CEFPODOXIME IN THE OUTPATIENT TREATMENT OF LOWER RESPIRATORY TRACT INFECTIONS
Keywords:bacterial exacerbation, bronchiectasis, cefpodoxime, chronic obstructive pulmonary disease, clinical remission, lower respiratory tract infections, pneumonia, side effects
According to the recent data, lower respiratory tract infections (LRTIs) represent the fourth most common cause of death at global level.
Aim. To assess efficacy and safety of cefpodoxime in the empirical treatment of LRTIs of bacterial origin in an outpatient setting.
We performed an observational, non-randomized, open-label study (a real life-study) including 126 patients with LRTI of bacterial origin, 59 patients with AECOPD, 32 patients with CAP and 35 patients with AEBX, who met criteria for treatment in an outpatient setting. All study subjects were treated with cefpodoxime 200 mg twice daily, and had intermediate visits at 3, 5, and 7 days (patients with AECB) and at 3, 5, 7, and 10 days (patients with CAP and AEBX) at which their symptoms as well as eventual side effects were evaluated. The treatment was considered to be successful if complete resolution of symptoms or their return to the baseline severity was achieved.
Percentage of clinical success varied from 77.9% in patients with AECOPD, 81.3% in patients with CAP to 77.1% in patients with AEBX. Mean time to clinical remission varied from 6.5 ± 0.3 days in patients with AECOPD, 7.8 ± 0.5 days in patients with CAP to 10.7 ± 1.2 days in patients with AEBX. Incidence of side effects during the treatment varied from 10.2% in patients with AECOPD, 12.5% to 8.6% in patients with AEBX.
Our findings supported the use of cefpodoxime in the treatment of bacterial LRTI due to its high efficacy and good tolerability.
Woodhead M, Blasi F, Ewig S, et al. Guidelines for the management of adult lower respiratory tract infections. Clin Microbiol Infect 2011; 17 (6): E1-E59.
Woodhead M, Blasi F, Ewig S, et al. Guidelines for the management of adult lower respiratory tract infections. Eur Respir J 2005; 26: 1138-1180.
Acute lower respiratory infections. In: European Lung White Book. Sheffield, UK: European Respiratory Society, 2020.
GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: A systematic analysis for the global burden of disease study 2015. Lancet 2016; 388: 1459–1544.
Torres A, Peetermans WE, Viegi G, Blasi F. Risk factors for community-acquired pneumonia in adults in Europe: A literature review. Thorax 2013; 68: 1057–1065.
Global Initiative for Chronic Obstructive Lung Disease 2020 Report. Available at: www. goldcopd.org/ (Accessed 12.09.2020).
Chalmers JD, Aliberti S, Blasi F, et al. Management of bronchiectasis in adults. Eur Respir J 2015; 45: 1446-1462.
Musher DM, Thorner AR. Community-acquired pneumonia. N Engl J Med 2014; 371: 1619–1628.
Miravittles M, Llor C, Naberan K, et al. Effect of various antimicrobial regimens on the clinical course of exacerbations of chronic bronchitis and chronic obstructive pulmonary disease in primary care. Clin Drug Invest 2004; 24 (2): 63-72.
Polverino E, Goeminne PC, McDonnell M, et al. European Respiratory Society guidelines for the management of adult bronchiectasis. Eur Respir J 2017; 50: 1700629.
Cefpodoxime. Available at: www.drugs.com (Accessed 28.12.2020).
Geddes AM. Cefpodoxime in the treatment of lower respiratory tract infections. Drugs 1991; 42: 34-40.
Niki Y, Kawanishi M. Clinical efficacy of cefpodoxime proxetil against community-acqured pneumonia. Jpn J Chemother 2005; 53 (7): 403-411.
Guyatt GH, Oxman AD, Kunz R, et al. GRADE guidelines: 2. Framing the question and deciding on important outcomes. J Clin Epidemiol 2011;64:395–400.
Wong T. Cephodoxime proxetil (January 1, 2017).
Available at: www.reliasmedia.com/ (Accessed 14.09.2020).
Minov J, Karadzinska-Bislimovska J, Petrova T, et al. Efficacy and tolerability of eight antimicrobial regimens in the outpatient treatment of exacerbations of chronic obstructive pulmonary disease. Maced J Med Sci 2014; 7 (3): 519-524.
Minov J, Stoleski S, Petrova T, et al. Moxifloxacin in the outpatient treatment of moderate exacerbations of chronic obstructive pulmonary disease. OA Maced J Med Sci 2018; 6 (11): 2017-2022.
Minov J, Stoleski S, Petrova T, et al. Efficacy and safety of levofloxacin in the outpatient treatment of exacerbations of chronic obstructive pulmonary disease: levofloxacin 750 mg vs. levofloxacin 500 mg. Health Prim Care 2020; 4: 1-5.
Smith SM, Fahey T, Smucny J, Becker LA. Antibiotics for acute bronchitis. Chichester, UK: John Wiley & Sons Ltd, 2017.
Acute lower respiratory infections. In: European Lung White Book. Sheffield, UK: ERS, 2020.
Anthonisen NR, Menfreda J, Warren CP, et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 1987; 106 (2): 196-204.
Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Acults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Disease Society of America. Am J Respir Crit Care Med 2019; 200 (4): e45-e67.
Pasteur MC, Bilton D, Hill AT, et al. British Thoracic Society guideline for non-CF bronchiectasis. Thorax 2010; 65: (1): i1–i58.
Hill AT, Haworth CS, Aliberti S, et al. Pulmonary exacerbation in adults with bronchiectasis: a consensus definition for clinical research. Eur Respir J 2017; 49: 1700051.
WHO Report on the Global Tobacco Epidemic, 2019, Geneva: World Health Organization, 2019.
Calculate your Body Mass Index. Available at: https://www.nhlbi.nih.gov (Accessed 28.12.2020).
GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: A systematic analysis for the global burden of disease study 2015. Lancet 2016; 388:1459–544.
Minov J. Smoking among Macedonian Workers. Saarbrücken: LAP LAMBERT Academic Publishing, 2013.
Antibiotic resistance in the European Union and European Economic Area (EARS-Net) 2018. Available at: www.ecdc.europa.eu/ (Accessed 29.12.2020).
Ефикасност и подносливост на цефподоксимот во амбулантското лекување на егзацербациите на хроничната опструктивна белодробна болест [Efficacy and tolerability of cefpodoxime in the outpatient treatment of exacerbation of chronic obstructive pulmonary disease, in Macedonian]. Vox Medici 2014; 82: 304-309.
Aaron SD. Management and prevention of exacerbations of COPD. BMJ 2014; 349:g5237.
Wedzicha JA, Miravitlles M, Hurst JR, et al. Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline Eur Respir J 2017; 49(3): pii:1600791.
Putcha N. Medication regimens for managing COPD exacerbations. Respir Care 2018; 63 (6): 773-779.
Dobler CC, Morrow AS, Beuschel B, et al. Pharmacologic therapies in patients with exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 2020; 172 (6): 413-423.
Johns Hopkins ABX Guide 2017. Available at: www.hopkinsguides.com (Accessed 21.12.2020).
Bartlett JG, Dowell SF, Mandell LA et al. Practice Guidelines for the Management of Community acquired Pneumonia in Adults. Guidelines from the Infectious Disease Society of America. CID 2000; 31: 347-382.
Systemic antibiotic treatment in upper and lower respiratory tract infections: official French guidelines. Copyright by the European Society of Clinical Microbiology and Infectious Diseases CMI 2003; 9: 1162-1178.
Lim WS, Baudouin SV, George RC, et al. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax 2009; 64 (Suppl. III): iii1-iii55.
Chalmers JD, Aliberti S, Blasi F. Management of bronchiectasis in adults. Eur Respir J 2015; 45: 1446-1462.