cefuroxime-axetil and Pneumonia--Bacterial

Empiric treatment of hospital-acquired pneumonia (HAP) should be focused on the suspected pathogens. We evaluated the efficacy and safety of moxifloxacin vs ceftriaxone in patients with HAP without risk of infections with Pseudomonas aeruginosa and other non-fermentative Gram-negative bacteria.. We performed a prospective, randomized, non-blind, multicentric and multinational study to compare the efficacy and safety of moxifloxacin 400 mg IV once daily followed by oral moxifloxacin 400 mg once daily to ceftriaxone 2 g IV once daily followed by oral cefuroxime axetil 500 mg twice daily to treat mild-to-moderate HAP in adult patients requiring initial parenteral therapy. The primary efficacy variable was clinical response 7-10 days after the end of a 7-14-day treatment period, secondary endpoints included clinical and bacteriologic response at different intervals for up to 31 days after treatment. The trial was terminated prematurely due to slow patient recruitment.. A total of 161 subjects (87 men, 74 women) between 18 and 95 years of age were enrolled, 120 of whom were eligible for per protocol efficacy analyses (60 each in the moxifloxacin and the comparator groups). Clinical success rates were 87% for moxifloxacin and 83% for the comparator [95% CI (-9.77 to 15.96%)]. The results for secondary endpoints were comparable between groups. Both treatments were safe and well tolerated.. Moxifloxacin IV/oral can be considered as a possible alternative for the antibiotic treatment of patients with mild-to-moderate nosocomial pneumonia without risk factors for highly resistant microorganisms.

Topics: Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Aza Compounds; Bacteria; Ceftriaxone; Cefuroxime; Cross Infection; Drug Therapy, Combination; Endpoint Determination; Female; Fluoroquinolones; Humans; Injections, Intravenous; Male; Middle Aged; Moxifloxacin; Pneumonia, Bacterial; Quinolines; Treatment Outcome

The efficacy of a 7-day switch therapy with parenteral cefuroxime in a dose of 750 mg for 3-5 days followed by the use of oral cefuroxime axetil in a dose of 500 mg every 12 hours was compared with that of a 7-day therapy with parenteral cefuroxime in a dose of 750 mg every 8 hours in hospitalized patients with community-acquired pneumonia. The clinical and bacteriological efficacies and pharmacokinetic properties of both the dosage forms were estimated. It was shown that the clinical and bacteriological effects did not significantly differ in the patients under the parenteral regimen with cefuroxime and under the parenteral-to-oral regimen with cefuroxime and cefuroxime axetil: the cure in 75 and 83 per cent of the patients and the bacteriological response in 100 and 86 per cent of the cases respectively. The results indicated that the cost of the switch therapy was much lower while the efficacy did not decrease.

Topics: Administration, Oral; Adolescent; Adult; Aged; Cefuroxime; Cephalosporin Resistance; Cephalosporins; Chromatography, High Pressure Liquid; Community-Acquired Infections; Drug Administration Schedule; Female; Humans; Injections, Intraperitoneal; Male; Middle Aged; Pneumonia, Bacterial; Prodrugs; Treatment Outcome

To compare the efficacy of two sequential therapy regimens of IV cefuroxime followed by oral cefuroxime axetil for the treatment of community-acquired pneumonia (CAP).. Prospective, multicenter, randomized, open-label, parallel-group study.. Sixty-six centers in 11 countries (Belgium, Canada, Czech Republic, Germany, Hungary, Ireland, Israel, Poland, Portugal, South Africa, and the United Kingdom).. Six hundred thirty-six adults with CAP requiring hospitalization and initial IV antibiotic treatment.. Cefuroxime, 1.5 g IV tid or bid for 48 to 72 h followed by oral cefuroxime axetil, 500 mg bid for 7 days.. For clinically evaluable patients, the clinical response rates were equivalent for cefuroxime tid and bid groups posttreatment (cure/improvement, 79% and 84%, respectively) and at follow-up (maintained cure, 87% and 82%, respectively). All signs and symptoms of pneumonia showed improvement at the time of switch from IV to oral therapy. A total of 111 pathogens were isolated, the most common being Streptococcus pneumoniae (23%), Haemophilus influenzae (18%), and Enterobacteriaceae (15%). Bacteriologic clearance was obtained posttreatment in 47 of 49 and 36 of 42 of bacteriologically evaluable patients in the cefuroxime tid and bid groups, respectively. Both regimens were well tolerated with a low incidence of drug-related adverse events, the most common being GI.. Twice daily IV cefuroxime followed by oral cefuroxime axetil is a simple and effective sequential therapy regimen for the treatment of CAP. It offers potential cost savings and can replace the current tid regimen in this indication.

Topics: Administration, Oral; Cefuroxime; Cephalosporins; Community-Acquired Infections; Drug Administration Schedule; Female; Humans; Injections, Intravenous; Male; Middle Aged; Pneumonia, Bacterial; Prodrugs; Prospective Studies; Treatment Outcome

Five hundred ninety patients were enrolled in a prospective, multicenter, randomized trial comparing the efficacy and safety of 7 to 14 days of levofloxacin treatment with that of ceftriaxone and/or cefuroxime axetil in the management of community-acquired pneumonia in adults. Patients received either intravenous and/or oral levofloxacin (500 mg once daily) or the comparative agents, parenteral ceftriaxone (1 to 2 g once to twice daily) and/or oral cefuroxime axetil (500 mg twice daily). Erythromycin or doxycycline could be added to the comparator arm at the investigator's discretion. The decision to use an intravenous or oral antimicrobial agent for initial therapy was made by the investigator. Clinical and microbiological evaluations were completed at the baseline, during treatment, 5 to 7 days posttherapy, and 3 to 4 weeks posttherapy. Four hundred fifty-six patients (226 given levofloxacin and 230 administered ceftriaxone and/or cefuroxime axetil) were evaluable for clinical efficacy. Streptococcus pneumoniae and Haemophilus influenzae were isolated in 15 and 12%, respectively, of clinically evaluable patients. One hundred fifty atypical pathogens were identified: 101 were Chlamydia pneumoniae, 41 were Mycoplasma pneumoniae, and 8 were Legionella pneumophila. Clinical success at 5 to 7 days posttherapy was superior for the levofloxacin group (96%) compared with the ceftriaxone and/or cefuroxime axetil group (90%) (95% confidence interval [CI] of -10.7 to -1.3). Among patients with typical respiratory pathogens who were evaluable for microbiological efficacy, the overall bacteriologic eradication rates were superior for levofloxacin (98%) compared with the ceftriaxone and/or cefuroxime axetil group (85%) (95% CI of -21.6 to -4.8). Levofloxacin eradicated 100% of the most frequently reported respiratory pathogens (i.e., H. influenzae and S. pneumoniae) and provided a >98% clinical success rate in patients with atypical pathogens. Both levofloxacin and ceftriaxone-cefuroxime axetil eradicated 100% of the S. pneumoniae cells detected in blood culture. Drug-related adverse events were reported in 5.8% of patients receiving levofloxacin and in 8.5% of patients administered ceftriaxone and/or cefuroxime axetil. Gastrointestinal and central and peripheral nervous system adverse events were the most common events reported in each treatment group. In conclusion, these results demonstrate that treatment with levofloxacin is superior to ceftriaxone and/or cefurox

Topics: Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Ceftriaxone; Cefuroxime; Cephalosporins; Community-Acquired Infections; Drug Therapy, Combination; Female; Humans; Injections, Intravenous; Levofloxacin; Male; Middle Aged; Ofloxacin; Pneumonia, Bacterial; Prodrugs; Prospective Studies; Treatment Outcome

The cephalosporin antibiotic zinnat was given to 171 outpatients with bronchopulmonary infections. Pneumonia patients received 500 mg, patients with acute bronchitis or exacerbation of chronic bronchitis 250 mg twice a day. The recovery was registered in 97.7, 98.8 and 91.8% of patients, respectively. The drug proved effective, low-toxic, convenient in use. Wide-spectrum action, significant activity against both gram-positive and gram-negative pathogens make zinnat a promising drug for outpatient treatment of bronchopulmonary infections.

Topics: Acute Disease; Adolescent; Adult; Ambulatory Care; Bronchitis; Cefuroxime; Cephalosporins; Chronic Disease; Female; Humans; Male; Middle Aged; Pneumonia, Bacterial; Prodrugs

Cefuroxime axetil has been evaluated previously in the treatment of lower respiratory tract infections, but not specifically in the treatment of community-acquired pneumonia. In a multicentre, investigator-blinded clinical trial, 162 patients with community-acquired pneumonia were randomly assigned to receive orally either cefuroxime axetil 500 mg bid (n = 84) or amoxycillin/clavulanate 500 mg/125 mg tid (n = 78) for 10 days. Organisms were isolated from the pretreatment sputum specimens of 97 of 162 (60%) patients, the commonest isolates being Streptococcus pneumoniae (38%) and Haemophilus influenzae (18%). A satisfactory clinical outcome (cure or improvement) was achieved in 100% (55 of 55) and 96% (49 of 51) of the clinically evaluable patients treated with cefuroxime axetil or amoxycillin/clavulanate, respectively (P = 0.23). With respect to eradication of bacterial pathogens, a satisfactory outcome (cure, presumed cure or cure with colonization) was obtained in 94% (32 of 34) and 93% (37 of 40) of bacteriologically evaluable patients treated with cefuroxime axetil or amoxycillin/clavulanate, respectively (P = 1.00). Both treatment regimens used in this study were well tolerated. The most common drug-related adverse experiences were gastrointestinal events, reported by 8% and 4%, respectively, of the patients in the amoxycillin/clavulanate and cefuroxime axetil groups, a difference which was not statistically significant (P = 0.32). These results indicate that cefuroxime axetil twice a day is as effective as amoxycillin/clavulanate three times a day in the treatment of outpatients with mild to moderate community-acquired pneumonia.

Topics: Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Cefuroxime; Cephalosporins; Child; Clavulanic Acids; Community-Acquired Infections; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Pneumonia, Bacterial; Prodrugs; Prospective Studies; Treatment Outcome

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amoxicillin; Anti-Bacterial Agents; Bronchitis; Cefuroxime; Clinical Trials as Topic; Female; Humans; Male; Middle Aged; Pneumonia, Bacterial; Respiratory Tract Infections; Single-Blind Method; Treatment Outcome

Topics: Alabama; Anti-Bacterial Agents; Bronchitis; Cefaclor; Cefuroxime; Clinical Trials as Topic; Community-Acquired Infections; Drug Combinations; Humans; Pneumonia, Bacterial; Reproducibility of Results; Respiratory Tract Infections; Safety; Treatment Failure; Treatment Outcome