cefuroxime-axetil and Rhinitis

It is not known whether intranasal corticosteroids are beneficial to treat acute rhinosinusitis in patients with a history of chronic or recurrent sinus symptoms.. To assess whether the addition of an intranasal corticosteroid to antibiotic therapy affects the speed and rate of recovery of such patients with acute rhinosinusitis.. A double-blind, randomized, placebo-controlled multicenter trial of 95 patients (median age, 39 years) with a history of recurrent sinusitis or chronic rhinitis and evidence of acute infection by sinus radiograph or nasal endoscopy, which was conducted from October 1998 through April 2000 at 22 sites (12 primary care and 10 otolaryngology).. Two puffs (total dose, 200 microgram) of fluticasone propionate (n = 47) or placebo nasal spray (n = 48) in each nostril once daily for 21 days; all received 2 puffs of xylometazoline hydrochloride in each nostril twice daily for 3 days and 250 mg of cefuroxime axetil twice daily for 10 days.. Time to clinical success (patient reported cured or much improved) during telephone follow-up at 10, 21, and 56 days.. A total of 88 patients (93%) completed follow-up. Patients recorded their symptoms, work assessment, and compliance during the 3-week treatment phase. Patients receiving fluticasone achieved a significantly higher rate of clinical success than patients receiving placebo (93.5% vs 73.9%; P =.009). Patients treated with fluticasone improved significantly more rapidly (median of 6.0 days to clinical success) vs patients in the placebo group (median of 9.5 days; P =.01).. The addition of fluticasone to xylometazoline and antimicrobial therapy with cefuroxime improves clinical success rates and accelerates recovery of patients with a history of chronic rhinitis or recurrent sinusitis who present for treatment of acute rhinosinusitis.

Topics: Acute Disease; Administration, Intranasal; Adult; Androstadienes; Anti-Inflammatory Agents; Cefuroxime; Cephalosporins; Chronic Disease; Cost of Illness; Double-Blind Method; Drug Therapy, Combination; Female; Fluticasone; Glucocorticoids; Humans; Imidazoles; Male; Middle Aged; Nasal Decongestants; Proportional Hazards Models; Quality of Life; Rhinitis; Sinusitis

The effects of antibiotics after endoscopic sinus surgery (ESS) were investigated in a prospective, randomized, double blind, placebo controlled study in 202 patients. Hundred and one patients received cefuroxime axetil (Zinnat, 2 x 250 mg/d). The other half received placebo. Patients received no nasal packing and were treated with nasal washes and steroids. Ten subjective symptoms (headache, maxillary pressure, nasal obstruction, nasal secretions, blood, post nasal drip, sneezing, cough, smell disturbances and illness) were recorded daily and at weekly postoperative visits (including suction cleaning when indicated) seven endoscopic parameters were evaluated. There were no statistical differences in the total and individual symptom and endoscopic scores. There was no significant difference in the incidence of postoperative infections between both groups. In conclusion, antibiotics do not influence the immediate postoperative clinical evolution after ESS.

Topics: Adolescent; Adult; Aged; Betamethasone; Cefuroxime; Cephalosporins; Child; Cough; Double-Blind Method; Endoscopy; Female; Glucocorticoids; Headache; Humans; Male; Middle Aged; Nasal Obstruction; Olfaction Disorders; Paranasal Sinuses; Placebos; Prodrugs; Prospective Studies; Rhinitis; Sneezing; Surgical Wound Infection

Despite its seeming relevance, limited information exists about antibiotic sinus tissue penetration and how it is affected by inflammation. Thus the reason for the present investigation.. A randomized, open, multiple-dose, pharmacological study, employing cefuroxime axetil, an approved oral antimicrobial for the treatment of acute bacterial rhinosinusitis, was developed.. Twenty subjects, selected for surgery because of chronic rhinosinusitis, were randomly allocated to receive either a short (3-8 d) or a long (9-14 d) preoperative treatment regime with 500 mg cefuroxime axetil BID, the last dosage being taken 3 to 4 hours before surgery. At the operation, tissue samples were collected at specific sinonasal sites for both pharmacological determination of antibiotic levels and histopathological assessment of the degree of inflammation. The blood levels of the drug were simultaneously assayed.. Cefuroxime kinetic behavior on chronically inflamed mucosa was shown to be, for the most part, dependent on the blood levels, regardless of the inflammatory state. Distribution was even throughout the different sinus cavities, and the tissue levels were still, 3 to 4 hours after dosing, above the reported minimum inhibitory concentration (MIC) values for some of the most prevalent sinus pathogens. The extended treatment course did not seem to add any extra histopathological or pharmacological benefit.. Cefuroxime penetrates adequately and uniformly into chronically inflamed sinus mucosa, apparently unaffected by the degree of inflammation, in a way not dissimilar to its pharmacokinetic behavior in the normal state. Persistent MIC levels for common pathogens still warrant antimicrobial efficacy for a significant period of time after dosing.

Topics: Adult; Aged; Cefuroxime; Cephalosporins; Chronic Disease; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Nasal Mucosa; Rhinitis; Sinusitis; Tissue Distribution

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