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

Abstract

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.

Efficacy and Safety of a 10-Day Course of 400 or 600 Milligrams of Grepafloxacin Once Daily for Treatment of Acute Bacterial Exacerbations of Chronic Bronchitis: Comparison with a 10-Day Course of 500 Milligrams of Ciprofloxacin Twice Daily

“…The frequency of occurrence of S. aureus appeared to be particularly high in this study, but this may have been related to the criteria used to determine the acceptability of sputum samples. Although the proportion of infections caused by S. pneumoniae was relatively low, the incidence of recovery of this organism varies from year to year, and rates of pneumococcal infection similar to those found in the present study have been observed in other studies (17,24). In addition, recovery of S. pneumoniae from transported clinical samples is relatively difficult.…”

Microorganisms Causing Community-Acquired Acute Bronchitis: The Role of Bacterial Infection

“…Macfarlane et al identified viruses in only 19% of patients, while typical and atypical bacteria were identified in 25.9% and 23.7% of patients, respectively [7]. In other studies, bacteria were detected in sputum samples in 45% of acute bronchitis patients [8,9]. In addition, several authors suggested that some patients with acute bronchitis had mixed infections involving both viruses and bacteria.…”

Differentialin vitroinhibition effects of some antibiotics on tumor associated carbonic anhydrase isozymes of hCA-IX and hCA-XII

“…Cefuroxime axetil is the subgroup of b-lactams named as cephalosporin [35]. But the cytosolic carbonic anhydrase isozymes were given more inhibition effects than tumor associated isozymes of hCA IX and hCA II with their IC 50 values (hCA I; 2.92 £ 10 25 mM, hCA II; 2.12 £ 10 25 mM).…”