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

Abstract

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)

Bacterial Infection in Chronic Obstructive Pulmonary Disease

“…It is difficult to estimate the proportion of exacerbations which are due to M. catarrhalis. However, one study performed in a Veterans Administration facility found that 30% of exacerbations were caused by M. catarrhalis (328). In our prospective study of patients with COPD, M. catarrhalis is the second most common cause of exacerbations after nontypeable H. influenzae (unpublished observations).…”

Intranasal Vaccination with Recombinant Outer Membrane Protein CD and Adamantylamide Dipeptide as the Mucosal Adjuvant Enhances Pulmonary Clearance of Moraxella catarrhalis in an Experimental Murine Model

“…In our hospital, between 1994 and 2001 the main bacterial etiological agents isolated from middle ear fluids of children were Haemophilus influenzae (45%) and Streptococcus pneumoniae (39%); the percentages of these organisms remained almost constant during this period, whereas the incidence of M. catarrhalis increased from 4 to 11%. In adults, M. catarrhalis is one of the etiological agents of recurrent infections, particularly in patients with chronic obstructive pulmonary disease, and is responsible for approximately 30% of the new cases (37). The clinical management of patients infected with M. catarrhalis also is a problem, since high costs are associated with established therapies and there is global emergence of antibiotic-resistant strains (35).…”

Lower respiratory tract infection

“…A Gram-stained sputum sample which shows a predominance of gram-negative diplococci is highly predictive for the presence of B. catarrhalis (80,128,170,175,185). Indeed, this is the single most useful diagnostic test in establishing B. catarrhalis lower respiratory tract infection.…”