Cefditoren in upper and lower community-acquired respiratory tract infections

Abstract

This article reviews and updates published data on cefditoren in the evolving scenario of resistance among the most prevalent isolates from respiratory tract infections in the community (Streptococcus pyogenes, Haemophilus influenzae, and Streptococcus pneumoniae). By relating the in vitro activity of cefditoren (in national and multinational surveillance and against isolates with emerging resistant genotypes/phenotypes) to its pharmacokinetics, the cefditoren pharmacodynamic activity predicting efficacy (in humans, animal models, and in vitro simulations) is analyzed prior to reviewing clinical studies (tonsillopharyngitis, sinusitis, acute exacerbations of chronic bronchitis, and community-acquired pneumonia) and the relationship between bacterial eradication and clinical efficacy. The high in vitro activity of cefditoren against the most prevalent respiratory isolates in the community, together with its pharmacokinetics (enabling a twice daily regimen) leading to adequate pharmacodynamic indexes covering all S. pyogenes, H. influenzae, and at least 95% S. pneumoniae isolates, makes cefditoren an antibiotic that will play a significant role in the treatment of respiratory tract infections in the community. In the clinical setting, studies carried out with cefditoren showed that treatments with the 400 mg twice daily regimen were associated with high rates of bacteriological response, even against penicillin-nonsusceptible S. pneumoniae, with good correlation between bacteriological efficacy/response and clinical outcome.

Changing trends in serotype distribution and antimicrobial susceptibility ofStreptococcus pneumoniaecausing invasive diseases in Central Thailand, 2009–2012

“…The pharmacokinetic and pharmacodynamics data suggested that the nonsusceptibility breakpoint of cefditoren should be within the range of ≤0.12 to ≤0.5 mg/L. 40 The US-FDA approved the breakpoints in the more conservative side. However, considering the favorable pharmacokinetic properties and the lowest MIC 90 of cefditoren among β-lactams, 41-43 the higher breakpoint was approved by the Spanish Agency.…”

Revisiting cefditoren for the treatment of community-acquired infections caused by human-adapted respiratory pathogens in adults

“…Revisiting cefditoren pharmacokinetic/ pharmacodynamic (PK/PD) data to interpret susceptibility [69][70][71] Fortunately, cefditoren is a drug with high number of pharmacodynamic studies published in the literature. Pharmacodynamics constitute one of the major basis for setting breakpoints by Regulatory Agencies [72].…”

A Comparison of Cefditoren Pivoxil 8-12 mg/kg/day and Cefditoren Pivoxil 16-20 mg/kg/day in Treatment of Children With Acute Presumed Bacterial Rhinosinusitis: A Prospective, Randomized, Investigator-Blinded, Parallel-Group Study

“…When given at 3 mg/kg three times a day (9 mg/kg/day) of cefditoren features 1.45 mcg/mL of Cmax and a 2.25-hour half-life and 6 mg/kg (three times a day; 18 mg/kg/day) features 2.85 mcg/mL of Cmax and a 1.68-hour half-life [ 14 ], indicates that adequate pharmacodynamic indexes covering all H. influenzae , and most S. pneumoniae isolates can be achieved. This makes cefditoren an antibiotic that may play a significant role in the treatment of bacterial respiratory tract infections in the community [ 15 ]. In the clinical setting, studies carried out with cefditoren showed that treatments with the 400 mg twice a day regimen were associated with high rates of bacteriological response, even against penicillin nonsusceptible S. pneumoniae , with good correlation between bacteriological efficacy/response and clinical outcome [ 15 ], consistent with the pharmacokinetic profile of cefditoren [ 16 ].…”

“…This makes cefditoren an antibiotic that may play a significant role in the treatment of bacterial respiratory tract infections in the community [ 15 ]. In the clinical setting, studies carried out with cefditoren showed that treatments with the 400 mg twice a day regimen were associated with high rates of bacteriological response, even against penicillin nonsusceptible S. pneumoniae , with good correlation between bacteriological efficacy/response and clinical outcome [ 15 ], consistent with the pharmacokinetic profile of cefditoren [ 16 ]. However, little is known about the efficacy of this drug at low and high doses.…”