluoroquinolones are inhibitors of cytochrome P450 enzymes, causing interactions with many different drugs, including HMG-CoA reductase inhibitors, calcium channel blockers, warfarin, benzodiazepines and other different drugs frequently used by elderly patients.…”

Section: Topic: Clinical Considerations On the Management Of Patientsmentioning

confidence: 99%

“…Moreover, cefditoren at 400 mg dosage every 12 h ensures the coverage of penicillin-resistant Pneumococcal strains. 7,33,34 • Oral cephalosporins can be included among the first-line treatments of mild-moderate AECB in elderly patients with risk factors, while the use of fluoroquinolones should be limited to more severe exacerbations, especially in patients with bronchiectasis.…”

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confidence: 99%

The most appropriate therapeutic strategy for acute lower respiratory tract infections: a Delphi-based approach

Blasi

Concia

Prato

et al. 2017

Journal of Chemotherapy

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Lower respiratory tract infections (LRTIs) cause high morbidity and mortality worldwide. Empiric therapy often base the choice of antibiotic treatment on antibacterial spectrum of the agent rather than on its pharmacological properties or the pathogen resistance profile. Inappropriate prescribing leads to therapeutic failure and antibiotic resistance, with increasing direct and indirect health costs. A consensus on appropriate prescribing in LRTI therapy was appraised by this Delphi exercise, based on a panel of 70 pulmonologists, coordinated by a Scientific Committee of nine experts in respiratory medical care. Full or very high consensus was reached on several issues, including the role of oral cephalosporins in first-line treatments of LRTIs and the appropriateness of cefditoren, with balanced spectrum and high intrinsic activity, in LRTI treatment. Evidence-based medicine approach and a comprehensive process of disease management, from diagnosis to therapy and follow-up, should guide antibiotic prescribing.

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“…In vitro studies have demonstrated that cefditoren is highly active against clinically relevant gram-positive and -negative lower respiratory tract organisms, including ␤-lactamase-producing strains of Haemophilus influenzae and Moraxella catarrhalis (12,22,24,29,40,(47)(48)(49). Cefditoren has also been shown to have highly favorable in vitro activity against penicillin-susceptible and penicillin-intermediate S. pneumoniae (12,22,24,25,28,29,40,47,49). It is currently approved in the United States and Europe for the treatment of adults and adolescents with acute exacerbations of chronic bronchitis (AECB) and community-acquired pneumonia (CAP), two of the lower respiratory tract infections most commonly encountered in clinical practice (9,21,50).…”

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confidence: 99%

Use of Population Pharmacokinetic Modeling and Monte Carlo Simulation To Describe the Pharmacodynamic Profile of Cefditoren in Plasma and Epithelial Lining Fluid

Lodise

Kinzig‐Schippers

Drusano

et al. 2008

Antimicrob Agents Chemother

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Cefditoren is a broad-spectrum, oral cephalosporin that is highly active against clinically relevant respiratory tract pathogens, including multidrug-resistant Streptococcus pneumoniae. This study described its pharmacodynamic profile in plasma and epithelial lining fluid (ELF). Plasma and ELF pharmacokinetic data were obtained from 24 patients under fasting conditions. Cefditoren and urea concentrations were determined in plasma and bronchoalveolar lavage fluid by liquid chromatography-tandem mass spectrometry. Concentration-time profiles in plasma and ELF were modeled using a model with three disposition compartments and first-order absorption, elimination, and transfer. Pharmacokinetic parameters were identified in a population pharmacokinetic analysis (big nonparametric adaptive grid with adaptive ␥). Monte Carlo simulation (9,999 subjects) was performed with the ADAPT II program to estimate the probability of target attainment at which the free-cefditoren plasma concentrations (88%) protein binding and total ELF concentrations exceeded the MIC for 33% of the dosing interval for 400 mg cefditoren given orally every 12 h. After the Bayesian step, the overall fits of the model to the data were good, and plots of predicted versus observed concentrations for plasma and ELF showed slopes and intercepts very close to the ideal values of 1.0 and 0.0, respectively. In the plasma probability of target attainment analysis, the probability of achieving a time for which free, or unbound, plasma concentration exceeds the MIC of the organism for 33% of the dosing interval was <80% for a MIC of >0.06 mg/liter. Similar to plasma, the probability of achieving a time above the MIC of 33% was <80% for MIC of >0.06 mg/liter in ELF. Cefditoren was found to have a low probability of achieving a bacteriostatic effect against MICs of >0.06 mg/liter, which includes most S. pneumoniae isolates with intermediate susceptibility to penicillin, when given in the fasting state in both plasma and ELF.

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Antimicrobial susceptibility of Haemophilus influenzae, Haemophilus parainfluenzae and Moraxella catarrhalis isolated from adult patients with respiratory tract infections in four southern European countries

Cited by 36 publications

References 12 publications

Clinical and Bacteriological Efficacy in Treatment of Acute Exacerbations of Chronic Bronchitis with Cefditoren-Pivoxil versus Cefuroxime-Axetil

Clinical and Bacteriological Efficacy in Treatment of Acute Exacerbations of Chronic Bronchitis with Cefditoren-Pivoxil versus Cefuroxime-Axetil

The most appropriate therapeutic strategy for acute lower respiratory tract infections: a Delphi-based approach

Use of Population Pharmacokinetic Modeling and Monte Carlo Simulation To Describe the Pharmacodynamic Profile of Cefditoren in Plasma and Epithelial Lining Fluid

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