cefpodoxime-proxetil and Pharyngitis

Most authorities continue to recommend penicillin as the treatment of choice for group A streptococcal pharyngitis. If penicillin is used, 10 days of treatment are necessary to achieve a clinical and bacteriologic cure. The usually recommended penicillin V dose is 250 mg (400,000 IU) three times daily. Twice daily dosing is acceptable to some authorities if compliance is good. However, oral penicillin fails to eradicate group A streptococci from the pharynx in up to 17% of cases; in some studies 30% failure rates have been reported. Several European and United States studies indicate that a variety of oral cephalosporins, when used for 10 days, are significantly superior to penicillin V in eradicating group A streptococci from the pharynx. For example cefpodoxime proxetil given twice daily for 10 days is comparable to penicillin V given three times daily for 10 days in achieving a clinical cure and appears to be significantly superior to penicillin in eradicating group A streptococci from the pharynx. Preliminary studies from Europe and the United States strongly suggest that 5-day therapy with cefpodoxime (or other selected oral cephalosporins) is at least as effective, clinically and microbiologically, as 10-day therapy with penicillin V. Further clinical trials are warranted to confirm the adequacy of 5-day treatment and to assess the efficacy of cefpodoxime and other agents in preventing rheumatic fever.

Topics: Administration, Oral; Adult; Amoxicillin; Cefpodoxime Proxetil; Ceftizoxime; Cephalosporins; Child; Clinical Trials as Topic; Drug Administration Schedule; Europe; Humans; Penicillins; Pharyngitis; Streptococcal Infections; Tonsillitis; Treatment Failure; United States

Topics: Adult; Bacterial Infections; Cefpodoxime Proxetil; Ceftizoxime; Child; Humans; Microbial Sensitivity Tests; Otitis Media; Pharyngitis; Respiratory Tract Infections; Urinary Tract Infections

A prospective economic evaluation was undertaken as part of a randomised clinical trial conducted in French general practice. Its aim was to compare the costs and therapeutic outcomes of a 5-day course of cefpodoxime proxetil 100 mg twice daily with 10-day courses of phenoxymethylpenicillin (penicillin V) 1 MIU 3 times daily and amoxicillin-clavulanic acid 500/125 mg 3 times daily for the treatment of recurrent pharyngotonsillitis in 575 adults. Over the 6-month study period, the total cost to society per patient treated with cefpodoxime proxetil was 123 French francs (FF; 1993 values) lower than that for patients treated with phenoxymethylpenicillin and FF227 lower than that for patients treated with amoxicillin-clavulanic acid. This cost saving was primarily attributable to a lower initial drug acquisition cost, and a reduction in the cost associated with lost productivity and general practitioner consultations. Furthermore, as a consequence of a lower relapse rate, the cost-saving ratio for cefpodoxime proxetil, expressed as FF per month free of recurrence, was FF50 less than for phenoxymethylpenicillin and FF60 less than for amoxicillin-clavulanic acid. Thus, a 5-day course of cefpodoxime proxetil is likely to be less costly for treatment of pharyngotonsillitis in the general practice setting than standard 10-day courses of phenoxymethylpenicillin and amoxicillin-clavulanic acid.

Topics: Adult; Amoxicillin; Anti-Bacterial Agents; Cefpodoxime Proxetil; Ceftizoxime; Clavulanic Acid; Clavulanic Acids; Cost-Benefit Analysis; Drug Therapy, Combination; Family Practice; France; Humans; Penicillin V; Pharyngitis; Prodrugs; Recurrence; Tonsillitis; Treatment Outcome

A total of 220 adults and children > 10 years old (mean 29.5 +/- 11.7 years) with pharyngitis/tonsillitis were randomized to receive either cefpodoxime proxetil 100 mg bid for 5 days (n = 113) or phenoxymethyl penicillin, 600 mg tid for 10 days (n = 107). At the end of treatment of the 166 evaluable patients, a satisfactory clinical response was obtained in 85/88 (96.6%) patients treated with cefpodoxime proxetil and in 75/78 (96.1%) treated with phenoxymethyl penicillin. Group A beta-hemolytic streptococci (GABHS) eradication was similar in both groups: 79/82 (96.3%) patients in the cefpodoxime proxetil group and 64/68 (94.1%) patients in the phenoxymethyl penicillin group. At follow-up (20-30 days after the end of treatment) the GABHS eradication persisted in 67/72 (93.1%) patients treated with cefpodoxime proxetil and in 56/61 (91.8%) patients treated with phenoxymethyl penicillin. Significantly better compliance (p < 0.01) was noticed with the cefpodoxime proxetil regimen compared with the phenoxymethyl penicillin regimen, with only 2/110 (2%) poorly compliant patients in the cefpodoxime proxetil group vs 17/104 (16%) in the phenoxymethyl penicillin group. Thus, the shorter duration of therapy, in conjunction with demonstrated clinical and bacteriological efficacy that is equivalent to standard therapy, makes cefpodoxime proxetil an acceptable alternative for the treatment of GABHS pharyngitis/tonsillitis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cefpodoxime Proxetil; Ceftizoxime; Child; Drug Administration Schedule; Female; France; Humans; Male; Middle Aged; Penicillin V; Pharyngitis; Prodrugs; Streptococcal Infections; Streptococcus pyogenes; Tonsillitis

This multicenter, randomized, parallel treatment, observer-blinded study was designed to evaluate the safety and efficacy of cefpodoxime proxetil (5 mg/kg twice daily for 10 days) compared with penicillin V (13.4 mg/kg three times daily for 10 days) for treatment of Group A streptococcal pharyngitis and tonsillitis in pediatric patients. Clinical and microbiologic results were evaluated before therapy, during therapy (Study Days 3 to 5), at the end of therapy (Study Days 14 to 18) and at long term follow-up (Study Days 30 to 32). Both drugs were well-tolerated in 578 patients evaluable for safety. Mild gastrointestinal complaints were noted in 6.7% of 386 cefpodoxime-treated patients and in 5.2% of 192 penicillin-treated patients. In 413 patients evaluable for efficacy, both treatment regimens resulted in comparably favorable clinical outcome; cure rates were 83.8% for 275 cefpodoxime-treated patients and 77.5% for 138 penicillin-treated patients. However, eradication of S. pyogenes at end of therapy was significantly higher with cefpodoxime (93.1%) than with penicillin (81.2%) (P < 0.01). Cefpodoxime proxetil provides an effective alternative to penicillin V for the treatment of streptococcal pharyngitis and tonsillitis.

Topics: Adolescent; Cefpodoxime Proxetil; Ceftizoxime; Child; Child, Preschool; Drug Administration Schedule; Drug Evaluation; Female; Humans; Infant; Male; Microbial Sensitivity Tests; Penicillin V; Pharyngitis; Single-Blind Method; Statistics as Topic; Streptococcal Infections; Streptococcus pyogenes; Tonsillitis; Treatment Outcome

A ten day course of oral penicillin is still recommended for pharyngotonsillitis with the aim of eradicating Streptococcus pyogenes and preventing rheumatic fever. However there is some evidence that penicillin V therapy is less satisfactory than in former years. Several explanations have been suggested, including inadequate pharmacokinetic properties, poor patient compliance, penicillin tolerance, re-infection and carrier state, and indirect pathogenicity. In this context we evaluated the efficacy of third generation cephalosporins. We have shown that a short course of five days treatment with cefpodoxime is as effective as the ten days of conventional treatment with penicillin in terms of both clinical and bacteriological efficacy. Moreover the possibility of reducing the duration of therapy and the twice daily administration of these new cephalosporins results in better patient compliance with treatment.

Topics: Adolescent; Adult; Cefpodoxime Proxetil; Ceftizoxime; Cefuroxime; Female; Humans; Male; Middle Aged; Penicillin V; Pharyngitis; Pilot Projects; Prodrugs; Streptococcus pyogenes; Tonsillitis

Topics: Aged; Anti-Bacterial Agents; Cefpodoxime Proxetil; Ceftizoxime; Clostridioides difficile; Colitis, Ulcerative; Colonoscopy; Enterocolitis, Pseudomembranous; Female; Humans; Pharyngitis; Risk Factors; Sulfasalazine; Vancomycin

Clinical studies on cefpodoxime proxetil (CS-807, CPDX-PR) dry syrup were carried out in the field of pediatrics, and the results are summarized as follows. 1. Eleven year-old male and 12 year-old female were administered orally at a dose level of 5.6 and 6.0 mg/kg, respectively, after or before meal. Cmax and T1/2 were 5.0 micrograms/ml and 2.13 hours, respectively, for the male and 4.04 micrograms/ml and 1.63 hours, respectively, for the female. 2. Good clinical responses were obtained in 21 of 22 child patients with bacterial pharyngitis, tonsillitis, scarlet fever and urinary tract infections. One child with Mycoplasma pneumonia did not respond. As to bacteriological effects, eradication of pathogens was observed in 8 out of 11 strains, showing an eradication rate of 72.7%. 3. As to side effect, 1 case of loose stool was observed, but there was no need of discontinuing the drug treatment.

Topics: Administration, Oral; Adolescent; Bacterial Infections; Cefpodoxime Proxetil; Ceftizoxime; Chemical Phenomena; Chemistry; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Male; Pharyngitis; Tonsillitis

Cefpodoxime proxetil (CS-807, CPDX-PR), a new cephalosporin antibiotic, was investigated for its usefulness in pediatrics. 1. The total number of patients treated were 21 with their ages ranging from 3 months to 9 years and 1 month, consisting of 5 male and 16 female infants. 2. Single dosages of the drug ranged between 4.4 mg and 5.8 mg/kg with oral administration for 3 times daily in fasting. A total aggregated dosage was between 46.4 mg/kg and 200.0 mg/kg. The length of administration was 3 to 12 days. 3. The breakdown of symptoms were 9 cases of acute pharyngitis, 5 cases of acute tonsillitis, 3 cases of acute bronchitis, and 1 case each of impetigo + purulent rhinitis, cervical lymphadenitis, scarlet fever, and urinary tract infection. 4. The clinical efficacy rate was 100% with 18 excellent responses and 3 good responses. 5. The bacteriological efficacy rate was 90.9% in eradication rate, based on results on 17 strains of suspected causative microorganism among which 10 strains were eradicated, 1 strain was decreased, and 6 strains were unknown. 6. There was no side effect during the treatment and after the discontinuation, while, in clinical laboratory tests, GOT and GPT were elevated in 1 case which was judged as abnormal. No patient refused the drug. CPDX-PR was considered to be very useful drug because of its excellent efficacy and safety in pediatrics in treating infectious diseases.

Topics: Administration, Oral; Bacteria; Bacterial Infections; Cefpodoxime Proxetil; Ceftizoxime; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Male; Pharyngitis; Tonsillitis