Journal of Antimicrobial Chemotherapy, Vol 40, 863-871, Copyright © 1997 by The British Society for Antimicrobial Chemotherapy
F Vogel, W Droszcz, V Vondra, K Reisenberg, C Marr and H Staley
A prospective, multicentre, randomized, open-label, parallel group study
compared the efficacy, safety and tolerability of cefuroxime 750 mg iv
administered either twice daily (bd) or three times daily (tds) for 48-72
h, followed by oral cefuroxime axetil 500 mg bd for 5-7 days in a
sequential therapy regimen for the treatment of acute exacerbations of
chronic bronchitis. A total of 628 adult patients entered the study; 323 in
the cefuroxime tds group and 305 in the cefuroxime bd group. For clinically
evaluable patients, the post- treatment clinical response rate was 86% and
88% in the cefuroxime tds and bd groups, respectively. Cure was maintained
at follow-up (14-28 days after treatment completion) in 85% of the
cefuroxime tds group and 84% of patients in the cefuroxime bd group. A
total of 189 pathogens was isolated, the most common being Haemophilus
influenzae (17%), other Haemophilus spp. (15%), Streptococcus pneumoniae
(15%) and Enterobacteriaceae (23%). At the post-treatment assessment, 66%
and 70% of pathogens were cleared in the cefuroxime tds and bd groups,
respectively. Both treatment regimens were well tolerated. The incidence of
drug-related adverse events was 7% in the cefuroxime tds group and 6% in
the cefuroxime bd group; the most common side-effects were
gastrointestinal. Qualitative and quantitative markers were used to
determine the optimal time to switch from iv to oral therapy and, of these,
peak expiratory flow rate was shown to be the most useful in the present
study. In conclusion, the findings of this study support the use of a bd
dosing schedule of cefuroxime in a sequential therapy regimen with oral
cefuroxime axetil, demonstrating it to be clinically equivalent to the
standard tds dosage currently used, as well as being simpler and more
convenient to administer at a lower cost.
ORIGINAL ARTICLES
Sequential therapy with cefuroxime followed by cefuroxime axetil in acute exacerbations of chronic bronchitis
Kliniken des Main-Taunus-Kreises, Hofheim am Taunus, Germany.
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