Comparison of roxithromycin with cefixime in the treatment of adults with community-acquired pneumonia

Abstract

This study compared the efficacy and tolerability of once-daily dosing with either roxithromycin or cefixime in previously healthy adult patients aged between 18 and 60 with markers of uncomplicated community-acquired pneumonia (CAP) in three outpatient clinics in an open, randomized study. Sixty patients were enrolled: 17 males and 13 females received roxithromycin 300 mg once daily for 8-10 days and 22 males and eight females received 400 mg cefixime once daily for the same period. All patients were assessed clinically, radiologically and bacteriologically before inclusion, immediately after the study and approximately 1 month later. The most common pathogen isolated from sputum was Streptococcus pneumoniae (in 26 (43%) of 60 patients), with mixed organisms isolated from the sputum of 18 (30%) of 60 patients. Staphylococcus aureus, Haemophilus influenzae or Moraxella catarrhalis occurred in 11/60 patients, and atypical pathogens were detected by serology in 7/26 cases in the roxithromycin group and 3/23 in the cefixime group. The severity of infection was rated as mild to moderate at the beginning of the trial. At the end of the study treatment period, clinical cure rates were 30/30 (100%) for roxithromycin and 28/30 (94%) for cefixime, with one patient on cefixime being classed as a partial responder and one patient being classed as a failure and withdrawn. However, radiological abnormalities persisted in three patients on roxithromycin and one on cefixime. Of the 59 patients who completed the study, none required further antibiotic therapy. No abnormal laboratory parameters or adverse events were reported in either group. Roxithromycin at a daily dose of 300 mg was an effective and well-tolerated treatment for the empirical treatment of mild to moderate CAP in this group of patients.

Antibacterial class is not obviously important in outpatient pneumonia: a meta-analysis

“…Two contacts indicated that additional data were unavailable, two confirmed that their studies included only outpatients and were thus eligible, and one provided data enabling calculation of outcomes among outpatients, thus permitting inclusion in the present analysis. Therefore, 13 studies were included (table 1) [9][10][11][12][13][14][15][16][17][18][19][20][21]. The two reviewers were in initial agreement on 340 (82%) out of 416 entries regarding study methods and results, and 115 (88%) out of 130 entries regarding study quality rating.…”

“…A total of 4,314 patients were included, of whom 3,402 could be analysed (those without protocol violations and not lost to follow-up). For the primary objective and meta-analysis (atypical versus no atypical coverage), there were six eligible studies, three regarding macrolides versus b-lactams [15][16][17] and three of fluoroquinolones versus b-lactams [11,13,14], with a total of 1,193 patients. For the secondary objective and metaanalyses, there were seven eligible studies, five regarding macrolides versus fluoroquinolones [9,12,[18][19][20] and two of cephalosporins versus b-lactams/b-lactamase inhibitors [10,21], with a total of 2,209 patients.…”

“…The present authors, therefore, believe that there is merit in performing a meta-analysis focusing on outpatients. Secondly, the present analysis of atypical coverage included two additional studies [15,17], with a total of 486 patients, not included in the study of MILLS et al [7]. Thirdly, differences between other classes of antibacterials in OCAP were also assessed, in order to maximise guidance to clinicians.…”

“…If the minimal clinically important difference were 1%, the required sample size would increase to .13,000 patients per group. Based on a baseline mortality of 0.7%, .6,700 patients per group would be KINASEWITZ [16] MACFARLANE [17] DONOWITZ [11] ODOHERTY [14] SALVAREZZA [15] PETITPRETZ [13] Study Overall a)…”

Lack of in vitro and in vivo Selection of Bacterial Resistance by Roxithromycin

“…Among these new compounds, roxithromycin (ROX) showed clinical and bacteriological efficacy similar to that of other antimicrobials, and better tolerability [2][3][4]. These characteristics, together with the advantage of a once-daily dose, make ROX an attractive therapeutic option in the treatment of respiratory infections [5].…”