Enoxacin in acute exacerbations of chronic bronchitis: a comparison with amoxycillin

Abstract

A total of 43 hospitalized adult patients with acute exacerbations of chronic bronchitis or bronchiectasis due to Gram-negative bacteria were randomized to receive either enoxacin (400 mg bd) or amoxycillin (1,000 mg tid) for 7-12 days. Micro-organisms isolated included 24 Haemophilus influenzae (three beta-lactamases positive), 11 Branhamella catarrhalis (six beta-lactamase positive), two Pseudomonas aeruginosa and two Neisseria meningitidis in 37 evaluable patients. In the enoxacin group (23 patients) 82.6% of the patients were clinically cured or improved against 93% of patients in the amoxycillin group (14 patients). In the enoxacin group 76% of the pathogens were eradicated with two failures (P. aeruginosa), one relapse (H. influenzae) and three superinfections (Streptococcus pneumoniae). In the amoxycillin group, 71% of the pathogens were eradicated with 29% relapses. The differences between the two groups were not statistically significant. An increase in theophylline concentration occurred in 15 of 16 patients receiving simultaneous administration of theophylline, without clinical evidence of toxicity when theophylline dosage was reduced and enoxacin continued. Enoxacin appears to be as effective as amoxycillin in the treatment of acute exacerbations of chronic bronchitis due to susceptible Gram-negative bacteria.

Fluoroquinolone antimicrobial agents

“…There have been six studies comparing quinolones with other agents for treatment of community-acquired lower respiratory tract infections (26,190,279,577,601,868 In comparative studies that included patients with pneumonia, oral ciprofloxacin (250 to 750 mg twice daily) was comparable to doxycycline (100 mg twice daily) (26), amoxicillin (250 mg three times daily) (279), or cefamandole (1 g every 6 h) (577) and ciprofloxacin (100 mg intravenously every 8 to 12 h or 500 mg orally twice daily) was comparable to imipenem-cilastatin (500 mg imipenem given intravenously every 6 h) (465). Because these studies included patients with bronchitis and pneumonia, however, it was not possible to determine the organisms causing pneumonia.…”

Fluoroquinolone antimicrobial agents.

“…There have been six studies comparing quinolones with other agents for treatment of community-acquired lower respiratory tract infections (26,190,279,577,601,868). In studies that included both patients with bronchitis and those with pneumonia, the rates of response in the two groups were not separated.…”

Tissue Penetration and Clinical Efficacy of Enoxacin in Respiratory Tract Infections

“…Of paramount concern is the relatively poor in vitro activity against pneumococci; although in many instances therapy of such infections has been successful, the overall bacteriological efficacy of enoxacin against this pathogen in lower respiratory tract infections is only 78% (data on file, Warner Lambert International). The overgrowth of S. pneumoniae reported in some studies (Prigogine et al 1988;Wijnands et al 1986) has been noted with other quinolones, notably ciprofloxacin, used to treat exacerbations of chronic bronchitis (Davies et al 1986) and is a further argument against the empirical use of these agents in chronic chest disease.…”