CIPROFLOXACIN VERSUS CEFUROXIME AXETIL IN THE TREATMENT OF ADULT PATIENTS WITH ACUTE BACTERIAL SINUSITIS

Objective: This study compared the use and efficacy of ciprofloxacin t o cefuroxime axetil for adult patients with acute bacterial sinusitis. Method: We conducted a prospective, randomized, double-blind pilot st udy of oral ciprofloxacin (500 mg twice daily) versus cefuroxime axeti l (250 mg twice daily) for 2 to 3 weeks in the treatment of adult pati ents with a clinical diagnosis of acute bacterial maxillary sinus infe ctions or acute exacerbation of chronic bacterial sinusitis. Patients with microbiologically and radiologically confirmed sinusitis infectio n composed the efficacy population. Results: Of the 83 patients enroll ed, 13 of 42 (31%) ciprofloxacin-and 19 of 41 (46%) cefuroxime axetil- treated patients had a respiratory pathogen isolated from a sinus aspi ration. The most frequent pretherapy isolates included Haemophilus inf luenzae (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 ach ieved in 12 (100%) ciprofoxacin-treated patients and in 14 (74%) cefur oxime axetil recipients. The five (26%) cefuroxime axetil clinical fai lures were due to development of superinfection. Bacteriologic eradica tion occurred in 12 (100%) and 14 (100%) ciprofloxacin and cefuroxime axetil patients, respectively. Similar clinical and bacteriologic resp onse rates were observed at the 2- to 4-week follow-up. Among 83 inten t-to-treat patients, 19 (45%) ciprofloxacin and 14 (34%) cefuroxime ax etil patients had drug-related adverse events. The most common adverse event in both treatment groups was gastrointestinal. Conclusion: This pilot study suggests that ciprofloxacin is efficacious in the managem ent of acute bacterial sinusitis.