Blinded Comparison of Cefuroxime to Cefaclor for Lower Respiratory Tract Infections

Schleupner, Charles J.; Anthony, William C.; Tan, James S.; File, Thomas M.; Lifland, Patti; Craig, William A.; Vogelman, Bennett

doi:10.1001/archinte.1988.00380020087014

Cited by 38 publications

(9 citation statements)

References 19 publications

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“…The bacteriological cure rate achieved with the 5-day regimen of cefuroxime axetil in the present studies (87%) is also similar to those reported in clinical trials comparing 7-to 10-day regimens of cefuroxime axetil at 250 mg twice daily with cefaclor at 250 mg three times daily (88 versus 89%, respectively) (11), cefaclor at 500 mg three times daily (76 versus 84%) (33), or cefixime at 400 mg once daily (89 versus 91%) (2) in the treatment of lower respiratory tract infections. Bacteriological cure rates were either not evaluated or not reported in any other clinical trial comparing cefuroxime axetil with other oral cephalosporins in patients with acute bronchitis.…”

Section: Discussionsupporting

confidence: 86%

“…The clinical cure or improvement rate reported in these studies (82%) with the 5-day regimen of cefuroxime axetil at 250 mg twice daily is similar to that observed in previous clinical comparisons of 10-day treatments for acute bronchitis or acute exacerbations of chronic bronchitis with cefuroxime axetil and cefaclor (90 to 100% versus 90 to 100%) (27,33), cefuroxime axetil and cefadroxil (89 to 98% versus 72 to 94%) (3,19), and cefuroxime axetil and cefixime (88% versus 91%) (2).…”

Section: Discussionsupporting

confidence: 85%

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Effectiveness of short-course therapy (5 days) with cefuroxime axetil in treatment of secondary bacterial infections of acute bronchitis

Henry

Ruoff

Rhudy

et al. 1995

Antimicrob Agents Chemother

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Five hundred thirty-seven patients were enrolled in two independent, investigator-blinded, multicenter, randomized clinical trials comparing the clinical and bacteriologic efficacies and the safety of 5-or 10-day treatment with cefuroxime axetil with those of 10-day treatment with amoxicillin-clavulanate in the treatment of secondary bacterial infections of acute bronchitis. Patients received either 5 or 10 days of treatment (n ‫؍‬ 177 in each group) with cefuroxime axetil at 250 mg twice daily or 10 days of treatment (n ‫؍‬ 183) with amoxicillinclavulanate at 500 mg three times daily. Patients in the cefuroxime axetil (5 days) group received placebo on days 6 to 10. Bacteriologic assessments were based on sputum specimen cultures obtained preceding and, when possible, following treatment. Organisms were isolated from the pretreatment sputum specimens of 242 of 537 (45%) patients, with the primary pathogens being Haemophilus influenzae, Haemophilus parainfluenzae, Moraxella catarrhalis, Streptococcus pneumoniae, and Staphylococcus aureus (28, 25, 13, 9, and 8% of isolates, respectively). Pathogens were eradicated or presumed to be eradicated in 87% (52 of 60), 91% (53 of 58), and 86% (60 of 70) of bacteriologically evaluable patients treated with cefuroxime axetil (5 days), cefuroxime axetil (10 days), and amoxicillin-clavulanate, respectively. A satisfactory clinical outcome (cure or improvement) was achieved in 82% (107 of 130), 86% (117 of 136), and 83% (130 of 157) of the clinically evaluable patients treated with cefuroxime axetil (5 days), cefuroxime axetil (10 days), and amoxicillin-clavulanate, respectively. Treatment with amoxicillin-clavulanate was associated with a significantly higher incidence of drug-related adverse events than was treatment with cefuroxime axetil for either 5 or 10 days (P ‫؍‬ 0.001), primarily reflecting a higher incidence of drug-related gastrointestinal adverse events (37 versus 19 and 15%, respectively; P < 0.001), particularly diarrhea and nausea. These results indicate that treatment with cefuroxime axetil at 250 mg twice daily for 5 days is as effective as treatment for 10 days with either the same dose of cefuroxime axetil or amoxicillin-clavulanate at 500 mg three times daily in patients with acute bronchitis. In addition, treatment with cefuroxime axetil for either 5 or 10 days is associated with significantly fewer gastrointestinal adverse events, particularly diarrhea and nausea, than is 10-day treatment with amoxicillin-clavulanate.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 85%

Effectiveness of short-course therapy (5 days) with cefuroxime axetil in treatment of secondary bacterial infections of acute bronchitis

Henry

Ruoff

Rhudy

et al. 1995

Antimicrob Agents Chemother

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“…The 37% incidence of P-lactamase production by our B. catarrhalis isolates was lower than expected: a previous study by Alvarez et al (1) The significance of B. catarrhalis as a respiratory pathogen, particularly in patients with underlying pulmonary disease (8,14), and its susceptibility to antimicrobial agents (15,17) have been reported previously. However, our data are in contrast to the findings of other investigators, who either failed to recover B. catarrhalis (5,6,13) or noted it to be a less frequent pathogen (10,11,16) in patients with chronic lung disease. Thus, the selection of an antimicrobial agent for treatment of an acute exacerbation of chronic bronchitis might preferably include a drug that is resistant to the effects of P-lactamase and that includes the currently recognized significant pathogens (H. influenzae, B. catarrhalis, and S. pneumoniae) in its spectrum.…”

contrasting

confidence: 99%

Randomized comparative study of cefixime versus cephalexin in acute bacterial exacerbations of chronic bronchitis

Verghese

Roberson

Kalbfleisch

et al. 1990

Antimicrob Agents Chemother

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Patients with purulent exacerbation of chronic bronchitis were randomized to receive either a single 400-mg daily dose of cefixime or 250 mg of cephalexin, orally, four times a day. In a population of patients with chronic bronchitis, acute bacterial exacerbations of bronchitis are frequently seen (4). Such exacerbations often cause worsening of other comorbid conditions and contribute to hospitalization and indirectly to death. Although there has been debate about the need for and the efficacy of antimicrobial therapy in this setting (2, 10, 18), most physicians continue to treat welldocumented bacterial exacerbations of chronic bronchitis.In the present study we compared the effects of a newer oral cephalosporin, cefixime, against those of cephalexin in the treatment of acute bacterial bronchitis. Cefixime is a ,-lactamase-stable cephalosporin that, because of its in vitro activity against gram-negative enteric pathogens, is considered the first broad-spectrum oral cephalosporin (19). It has a sufficiently long half-life (4 h) to allow for once-daily dosing, and the peak level in serum after a 400-mg dose is 3 to 5 jxg/ml (7). Cefixime has excellent in vitro activity against pathogens considered important in patients with bronchitis, including P-lactamase-producing Branhamella catarrhalis and Haemophilus influenzae (MIC for 90%o of strains [MIC9], 0.25 ,ug/ml for both organisms) and Streptococcus pneumoniae (MIC90, 0.2 ,ug/ml) (3).Cephalexin, the comparative agent, is often selected by clinicians in the empiric treatment of patients with acute bronchitis. It is active against S. pneumoniae (MICg, 3.1 ,ug/ml), B. catarrhalis (MIC90, 0.5 ,ug/ml), and P-lactamasenegative H. influenzae (MIC90, 6.0 ,ug/ml) (9) and is generally well tolerated. A mean peak level of 10 ,ug/ml in serum is typical after a single 250-mg dose of cephalexin (12)

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“…In addi-tion, these agents have documented in vitro activity against many typical aerobic gram-positive cocci and gram-negative bacilli associated with community-acquired pneumonia (31,35). Numerous clinical trials have led to reports of the effectiveness of ceftriaxone (1,3,15,25,34) and cefuroxime axetil (4,7,36) in the management of lower respiratory tract infections, including community-acquired pneumonia caused by susceptible pathogens. One important limitation, however, of all ␤-lactam agents is their lack of in vitro activity against atypical respiratory tract pathogens.…”

mentioning

confidence: 99%

A Multicenter, Randomized Study Comparing the Efficacy and Safety of Intravenous and/or Oral Levofloxacin versus Ceftriaxone and/or Cefuroxime Axetil in Treatment of Adults with Community-Acquired Pneumonia

File

Segreti

Dunbar

et al. 1998

Infectious Diseases in Clinical Practice

126

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Five hundred ninety patients were enrolled in a prospective, multicenter, randomized trial comparing the efficacy and safety of 7 to 14 days of levofloxacin treatment with that of ceftriaxone and/or cefuroxime axetil in the management of community-acquired pneumonia in adults. Patients received either intravenous and/or oral levofloxacin (500 mg once daily) or the comparative agents, parenteral ceftriaxone (1 to 2 g once to twice daily) and/or oral cefuroxime axetil (500 mg twice daily). Erythromycin or doxycycline could be added to the comparator arm at the investigator's discretion. The decision to use an intravenous or oral antimicrobial agent for initial therapy was made by the investigator. Clinical and microbiological evaluations were completed at the baseline, during treatment, 5 to 7 days posttherapy, and 3 to 4 weeks posttherapy. Four hundred fifty-six patients (226 given levofloxacin and 230 administered ceftriaxone and/or cefuroxime axetil) were evaluable for clinical efficacy. Streptococcus pneumoniae and Haemophilus influenzae were isolated in 15 and 12%, respectively, of clinically evaluable patients. One hundred fifty atypical pathogens were identified: 101 were Chlamydia pneumoniae, 41 were Mycoplasma pneumoniae, and 8 were Legionella pneumophila. Clinical success at 5 to 7 days posttherapy was superior for the levofloxacin group (96%) compared with the ceftriaxone and/or cefuroxime axetil group (90%) (95% confidence interval [CI] of ؊10.7 to ؊1.3). Among patients with typical respiratory pathogens who were evaluable for microbiological efficacy, the overall bacteriologic eradication rates were superior for levofloxacin (98%) compared with the ceftriaxone and/or cefuroxime axetil group (85%) (95% CI of ؊21.6 to ؊4.8). Levofloxacin eradicated 100% of the most frequently reported respiratory pathogens (i.e., H. influenzae and S. pneumoniae) and provided a >98% clinical success rate in patients with atypical pathogens. Both levofloxacin and ceftriaxone-cefuroxime axetil eradicated 100% of the S. pneumoniae cells detected in blood culture. Drug-related adverse events were reported in 5.8% of patients receiving levofloxacin and in 8.5% of patients administered ceftriaxone and/or cefuroxime axetil. Gastrointestinal and central and peripheral nervous system adverse events were the most common events reported in each treatment group. In conclusion, these results demonstrate that treatment with levofloxacin is superior to ceftriaxone and/or cefuroxime axetil therapy in the management of community-acquired pneumonia in adults.

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Blinded Comparison of Cefuroxime to Cefaclor for Lower Respiratory Tract Infections

Cited by 38 publications

References 19 publications

Effectiveness of short-course therapy (5 days) with cefuroxime axetil in treatment of secondary bacterial infections of acute bronchitis

Effectiveness of short-course therapy (5 days) with cefuroxime axetil in treatment of secondary bacterial infections of acute bronchitis

Randomized comparative study of cefixime versus cephalexin in acute bacterial exacerbations of chronic bronchitis

A Multicenter, Randomized Study Comparing the Efficacy and Safety of Intravenous and/or Oral Levofloxacin versus Ceftriaxone and/or Cefuroxime Axetil in Treatment of Adults with Community-Acquired Pneumonia

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