SEQUENTIAL THERAPY WITH CEFUROXIME FOLLOWED BY CEFUROXIME AXETIL IN COMMUNITY-ACQUIRED PNEUMONIA

Study objectives: To compare the efficacy of two sequential therapy re gimens of IV cefuroxime ! followed by oral cefuroxime axetil for the t reatment of community-acquired pneumonia (CAP). Design: Prospective, m ulticenter, randomized, open-label, parallel-group study. Setting: Six ty-six centers in 11 countries (Belgium, Canada, Czech Republic, Germa ny, Hungary, Ireland, Israel, Poland, Portugal, South Africa, and the United Kingdom). Patients: Six hundred thirty-six adults with CAP requ iring hospitalization and initial IV antibiotic treatment. Interventio ns: Cefuroxime, 1.5 g IV tid or bid for 48 to 72 h followed by oral ce furoxime axetil, 500 mg bid for 7 days. Measurements and results: For clinically evaluable patients, the clinical response rates were equiva lent for cefuroxime tid and bid groups posttreatment (cure/improvement , 79% and 84%, respectively) and at follow-up (maintained cure, 87% an d 82%, respectively). All signs and symptoms of pneumonia showed impro vement at the time of switch from IV tb ol nl therapy. h total of 111 pathogens were isolated, the most common being Streptococcus pneumonia e (23%), Haemophilus influenzae (18%), and Enterobacteriaceae (15%). B acteriologic clearance was obtained posttreatment in 47 of 49 and 36 o f 42 of bacteriologically evaluable patients in the cefuroxime tid and bid groups, respectively. Both regimens were well tolerated with, a l ow incidence of drug-related adverse events, the most common being GI. Conclusions: Twice daily IV cefuroxime followed by oral cefuroxime ax etil is a simple and I effective sequential therapy regimen for the tr eatment of CAP. It offers potential cost savings and can replace the c urrent tid regimen in this indication.