cefuroxime-axetil and Pharyngitis

Studies evaluating short-course therapy have focused on prevalent infections with demonstrable aetiology. Metaanalyses of clinical trials demonstrate that uncomplicated acute otitis media in children can be successfully treated with a 5-day course of cefuroxime axetil. In the treatment of tonsillopharyngitis, 4 - 5-day courses of oral cephalosporins compared favourably with the standard 10-day penicillin V regimen. The clinical cure rate and the bacteriological eradication rate were both significantly higher for cephalosporins than for penicillin V. Bacteriological failure rates for cephalosporins were about half those for penicillin. In studies on acute bacterial exacerbations of chronic bronchitis, no difference in the clinical cure rates or relapse rates was found between short-course therapy using cephalosporins and standard courses. The short courses had the advantage of improved gastrointestinal tolerance compared with longer durations of treatment. The results suggest that new short-course dosing regimens are viable and may be favourable in terms of increased tolerability, reduction in healthcare costs, enhanced patient compliance and the control of the development of antibiotic resistance.

Topics: Anti-Bacterial Agents; Bronchitis; Cefuroxime; Cephalosporins; Drug Administration Schedule; Humans; Otitis Media; Palatine Tonsil; Pharyngitis

The recommended duration of antibiotic treatment of tonsillopharyngitis caused by group A beta-hemolytic streptococci (GABHS) with penicillin V (PenV) is mostly 10 days. However, compliance with 10-day courses is bad. Shorter therapeutic courses are necessary, especially in young children.. In a prospective, randomized, multi-center study, children aged 1-17 years with acute tonsillopharyngitis and a positive culture for GABHS were treated with cefuroxime axetil (CAE) 20 mg/kg/day (max. 500 mg) b.i.d. for 5 days or with PenV 50,000 IU/kg (30 mg/kg) t.i.d. for 10 days. Patients were evaluated for clinical efficacy 2-4 and 7-9 days after the end of therapy. Throat swabs were taken 2-4 days after the end of therapy and at the first follow-up visit. Follow-up visits were carried out 7-8 weeks, 6 months and 12 months after study inclusion.. 1,952 patients (CAE for 5 days, 496 patients/PenV for 10 days, 1,456 patients) could be included in the intent-to-treat analysis. Two to 4 days after completion of the treatment course, the bacteriological eradication in group A (1-5 years) and group B (6-17 years) was 90.52 and 89.53% (CAE) vs. 84.13 and 84.20% (PenV), respectively; p = 0.0172; 0.0382; clinical success was 98.30% (CAE) versus 93.25% (PenV), p = 0.0017. Recurrent infections were significantly higher in younger children (group A) under both treatment regimens. Poststreptococcal sequelae (glomerulonephritis) were observed in only 1 case, in the PenV group.. CAE b.i.d. for 5 days was at least as effective as PenV t.i.d. for 10 days. Incountries with a low incidence of rheumatic fever, CAE for 5 days can be recommended for the therapy of tonsillopharyngitis due to GABHS - also in young children.

Topics: Adolescent; Anti-Bacterial Agents; Cefuroxime; Child; Child, Preschool; Humans; Infant; Penicillin V; Pharyngitis; Streptococcal Infections; Streptococcus pyogenes; Tonsillitis

Throat cultures were performed on 297 children suspected of tonsillopharyngitis on clinical findings. Group A beta-haemolytic streptococci (GABHS) were isolated from 86 patients (41 males/45 females) aged 6-15 (mean (SD) 7.8 (0.04)) years. They were randomly allocated to receive oral cefuroxime axetil for 10 days (group 1) or one dose of benzathine penicillin by intramuscular injection (group 2) and responses were evaluated 2 weeks later. Clinical cure was observed in 95% of group 1 and 96% of group 2 and bacteriological cure in 86 and 84% of groups 1 and 2, respectively. Our results show that intramuscular benzathine penicillin remains an effective treatment for GABHS and that oral cefuroxime axetil is also effective.

Topics: Adolescent; Cefuroxime; Cephalosporins; Child; Female; Humans; Injections, Intramuscular; Male; Penicillin G Benzathine; Penicillins; Pharyngitis; Prodrugs; Streptococcal Infections; Streptococcus pyogenes; Tonsillitis; Treatment Outcome

Tonsillopharyngitis caused by group A beta-hemolytic streptococci (GABHS) is common in pediatric clinical practice. Standard penicillin therapy may be associated with poor compliance, penicillin tolerance in GABHS and microbial copathogenicity. Alternative treatments are available (e.g. oral cephalosporins), and data suggest that shorter courses of these agents may be effective.. This open, randomized, multicenter study compared a conventional 10-day course of the broad spectrum oral cephalosporin, cefuroxime axetil, with a shorter 5-day course.. Cefuroxime axetil suspension, 10 mg/kg, was given twice daily to children (ages 3 to 13 years) screened for GABHS tonsillopharyngitis. Patients were assessed clinically and bacteriologically 4 to 7 days after completing the course and followed up at 21 to 28 days. Among 651 patients recruited 520 had throat cultures positive for GABHS and were randomized to treatment.. In the 406 patients with microbiologically confirmed GABHS infection, eradication of the initial pathogen was recorded in 177 of 201 (88%) and 189 of 205 (92%) of patients in the 5- and 10-day groups, respectively, at posttreatment. At follow-up, 137 of 162 (85%) of patients in the 5-day group and 145 of 167 (87%) in the 10-day group maintained bacteriologic eradication. All posttreatment isolates of GABHS were susceptible to cefuroxime, and reinfection with a different serotype of GABHS was rare (< or =2%) in both groups. The rates of recurrence of the pretreatment serotype were 10 and 7% in the 5- and 10-day groups, respectively.. Short course therapy with cefuroxime axetil suspension may offer an effective alternative treatment to conventional regimens, with potential for better compliance and reduced costs.

Topics: Cefuroxime; Cephalosporins; Child; Child, Preschool; Drug Administration Schedule; Humans; Pharyngitis; Streptococcal Infections; Streptococcus pyogenes; Tonsillitis; Treatment Outcome

In a prospective randomized multicenter study, 308 children, ages 2 to 15 years, were randomized to receive either cefuroxime axetil suspension (N = 152; 20 mg/kg/day twice daily) for 4 days, penicillin suspension (N = 156; 45 mg/kg/day divided three times daily) for 10 days, of whom 97 and 103, respectively, had culture-proved group A beta-hemolytic Streptococcus infection. Two to 4 days after completion of the treatment, group A beta-hemolytic Streptococcus were eradicated from 85 of 97 (87.6%) children taking cefuroxime and from 90 of 103 (87.4%) taking penicillin; respective clinical cure rates were 94.8% and 96.1%. Clinical signs and symptoms resolved significantly more rapidly with cefuroxime (P < 0.05). At 28 to 32 days posttreatment the eradication of the primary isolate was confirmed in 94.4 and 91.9% of cefuroxime axetil and penicillin-treated patients, respectively. Drug-related adverse events (mainly gastrointestinal and cutaneous reactions) were reported in 2.1 and 2.7% of the cefuroxime- and penicillin-treated patients, respectively. Results indicated that a 4-day treatment with cefuroxime axetil was as effective and well-tolerated as the conventional 10-day treatment with penicillin in children with acute group A beta-hemolytic Streptococcus pharyngitis.

Topics: Adolescent; Cefuroxime; Child; Child, Preschool; Confidence Intervals; Drug Administration Schedule; Female; Humans; Male; Penicillins; Pharyngitis; Prodrugs; Prospective Studies; Streptococcal Infections; Streptococcus pyogenes; Treatment Outcome

The efficacy of cefuroxime axetil compared with phenoxymethylpenicillin (PcV) was studied in group A beta-haemolytic streptococci (GAS) culture-proven tonsillitis in children aged 3-12 years with a history of at least 1 episode of tonsillopharyngitis requiring antibiotic therapy during the previous 3 months. This was a comparative, randomized, investigator-blind, multicentre study. A total of 236 children received either cefuroxime axetil suspension or PcV syrup. Inclusion criteria were a positive, rapid, group A strep test verified by bacteriological culture and clinical signs and symptoms of tonsillopharyngitis. Cefuroxime axetil treatment gave a significantly higher bacteriological eradication rate and clinical cure rate than PcV. At day 2-5 post treatment the eradication rates were 99/114 (87%) for cefuroxime axetil vs 61/109 (56%) for PcV (p < 0.001). The clinical cure rates were 98/114 (86%) and 73/109 (67%) respectively (p < 0.01). Up to 21-28 days post-treatment, 9/114 (8%) cefuroxime axetil patients and 37/109 (34%) PcV patients were treatment failures or had recurrence/reinfection of GAS tonsillopharyngitis (p < 0.001). More than 90% of the patients who experienced bacteriological treatment failure at either the first or second follow-up had the same serotype isolated pre- and post-treatment. During the study period, 21/114 (18%) patients in the cefuroxime axetil group and 50/109 (46%) patients in the PcV group received additional antibiotics (p < 0.001). No serious adverse events were noted and the mild adverse events were equally distributed among the patients in the 2 study groups: 15% for cefuroxime axetil and 14% for PcV.

Topics: beta-Lactamases; Cefuroxime; Cephalosporins; Child; Child, Preschool; Double-Blind Method; Female; Humans; Male; Penicillin V; Penicillins; Pharyngitis; Pharynx; Prodrugs; Recurrence; Saliva; Streptococcal Infections; Streptococcus; Suspensions; Tonsillitis; Treatment Failure

The bacteriological and clinical efficacies of cefuroxime axetil suspension (20 mg/kg of body weight per day in two divided doses) were compared with those of penicillin V suspension (50 mg/kg/day in three divided doses) in a multicenter, randomized, evaluator-blinded study. Children aged 2 to 13 years with clinical signs and symptoms of acute pharyngitis and a positive throat culture for group A beta-hemolytic streptococci (GABHS) were eligible. Patients were assessed and samples from the throat for culture were obtained at the time of diagnosis, 3 to 7 days after the initiation of treatment, and 4 to 8 days and 19 to 25 days after the completion of 10 days of therapy. Of the 385 evaluable patients, GABHS were eradicated from 244 of 259 (94.2%) cefuroxime-treated patients and 106 of 126 (84.1%) penicillin-treated patients (P = 0.001). Complete resolution of the signs and symptoms present at the time of diagnosis was achieved in 238 of 259 (91.9%) cefuroxime-treated patients and 102 of 126 (81.0%) penicillin-treated patients (P = 0.001). Potential drug-related adverse events were reported in 7.0 and 3.2% of the cefuroxime- and penicillin-treated patients, respectively (P = 0.078). In the present study, cefuroxime axetil suspension given twice daily resulted in significantly greater bacteriological and clinical efficacies than those of penicillin V suspension given three times daily to pediatric patients with acute pharyngitis and a positive throat culture for GABHS.

Topics: Acute Disease; Age Factors; Cefuroxime; Child; Child, Preschool; Ethnicity; Female; Humans; Male; Patient Compliance; Penicillin V; Pharyngitis; Sex Factors; Streptococcal Infections; Streptococcus pyogenes; Suspensions

A total of 110 adults with acute ear, nose and throat infections were treated orally with 750 mg/day (n = 9) or 1500 mg/day (n = 46) sultamicillin, or 500 mg/day (n = 51) or 1000 mg/day (n = 4) cefuroxime axetil for a minimum of 5 days. Variations in dose and duration of treatment were due to severity of symptoms. After treatment with sultamicillin for 8.1 +/- 1.5 days or with cefuroxime axetil for 7.9 +/- 1.6 days, local pain, erythema, exudate, oedema and adenopathies were improved in both treatment groups and all sultamicillin-treated patients were apyretic. All sultamicillin-treated and all but three cefuroxime axetil-treated patients experienced cure or improvement; only one cefuroxime axetil-treated patient discontinued treatment due to treatment failure. Gastrointestinal adverse events occurred in both treatment groups (eight sultamicillin-treated patients and three cefuroxime axetil-treated patients); one patient receiving cefuroxime axetil discontinued treatment due to nausea. Pruritus was reported by one sultamicillin-treated patient.

Topics: Adult; Ampicillin; Bacterial Infections; Cefuroxime; Drug Therapy, Combination; Humans; Otitis Media; Pharyngitis; Respiratory Tract Diseases; Rhinitis; Sinusitis; Sulbactam; Tonsillitis

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

Ninety-three children from four pediatric practices, with clinical and bacteriologic evidence of acute Group A beta-hemolytic streptococcal pharyngitis (GABHS) randomly received cefuroxime axetil (60 cases) or phenoxymethyl penicillin (33 cases). Cefuroxime axetil was given twice daily (125 mg). Phenoxymethyl penicillin was given three times daily (250 mg). The treatment groups were similar. Throat cultures were routine 2 to 7 days after the start of therapy and 2 days and 14 days after the end of therapy. The bacterial cure rates were 85 percent (51/60) for cefuroxime axetil, and 88 percent (29/33) for phenoxymethyl penicillin treated patients. Clinical results were comparable in both treatment groups. It was concluded that cefuroxime axetil given twice daily is as effective as phenoxymethyl penicillin given three times daily in producing bacteriologic eradication and clinical symptomatic improvement in children with GABHS.

Topics: Adolescent; Cefuroxime; Cephalosporins; Child; Child, Preschool; Clinical Trials as Topic; Female; Humans; Male; Penicillin Resistance; Penicillin V; Pharyngitis; Random Allocation; Streptococcal Infections; Streptococcus pyogenes; Time Factors

The aim of this work was the assessment of therapeutic efficacy of antibiotic Zinnat (Cefuroksym Aksetyl) in ambulatory treatment of acute pharyngitis and otitis media in 20 adult patients, aged 21-36. The efficacy of Zinnat was assessed on the basis of the smear from the throat and external auditory meatus to examine the culture and antibiogram, fever chart and self-assessment chart of symptoms which were assessed from 0 to 4. It was shown that Zinnat is an effective antibiotic in ambulatory treatment of acute pharyngitis and otitis media. It shows a wide range of antibacterial effect comprising most often occurring pathogens bringing about acute pharyngitis and otitis media.

Topics: Acute Disease; Adult; Ambulatory Care; Cefuroxime; Cephalosporins; Female; Humans; Male; Otitis Media; Pharyngitis

Patients with the signs and symptoms of acute tonsillopharyngitis were treated with cefuroxime axetil, an orally administered, beta-lactamase stable cephalosporin, or penicillin V for ten days. Group A beta-hemolytic streptococcal (GABHS) infection was confirmed bacteriologically in 115 patients. Patients aged 13 to 18 years received 250 mg of cefuroxime or 500 mg of penicillin V twice daily. Bacteriologic cure was found in 33 (94%) of 35 patients treated with the cefuroxime and in 12 (67%) of 18 treated with penicillin (P less than 0.05). Patients aged 4 to 12 years who received 125 mg of cefuroxime axetil twice daily also experienced a greater rate of bacteriologic cure than patients who received 250 mg of penicillin V three times daily, but the difference was not statistically significant. Cefuroxime axetil is at least as effective as penicillin V in the management of streptococcal pharyngitis and may be more effective in preventing the carrier state.

Topics: Adolescent; Carrier State; Cefuroxime; Cephalosporins; Child; Child, Preschool; Drug Evaluation; Female; Hemolysis; Humans; Male; Penicillin V; Pharyngitis; Streptococcal Infections; Streptococcus pyogenes; Tonsillitis