Comparative efficacy and safety of ceftizoxime, cefotaxime and latamoxef in the treatment of bacterial pneumonia in high risk patients

Abstract

One hundred and thirty-five patients with bacterial pneumonia who had risk factors (alcoholism, chronic obstructive pulmonary disease, corticosteroid therapy diabetes mellitus, advanced age, solid tumours) were randomly allocated in a double-blind fashion to receive either ceftizoxime (2-4 g every 8 h), cefotaxime (1-2 g every 4 h), or latamoxef (2-4 g every 8 h). Of the 84 patients evaluable for efficacy, clinical cure was achieved in 91%, 85%, and 89% of ceftizoxime- (20/22), cefotaxime-(23/27), and latamoxef-treated (31/35) patients, respectively. Adverse reactions occurred in one of 45 ceftizoxime-treated patients, one of 43 cefotaxime-treated patients, and seven of 47 latamoxef-treated patients. Abnormal laboratory values during therapy were seen in 50% of latamoxef-treated and 43% of cefotaxime-treated patients and in 29% of ceftizoxime-treated patients. Hypoprothrombinaemia occurred in five latamoxef-treated patients and one of these patients experienced an episode of haematemesis. In this study, ceftizoxime, cefotaxime, and latamoxef were similarly effective; however, the incidence of side effects was most frequent with latamoxef.

The Association Between Cephalosporin and Hypoprothrombinemia: A Systematic Review and Meta-Analysis

“…The remaining 15 studies were included in the final meta-analysis. They were five RCTs [12,13,14,15,16], four prospective cohort studies [17,18,19,20], five retrospective cohort studies [21,22,23,24,25], and one case-control study [26], published between 1984 and 2016. A total of five NMTT-cephalosporins were included in the analysis; cefamandole [13,23,24], cefoperazone [20,22,25,26], cefotetan [15,16,18,19,20], cefmetazole [26], and moxalactam [12,14,17,21,22,24].…”

“…The majority of studies (n = 9) [12,13,16,19,20,21,22,23,24] included in our review were conducted in the US, with the exception of four [14,17,18,25] that were conducted in England, one in South African [15], and one in Taiwan [26]. The studies reported that cephalosporins were prescribed for the following indications: pneumonia, preoperative and postoperative antibiotic regimen, and sepsis.…”

“…Among the 15 studies, moxalactam (latamoxef) was the most commonly used NMTT-cephalosporin (6 studies), followed by cefotetan (5 studies). A total of 13 [12,13,14,15,16,18,19,20,21,22,23,24,25] and 11 studies [12,14,16,17,19,20,21,22,24,25,26] out of 15 studies reported PT prolongation and bleeding events, respectively. As the control group, most of the studies included patients who received other types of antibiotics, including non-NMTT-cephalosporins, aminoglycosides, and penicillin.…”

“…The risk of bias of five RCTs [12,13,14,15,16] using the RoB algorithm is displayed in Figure 2. All five studies showed a low probability of bias in three domains: (1) incomplete outcome data addressed, (2) free of selective reporting, and (3) free of other bias.…”

“…All five studies showed a low probability of bias in three domains: (1) incomplete outcome data addressed, (2) free of selective reporting, and (3) free of other bias. Other than the study by Calandra et al [12], which adopted a non-blinded design, the outcomes from the remaining four studies [13,14,15,16] were not likely to be influenced by blinding. However, the qualities of most studies were “low” in random sequence generation [12,14,16] and allocation concealment [12,13,14,16].…”