A comparison of cefditoren pivoxil and amoxicillin/ clavulanate in the treatment of community-acquired pneumonia: a multicenter, prospective, randomized, investigator-blinded, parallel-group study.

Abstract

BACKGROUND:

Cefditoren pivoxil is a broad-spectrum cephalosporin that is approved for the treatment of pharyngitis, acute exacerbations of chronic bronchitis, and skin and skin-structure infections.

OBJECTIVE:

This study was conducted to examine the efficacy and tolerability of cefditoren in the treatment of community-acquired pneumonia (CAP). Amoxicillin/clavulanate was chosen as a comparator because of its established efficacy and general acceptance as a standard of care in CAP.

METHODS:

This multicenter, prospective, randomized, investigator-blinded, parallel-group trial compared oral cefditoren 200 and 400 mg BID with oral amoxicillin/clavulanate 875/125 mg BID for 14 days in adult outpatients with CAP.

RESULTS:

Eight hundred two patients (404 men, 398 women; mean age, 50 years; age range, 12-93 years) with CAP were enrolled. Comparable clinical cure rates were observed among evaluable patients in all treatment groups at both the posttreatment and follow-up visits: 88.0% (125/142) for cefditoren 200 mg, 89.9% (143/159) for cefditoren 400 mg, and 90.3% (130/144) for amoxicillin/clavulanate at the posttreatment visit, and 86.5% (128/148), 86.8% (138/159), and 87.8% (129/147) for the respective groups at the follow-up visit. Of 82 Streptococcus pneumoniae strains isolated before treatment, 22 (26.8%) had reduced susceptibility to penicillin, 12 (14.6%) of them penicillin resistant. Overall eradication rates at the posttreatment visit for pathogens isolated from microbiologically evaluable patients were 84.0%, 88.6%, and 82.6% for cefditoren 200 mg, cefditoren 400 mg, and amoxicillin/clavulanate, respectively. In the respective treatment groups, 80.6%, 88.6%, and 88.0% of Haemophilus influenzae strains and 95.0%, 96.2%, and 89.5% of S pneumoniae strains were eradicated. The rates of resolution of or improvement in clinical signs and symptoms were comparable between treatment groups. The treatment regimens were well tolerated, with 4.9%, 3.0%, and 5.2% of patients in the respective treatment groups requiring discontinuation of study drug due to an adverse event.

CONCLUSIONS:

In this study in adult outpatients with CAP, both doses of cefditoren demonstrated equivalence to amoxicillin/clavulanate based on rates of clinical and microbiologic cure. All 3 regimens were effective in resolving or improving the clinical signs and symptoms of CAP. Both cefditoren and amoxicillin/ clavulanate were well tolerated.

• Authors: Charles M Fogarty, Marcia Cyganowski, William A Palo, Richard C Hom, William A Craig
• Journal: Clinical therapeutics (Clin Ther) Vol. 24 Issue 11 Pg. 1854-70 (Nov 2002) ISSN: 0149-2918 [Print] United States
• PMID: 12501879 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)

Chemical References

• Anti-Bacterial Agents
• Cephalosporins
• Amoxicillin-Potassium Clavulanate Combination
• cefditoren pivoxil

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Amoxicillin-Potassium Clavulanate Combination (adverse effects, pharmacology, therapeutic use)
• Anti-Bacterial Agents (adverse effects, pharmacology, therapeutic use)
• Cephalosporins (adverse effects, pharmacology, therapeutic use)
• Child
• Community-Acquired Infections (drug therapy, microbiology)
• Drug Therapy, Combination (adverse effects, pharmacology, therapeutic use)
• Female
• Humans
• Male
• Microbial Sensitivity Tests
• Middle Aged
• Pneumonia, Pneumococcal (drug therapy, microbiology)
• Prospective Studies
• Researcher-Subject Relations
• Streptococcus pneumoniae (drug effects, isolation & purification)
• Treatment Outcome
• United States