Bacteriological eradication of Streptococcus pneumonia from patients with acute exacerbations of chronic bronchitis: Cefuroxime axetil versus cefixime

The bacteriological eradication rates of Streptococcus pneumoniae from sput um of patients experiencing acute exacerbations of chronic bronchitis (WHO definition) have been compared following therapy with either cefuroxime axe til 250 mg b.d. or cefixime 200 mg b.d. All patients were hospitalised for an acute exacerbation of chronic bronchitis. The study design was a multice ntre, double-blind, randomised, parallel group with patients giving written informed consent initially. Patients were recruited to the study if they m et the WHO definition of chronic bronchitis, were aged 30-75 years and had a high probability of S. pneumoniae infection based on initial sputum Gram stain. All S. pneumoniae isolates were serotyped and susceptibility tested at the National Reference Centre, Paris. S. pneumoniae was eradicated more rapidly following cefuroxime axetil administration than after cefixime and this difference was statistically significant (p=0.002) at 2-4 days post-tr eatment. Clinical endpoints showed a similar trend - 94% response to cefuro xime axetil compared with 71% response to cefixime (RR 6.39.1). Cefuroxime eradicated S. pneumoniae significantly more rapidly than cefixime and patie nts in the cefuroxime axetil arm had favourable clinical criteria. The data suggest that focused antibacterial studies may be helpful in evaluating an tibiotics in acute exacerbation of chronic bronchitis.