COMPARATIVE-EVALUATION OF THE CLINICAL AND MICROBIOLOGICAL EFFICACY OF CO-AMOXICLAV VS CEFIXIME OR CIPROFLOXACIN IN BACTERIAL EXACERBATION OF CHRONIC-BRONCHITIS

In an open randomized study 218 outpatients (159 males and 59 females) ranging between 18 and 85 years of age (mean 61.9) suffering from bac terial exacerbation of chronic bronchitis have been randomly treated: 79 with co-amoxiclav (amoxicillin 875 mg + clavulanic acid 125 mg) twi ce daily, 69 with cefixime (400 mg) once daily, and 70 with ciprofloxa cin (500 mg) twice daily for an average period of 10 days, Before trea tment start, 234 bacterial strains (105 Gram-positive and 129 Gram-neg ative) were isolated as the cause of exacerbation; the leading pathoge ns were Streptococcus pneumoniae and Haemophilus spp. Eradication rate s at the end of treatment were 82.2% for the co-amoxiclav group, 77.6% for the cefixime group, and 81.2% for ciprofloxacin group, Clinical s uccess (cure + improvement) was obtained in 90.8% of the cases treated with co-amoxiclav, in 80.9% for the cefixime group and in 85.7% of pa tients treated with ciprofloxacin. Seven adverse events (8.9%) of whic h 4 cases of diarrhea and 3 of itching, were recorded in the co-amoxic lav group. Eleven adverse events (14.7%) were recorded in the cefixime group including gastrointestinal disturbances in 6 patients and mild to moderate increase of liver function in 2. Nine adverse events (12.9 %) occurred in the ciprofloxacin group, including insomnia in 3 patien ts, gastrointestinal disturbances in 2, and serious increase of liver function rests in one patient. It can be concluded that there were no statistically significant differences among the three treatment groups . However, co-amoxiclav demonstrated a higher efficacy rate than cefix ime and ciprofloxacin and was better tolerated. Therefore, it can be u sed as a first-choice drug in the treatment of exacerbation of chronic bronchitis.