Multicenter Randomized Study of Two Once Daily Regimens in the Initial Management of Community-Acquired Respiratory Tract Infections in 163 Children: Azithromycin versus Ceftibuten

Abstract

In a randomized trial, we compared the efficacy and toxicity of azithromycin and ceftibuten once daily in the initial (empiric) therapy of proven or suspected community-acquired respiratory tract infections (CARTI) in 163 pediatric patients: 95.5% of those treated with azithromycin and 83.6% of those treated with ceftibuten were cured or improved. Streptococcus pneumoniae was more frequently eradicated in the azithromycin than in the ceftibuten group, whereas gram-negative bacilli were more susceptible to ceftibuten. Elimination rates for Staphylococcus aureus and Haemophilus influenzae were similar; adverse reactions did not differ in both arms. Thus, azithromycin was more effective but equally safe than ceftibuten in the initial therapy of pediatric CARTI.

A cross-sectional study of the clinical characteristics of hospitalized children with community-acquired pneumonia in eight eastern cities in China

“…Antibiotics were the mainstay of childhood pneumonia treatment in the 13 hospitals included in our study. Other authors [33][34][35] have reported that macrolides are more effective in shortening disease duration and reducing severity of M pneumoniae pneumonia compared with other antibiotics. Macrolides are also more effective for a wide range of bacterial pathogens [33,35], which might be one of the reasons that in our study this class of antibiotics was widely used.…”

“…Other authors [33][34][35] have reported that macrolides are more effective in shortening disease duration and reducing severity of M pneumoniae pneumonia compared with other antibiotics. Macrolides are also more effective for a wide range of bacterial pathogens [33,35], which might be one of the reasons that in our study this class of antibiotics was widely used. However, macrolide resistance is a serious worldwide problem [36][37][38].…”

British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011

“…[II] 63 [II] 147 [II] 148 [II] 149 [II] 150 [II] 151 [II] 152 [II] Additionally, newer antibiotics such as levofloxacin153 [II] have shown efficacy in similar studies in the USA. Despite pharmacological differences in oral cephalosporins (cefaclor has an association with skin reactions but, compared with cefalexin, good activity against S pyogenes and S pneumoniae ; cefixime is poorly active against S aureus and cefuroxime axetil has poor oral absorption), no differences in clinical efficacy have been identified.…”

Ceftibuten: An Overview

“…Patients receiving ceftibuten or azithromycin for upper and lower respiratory tract infections were comparable regarding age, and infection type and etiology. 45 Combined clinical cure and improvement rates were significantly different between the groups (p<0.02), favoring azithromycin. Overall microbiologic eradication was similar, but there were significantly more ceftibuten failures (7/17) when the isolated pathogen was S. pneumoniae (p=O.Ol).…”

“…Alternatively, for pathogens such as S. pneumoniae and M. catarrhalis for which this criterion was not met, outcomes were less than optimal in several trials. [44][45][46] Indications Ceftibuten was granted approval by the FDA for mild to moderate cases of specific infections caused by S. pyogenes, P-lactamase-producing and -nonproducing strains of H. influenzae, M. catarrhalis, and S. pneumoniae (penicillinsusceptible strains only) . 26 Current indications are treatment of acute exacerbations of chronic bronchitis caused by H. influenzae, M. catarrhalis, and S. pneumoniae; acute bacterial otitis media d u e to H. influenzae, M. catarrhalis, or S. pyogenes; and pharyngitis or tonsillitis due to S. pyogenes.…”