cefuroxime-axetil and Sinusitis

Poor compliance with standard antibiotic regimens of 7 - 10 days' duration used in the treatment of acute upper respiratory tract infections contributes significantly to treatment failure. Patients fail to complete the recommended course of treatment, stopping once symptoms have resolved, which is typically within 2 - 5 days. Accumulating evidence from a large number of prospective clinical studies suggests that shortened courses of treatment may be as, or more, effective than conventional regimens of longer duration. As an example, a study comparing 5 days of cefuroxime axetil therapy with either 10 days of cefuroxime axetil or amoxycillin/clavulanate showed no differences in rates of clinical cure, bacteriological eradication and recurrence in paediatric patients with either acute otitis media or sinusitis. Shortened-course therapy with agents such as cefuroxime axetil has the potential to improve patient compliance and so reduce the rate of clinical failure and the emergence of resistant strains. Other potential benefits include fewer side-effects, improved patient satisfaction and lower treatment costs.

Topics: Acute Disease; Amoxicillin; Anti-Bacterial Agents; Cefuroxime; Clavulanic Acid; Drug Administration Schedule; Drug Prescriptions; Drug Resistance, Microbial; Humans; Otitis Media; Sinusitis; Time Factors

Cefuroxime axetil is a beta-lactamase-stable, second-generation, oral cephalosporin that penetrates sinus tissue in concentrations exceeding the MIC90 values (the minimum concentration of drug needed to inhibit the growth of 90% of an isolate of a particular microorganism) for pathogens most commonly associated with acute sinusitis, including Streptococcus pneumoniae and Haemophilus influenzae. A review of all clinical data published to date demonstrates that cefuroxime axetil has been evaluated in the treatment of acute sinusitis and acute exacerbations of chronic sinusitis ("acute-on-chronic sinusitis") in 18 clinical trials involving 1516 assessable patients. In 12 randomized, comparative trials, the rates of satisfactory clinical outcomes (cure or improvement, 79% to 100%) and bacteriologic eradication (84% to 100%) reported with the use of 250 mg of cefuroxime axetil twice daily were similar to those observed with the use of amoxicillin, amoxicillin/clavulanate potassium, cefaclor, cefadroxil, cefixime, clarithromycin, and doxycycline. In these comparisons, no antibiotic demonstrated any therapeutic advantages over cefuroxime axetil regarding time to symptom abatement. Cefuroxime axetil was at least as well tolerated as the other antibiotics. Overall, the role of cefuroxime axetil in the treatment of sinusitis appears to be as one of the broad-spectrum antibiotics that can be used for infections due to the most commonly implicated sinus pathogens, especially those due to the increasing number of relatively penicillin-resistant strains of S pneumoniae and beta-lactamase-producing strains of H influenzae and Moraxella catarrhalis.

Topics: Acute Disease; Anti-Bacterial Agents; Bacterial Infections; Cefuroxime; Chronic Disease; Clinical Trials as Topic; Humans; Prodrugs; Randomized Controlled Trials as Topic; Sinusitis; Treatment Outcome

To compare the efficacy and safety of faropenem medoxomil, 300 mg twice daily for seven or ten days, with cefuroxime axetil 250 mg twice daily for ten days in adults with acute bacterial sinusitis (ABS).. Prospective, double-blinded, phase III trial with entry criteria consistent with FDA/IDSA guidelines for diagnosis of ABS. Primary efficacy parameter was clinical response at 7 to 21 days posttherapy.. One thousand ninety-nine subjects were randomized and treated; 861 were efficacy valid. Clinical cure rates were 80.3% for seven days of faropenem, 81.8% for ten days of faropenem, and 74.5% for 10 days of cefuroxime axetil. The incidence of adverse events and premature discontinuations were similar for the three treatment regimens.. Seven- and ten-day faropenem medoxomil regimens were similar (noninferior) to a ten-day cefuroxime axetil regimen based on clinical response in patients with ABS.. A seven-day course of faropenem medoxomil 300 mg twice-daily regimen is a promising alternative for treatment of ABS.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Infections; beta-Lactams; Cefuroxime; Double-Blind Method; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Prospective Studies; Sinusitis; Time Factors

To evaluate the efficacy of antibiotic treatment in children who presented in medical care with respiratory infection and had imaging evidence of sinusitis.. Eighty-two children (4-10 y) with acute respiratory symptoms and ultrasonography findings suggestive of acute rhinosinusitis were enrolled in a randomized, double-blind trial. The sinus findings were confirmed with plain radiographs. The children received either cefuroxime axetil in 125-mg capsules twice a day for 10 d or placebo. Main outcome measures were complete cure in 2 wk and absence of prolonged symptoms or complications.. A total of 72 children (88%) completed follow-up. The sinusitis findings in the ultrasound could be confirmed with plain radiographs in 65 of the 72 patients (90%). The proportion of children completely cured by day 14 was similar in both groups (difference 6%, 95% confidence interval -16% to 29%). Similarly, there was no significant difference in the proportions of children who escaped prolonged disease and complications between the groups (difference 7%, -9% to 24%).. A 10-d course of cefuroxime axetil offered no clinical benefit to children with an acute respiratory illness and imaging evidence of acute sinusitis.

Topics: Acute Disease; Anti-Bacterial Agents; Cefuroxime; Child; Child, Preschool; Double-Blind Method; Female; Humans; Male; Placebos; Respiratory Tract Infections; Sinusitis; Time Factors; Treatment Outcome

We started therapy sinusitis of our patients with antibiotics cefuroxime axetil (Zinnat, GSK), clarithromycin (Klacid Uno, Abbott) and orally given steroid-prednisone in one group (A+S) 56 patients. Second group of 60 patients were cured only with antibiotics (A). We compare effects of this therapy. There were 50% totally cured patients in the first group (A+S) and 46.6% cured in the second group. Percentage totally cured patients with (A+S) is 3.4% better that cured only with antibiotics in the same time. It is statistically important. We present benefits for patients who were operated in the next step. Post therapy with the use of antibiotics and steroids there were less bleeding from the mucosal membrane, and there was no edema. It is a good method of therapy if patients have no contraindications.

Topics: Anti-Infective Agents; Cefuroxime; Chronic Disease; Clarithromycin; Drug Therapy, Combination; Female; Humans; Male; Prednisone; Sinusitis; Treatment Outcome

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 aim of this multicentre, randomized study was to compare the efficacy and safety of moxifloxacin (BAY 12-8039), a new 8-methoxy fluoroquinolone, with that of cefuroxime axetil for the treatment of acute bacterial sinusitis in adults. Diagnosis was made on a range of clinical signs and symptoms combined with radiology and microbiology. A 400 mg dose of moxifloxacin was administered once daily for 7 days to 242 patients and 250 mg twice daily of cefuroxime axetil was administered to 251 patients for 10 days. The clinical success rate at the end of treatment in the evaluable population was significantly higher (96.7%) in the moxifloxacin group (204/211) than in the cefuroxime axetil group (204/225, 90.7%; 95% confidence intervals 1.5%; 10.6%). At follow-up the success rate in the moxifloxacin group was 90.7% and that for the cefuroxime axetil group was 89.2% (95% confidence intervals -4.3%; 5.4%). The predominant pathogens isolated were Streptococcus pneumoniae and Haemophilus influenzae, followed by Moraxella catarrhalis and Staphylococcus aureus. The bacteriological eradication rates were higher for moxifloxacin (94.5%, 103/109) than for cefuroxime axetil (83.5%, 96/115; 95% CI 3.6%; 19.7%). Only one S. pneumoniae infection persisted following moxifloxacin therapy in contrast with three in individuals on cefuroxime axetil. There were slightly more adverse events in the moxifloxacin group than in the cefuroxime axetil group, but there were fewer serious adverse events following moxifloxacin treatment (three vs. eight). The drug was discontinued because of adverse events in 14 moxifloxacin patients and in 11 cefuroxime axetil patients. Overall, in all assessments, moxifloxacin was at least as effective clinically and bacteriologically, and as well tolerated, as cefuroxime axetil in the treatment of acute sinusitis.

Topics: Acute Disease; Adult; Anti-Infective Agents; Aza Compounds; Bacterial Infections; Cefuroxime; Cephalosporins; Double-Blind Method; Drug Evaluation; Female; Fluoroquinolones; Humans; Male; Middle Aged; Moxifloxacin; Prospective Studies; Quinolines; Sinusitis

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

This study compared the use and efficacy of ciprofloxacin to cefuroxime axetil for adult patients with acute bacterial sinusitis.. We conducted a prospective, randomized, double-blind pilot study of oral ciprofloxacin (500 mg twice daily) versus cefuroxime axetil (250 mg twice daily) for 2 to 3 weeks in the treatment of adult patients with a clinical diagnosis of acute bacterial maxillary sinus infections or acute exacerbation of chronic bacterial sinusitis. Patients with microbiologically and radiologically confirmed sinusitis infection composed the efficacy population.. Of the 83 patients enrolled, 13 of 42 (31%) ciprofloxacin- and 19 of 41 (46%) cefuroxime axetil-treated patients had a respiratory pathogen isolated from a sinus aspiration. The most frequent pretherapy isolated included Haemophilus influenzae (11), streptococcus species (20), staphylococcus species (7), Proteus mirabilis (3), and Neisseria sicca (3). At the end of therapy, clinical resolution or improvement in efficacy-valid patients was achieved in 12 (100%) ciprofloxacin-treated patients and in 14 (74%) cefuroxime axetil recipients. The five (26%) cefuroxime axetil clinical failures were due to development of superinfection. Bacteriologic eradication occurred in 12 (100%) and 14 (100%) ciprofloxacin and cefuroxime axetil patients, respectively. Similar clinical and bacteriologic response rates were observed at the 2- to 4-week follow-up. Among 83 intent-to-treat patients, 19 (45%) ciprofloxacin and 14 (34%) cefuroxime axetil patients had drug-related adverse events. The most common adverse event in both treatment groups was gastrointestinal.. This pilot study suggests that ciprofloxacin is efficacious in the management of acute bacterial sinusitis.

Topics: Acute Disease; Adult; Aged; Analysis of Variance; Anti-Infective Agents; Cefuroxime; Cephalosporins; Chi-Square Distribution; Ciprofloxacin; Double-Blind Method; Female; Humans; Male; Middle Aged; Pilot Projects; Prospective Studies; Random Allocation; Sinusitis

In a double-blind, multicentre trial, 382 patients with a diagnosis of acute purulent sinusitis were randomised to receive sparfloxacin 200 mg once daily for 5 days following a loading dose of 400 mg on day 1 (n = 193) or cefuroxime axetil 250 mg twice daily for 8 days (n = 189). Patients were classified as success or failure according to clinical symptoms plus bacteriological and radiological data at the end of treatment and at a follow-up visit. In analyses of the intent-to-treat (n = 374) and evaluable populations (n = 304), the 5 day course of sparfloxacin was at least as effective and well tolerated as the 8 day course of cefuroxime axetil. The success rates at the end of treatment in the evaluable population were 82.6% and 83.2% in the sparfloxacin and cefuroxime axetil groups, respectively. The pathogens isolated most frequently were Haemophilus influenzae (33%) and Streptococcus pneumoniae (28%). Response rates according to the bacterial aetiology of the acute sinusitis were similar in the two treatment groups. Both drugs were well tolerated. The commonest adverse events were gastrointestinal and were reported in 2.6% and 3.8% of sparfloxacin- and cefuroxime axetil-treated patients, respectively.

Topics: Acute Disease; Adult; Anti-Infective Agents; Cefuroxime; Cephalosporins; Double-Blind Method; Female; Fluoroquinolones; Humans; Male; Prodrugs; Quinolones; Sinusitis

A study of the efficacy of cefuroxime axetil was conducted for the treatment of acute sinusitis in childhood. Thirty-nine patients aged 5-14 years were given cefuroxime axetil 20 mg/kg/day divided into two doses for seven days. The diagnosis of acute sinusitis was based on history, physical examination, and radiological findings. The results of throat cultures before treatment were 17 patients with group A beta-haemolytic streptococci, seven patients with pneumococci, and two patients with Staphylococcus aureus; in the remainder of the patients only normal throat flora were isolated. In 36 patients (92%) a satisfactory improvement was reported at the end of the treatment. It was found that cefuroxime axetil was efficaceous for the treatment of sinusitis in childhood.

Topics: Adolescent; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Cefaclor; Cefuroxime; Cephalosporins; Child; Child, Preschool; Clavulanic Acids; Female; Humans; Male; Pharynx; Sinusitis; Staphylococcus aureus; Streptococcus; Treatment Outcome

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

The aim of the study was to substantiate clinically and microbiologically administration of such oral cephalosporins as cefuroxime axetil and ceftibuten in acute sinusitis. The spectrum of causative agents of acute sinusitis was determined, most common pathogens were identified and their sensitivity to antibiotics was tested. The conclusion is made that cephalosporins of the II-III generation meet the requirements to antibacterial drugs for treatment of acute sinusitis.

Topics: Acute Disease; Adult; Ceftibuten; Cefuroxime; Cephalosporins; Drug Tolerance; Female; Humans; Male; Sinusitis; Treatment Outcome

Nineteen patients presenting for sinus surgery were studied to evaluate the percentage penetration from serum to paranasal sinus tissue of a single orally administered dose of cefuroxime axetil. The methods and results are presented. Cefuroxime penetrates well into human sinus mucosa following oral administration and the concentrations obtained exceed minimum inhibitory concentrations of cefuroxime for the most common pathogens in sinusitis.

Topics: Administration, Oral; Bacterial Infections; Cefuroxime; Drug Evaluation; Female; Humans; Male; Middle Aged; Mucous Membrane; Paranasal Sinuses; Prodrugs; Prospective Studies; Sinusitis

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Infections; Cefuroxime; Clinical Trials as Topic; Humans; Middle Aged; Sinusitis; Treatment Outcome