SEQUENTIAL THERAPY WITH CEFUROXIME FOLLOWED BY CEFUROXIME AXETIL IN ACUTE EXACERBATIONS OF CHRONIC-BRONCHITIS

A prospective, multicentre, randomized, open-label, parallel group stu dy compared the efficacy, safety and tolerability of cefuroxime 750 mg iv administered either twice daily (bd) or three times daily (tds) fo r 48-72 h, followed by oral cefuroxime axetil 500 mg bd for 5-7 days i n a sequential therapy regimen for the treatment of acute exacerbation s of chronic bronchitis. A total of 628 adult patients entered the stu dy; 323 in the cefuroxime tds group and 305 in the cefuroxime bd group . For clinically evaluable patients, the post-treatment clinical respo nse rate was 86% and 88% in the cefuroxime tds and bd groups, respecti vely. Cure was maintained at follow-up (14-28 days after treatment com pletion) 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 t he 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 quant itative 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 findin gs of this study support the use of a bd dosing schedule of cefuroxime in a sequential therapy regimen with oral cefuroxime axetil, demonstr ating it to be clinically equivalent to the standard tds dosage curren tly used, as well as being simpler and more convenient to administer a t a lower cost.