Treatment of Sinus Empyema in Adults: A Coordinated Nordic Multicenter Trial of Cefixime vs. Cefaclor

Abstract

In sinus empyema, H. influenzae is the most prevalent pathogen in some subpopulations and in case of therapeutic failure. Cefixime, the first oral cephalosporin of the 3rd generation, is highly potent in vitro against H. influenzae. To study the efficacy and safety of cefixime in adults with acute sinusitis, a coordinated, double-blind multicenter trial was designed for purulent cases, as confirmed by antral aspiration. A total of 364 patients were enrolled in the study with 125 cases randomized to the reference group, assigned to treatment with cefaclor. Evaluation was based on clinical outcome and on antral reaspiration (86% of the cases). No significant differences between the treatment groups were found, as regards short-term or long-term clinical outcome. However, the clinical examination overestimated the therapeutic results. Only 4% of the patients were considered as failures, but the re-aspiration demonstrated remaining suppuration in 14% of all cases (p less than 0.001). Based on re-aspiration, the failure rate among patients with initial growth of pathogens was lower for cefixime (8%) than for cefaclor (20%) (p less than 0.05). Such a difference was not found among patients with growth of H. influenzae. No serious adverse reactions were recorded, but loose stools and diarrhoea were significantly more frequent in the cefixime treatment group. Five patients (2%) in the cefixime treatment group discontinued their treatment due to adverse events.

Efficacy and safety of cefdinir in the treatment of maxillary sinusitis

“…These and a variety of other gram-positive and gram-negative pathogens, including anaerobes all frequently associated with acute bacterial sinusitis, were also isolated [17]. Nonetheless, no statistical differences were found in the number of isolates in our three treatment groups, although there were slightly more H. influenzae isolates than reported in other studies [1,3,14].…”

The prevalence of bacterial infection in acute rhinosinusitis: A Systematic review and meta‐analysis

“…Of note, the four studies that did not require either radiographic evidence or purulence had the highest bacterial prevalence on culture (61.1%). These studies were from 1976, 1979, and 1990, and are four of the seven oldest studies in our meta‐analyses, but no other common characteristics seem to make the patients in these studies more likely to have bacterial ARS compared to patients in later studies.…”

Acute Community-Acquired Bacterial Sinusitis: Continuing Challenges and Current Management

“…The importance of optimal dosing in the treatment of community-acquired bacterial sinusitis is emphasized in a review of several antibiotic trials in which cultures of sinus aspirates obtained before and after treatment were used to evaluate microbiological efficacy [8]. In this review, 2 studies showed that the bacteriologic cure rate was 90% in patients whose antibiotic concentration was greater than the MIC for the pathogen after treatment but only 45% in patients whose antibiotic concentration was less than the MIC for the organism (table 4) [8,11,12,37,38]. It also showed that in several other similarly designed studies, the bacteriologic cure rate was 93% in patients who received an appropriate dose of an appropriate drug but only 71% in those who received a suboptimal dose [8].…”