Cefuroxime Case Study

7/27/2019 Cefuroxime Case Study

1/4

Journal of Antimicrobial Chemotherapy (1996) 38, 547-550

Cefuroxime axetil in the treatment of acute sinusitis in childhoodN . Curses, A. G. Kalayci*, I . Is lek and S. Uysal

Ondokuz M ayis University, School of Medicine, Departments of Pediatrics,55139 Samsun, Turkey

A study of the efficacy of cefuroxime axetil was conducted for the treatment of acutesinusitis in childhood. Thirty-nine patients aged 5-14 years were given cefuroximeaxetil 20 mg /kg/d ay divided into tw o doses for seven days. Th e diagnosis of acutesinusitis was based on history, physical examination, and radiological findings. Theresults of throat cultures before treatment were 17 patients with group A/?-haemolytic streptococci, seven patients with pneumococci, and two patients withStaphylococcus aureus; in the remainder of the patients only normal throat flora wereisolated. In 36 patients (92%) a satisfactory improvement was reported at the endof the treatment. It was found that cefuroxime axetil was efficaceous for the treatmentof sinusitis in childhood.

IntroductionAcute bacterial sinusitis is a common clinical problem in childhood (Wald, 1992). Theincidence of acute sinusitis remains to be denned and the criteria for diagnosis varywidely. Between 5% and 10% of upper respiratory infections may be complicated byacute sinusitis. Microbiologic evaluation of patients with acute sinusitis requires sinusaspiration, but this method is a difficult procedure and so should be reserved for usein cases of treatment failure. An empirical therapy for acute sinusitis should ideally beeffective against Streptococcus pneumoniae, Haemophilus influenzae, and Moraxellacatarrhalis. Other bacterial species recovered much less frequently include Group Astreptococci, Group C streptococci, Streptococcus viridans, peptostreptococci, and otherMoraxella spp. (Wald et al., 1981, 1984). Antibiotics that penetrate well into the sinuses,and are stable against bacterial /9-lactamases are preferred in the treatment of acutesinusitis (Anderson, Maurer & Dajani, 1980; Jackson et al., 1984). Cefuroxime axetilis a second-generation cephalosporin characterized by stability to /Mactamases ofGram-positive and Gram-negative bacteria. Oral administration and its extendedhalf-life allow twice-daily dosing, a treatment regimen that facilitates patients'compliance (Sommers et al., 1984; K na pp & W ashington, 1988; Jam es et al., 1991).The purpose of this study was to evaluate the effectiveness of cefuroxime axetil inthe treatment of children with acute sinusitis.

Corresponding author. Tel: + 90 362 457 60 00; Fax: + 90 362 457 60 41.547

0305-7453/96/090547 + 04 $12.00/0 f) 1996 The British Society for Antim icrobial Ch em othe rap y

byguestonJuly31,201

3

http://jac.oxfordjournals.org/

Downloadedfrom
http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/http://jac.oxfordjournals.org/


2/4

548 N. GQrses et al.

Patients and methodsThirty-nine patients with clinical and radiographic evidence of acute sinusitis werestudied. The duration of symptoms in each case was less than 30 days. Clinical signsand symptoms were recorded, and throat culture and radiography of the sinuses wereperformed at patient enrollment. Cefuroxime axetil was administered orally twice dailyat a dose of 20 mg/kg per day for 7 days. On the last day of treatment all patients werere-examined. Radiological findings, physical signs and symptoms were evaluated andthroat culture was repeated. The resolution of clinical symptoms with radiographicevidence of improvement was defined as cure; improvement of clinical symptoms andradiographic evidence of residual sinus congestion was defined as improvement; and noimprovement of clinical symptoms with persistence of radiographic findings was definedas failure (Wald et al., 1984; W ald, Chiponis & Le desm a-M edin a, 1986; W ald, 1992).Patients were followed-up for three months.

Results and discussionOf 39 patients (aged 5-14 years), 16 (41 %) were female and all had maxillary sinusitis.Presenting symptoms and signs of acute sinusitis were cough (69%), nasal discharge(54%) , headache (49%), hypertrophied tonsils (44%), tenderness on percussion (31%),and postnasal drip (26%). Radiographic findings were complete or incompleteopacification in 33 patients (85%), mucosal thickening (31%), and air-fluid level in onecase. Clinical diagnosis of tonsillitis/pharyngitis (26 patients), otitis media (fourpatients) and asthma (three patients) were made concurrently.Bacterial isolates obtained from pre-treatment throat cultures included group A/?-haemolytic streptoc occi in 17 patients (44 % ), pneu mo cocc i in seven patients (18 % ),and S. aureus in two patients (5%). All 26 of these isolates were susceptible tocefuroxime on disc testing.

At the end of treatment, 36 patients (92%) were cured or improved. Three patients(8%) did not respond to the treatment. An air-fluid level persisted in one patient andmucosal thickening in one patient of the three who did not respond to treatment.Symptoms such as nasal discharge, fetid breath, hypertrophied tonsil, and postnasaldrip continued, and group A /?-haemolytic streptococcus, and S. aureus were isolatedin two of the three treatment failure patients. Cefuroxime axetil treatment wasadm inistere d in a dose of 20 mg /kg per day for an ad ditio nal 7 days in three patie nts.Two of the patients were cured with this treatment. The third patient did not respond,and erythrom ycin (40 mg /kg/day ) plus co-trimoxazole (8 mg trimethoprim -I- 40 mgsulph am etho xaz ole/kg /day) therapy for 10 days resulted in symptom resolution. Non eof the patients subsequently had relapse of symptoms in the three months after cessationof antibiotic treatment. Diarrhoea was an adverse event in one patient.

The symptoms of our patients were in accordance with those of the previousinvestigations (Wald et al., 1981, 1984).Viral illness, anatomic obstruction, immunodeficiencies (especially Ig G 3 and Ig Adeficiency), and immotile cilia syndrome are predisposing factors for sinusitis in thepaediatric age group. Recurrrent sinusitis is more prevalent in asthma patients and suchepisodes may trigger flare-ups of reactive airway disease (Riding & Irvine, 1987; Shapiroet al., 1991). We observed upper respiratory infections in most of the patients,

byguestonJuly31,201

3

http://jac.oxfordjo

urnals.org/

Downloadedfrom


3/4

Cefuroxime axetil and acute sinusitis 549hypertrophied tonsils in 44%, hypertrophied adenoids in 10%, and signs of asthma in8% of cases.Microbial pathogens in sinusitis are determined ideally by sinus aspiration, but thisis a difficult procedure particularly in children. Therefore, we performed only throatculture to determine potential pathogens. In almost half of the study group group A/?-haemolytic streptococci were isolated. We did not culture specifically for anaerobicbacteria, but these are more prevalent in chronic as opposed to acute sinusitis.

Transillumination and ultrasonography may be helpful in the diagnosis of sinusitis.CT and MRI are not necessary in children with uncomplicated acute sinusitis andshould be reserved for the evaluation of recurrent or chronic sinus infections (Wald,1992; Druce, 1993). In children with signs and symptoms of acute sinus infection plainradiography is sufficient to confirm or exclude the diagnosis. Radiologic findings inacute sinusitis include diffuse opacification, mucosal thickening of at least 4 mm, or anair-fluid level (Camacho el al., 1992; Wald, 1992). Radiographic findings of our patientswere in accordance with these descriptions.Cefuroxime axetil has been compared with co-amoxiclav and cefaclor for thetreatment of upper respiratory tract infections such as tonsillitis, otitis, and sinusitis(Griffiths et al., 1987; Hebblethwaite, Brown & Cox, 1987; Brodie, Knight &Cun ningh am , 1989). Syndor et al. (1989) reported that in a randomized control trial,treatment with cefuroxime axetil achieved a higher bacterial eradication rate (71% vs95%) than cefaclor. In another clinical study cefuroxime axetil was reported to be aseffective as amoxiclav with fewer side effects (Camacho et al., 1992). In ourinvestigations the cure and improvem ent rate of patients was 92% . This relatively lowercure rate in comparison with other studies can be attributed to the shorter treatmentperiod (7 vslO days). Diarrhoea, tremor and convulsions were reported by Camachoel al. (1992) during treatment with cefuroxime axetil. In our study, only diarrhoea wasobserved in one patient. W e conclude that cefuroxime axetil 20 mg/kg divided into twodaily doses for seven days is effective for the treatment of acute bacterial sinusitis inchildhood.

ReferencesAn derso n, K. C , M aure r, M . J. & Dajani, A. S. (1980). Pneum ococci relatively resistant topenicillin: a prevalence survey in children. Journal of Pediatrics 97, 939-41.Brodie, D. P., Knight, S. & Cunningham, K. (1989). Comparative study of cefuroxime axetil andamoxycilhn in the treatment of acute sinusitis in general practice. Journal of InternationalMedical Research 17 , 547-51.Camacho, A. E., Cobo, R., Otte, J., Spector, S. L., Lerner, C. J., Garrison, N. A. et al. (1992).Clinical comparison of cefuroxime axetil and amoxicillin-clavulanate in the treatment ofpatients with acute bacterial maxillary sinusitis. American Journal of Medicine 93, 271-6.Druce, H. M. (1993). Sinusitis: agents, diagnostic strategies and techniques, treatments, andproblems. Immunology and Allergy Clinics of North America 13, 119-33.Griffiths, G. K., VandenBurg, M. J., Wight, L. J. Gudgeon, A. C. & Kelsey, M. (1987). Efficacyand tolerability of cefuroxime axetil in the patients with upper respiratory tract infections.Current Medical Research and Opinion 10, 555-61.Hebblethwaite, E. M., Brown, G. W. & Cox, D. M. (1987). A comparison of the efficacy andsafety of cefuroxime axetil and augmentin in the treatment of upper respiratory tractinfections. Drugs under Experimental and Clinical Research 13, 914.Jackson, M. A., Shelton, S., Nelson. J. D. & McCracken, G. H. (1984). Relativelypenicillin-resistant pneumococcal infections in pediatric patients. Pediatric InfectiousDiseases 3, 129-32.

byguestonJuly31,2013

http://jac.oxfordjournals.org/

Downloadedfrom


4/4

550 N. Curses et al.Jam es, N . C , Do nn, K . H., Collins, J. J. , Davis, I. M ., Lloyd, T. L., H art, R. W. et al. (1991).Pharmacokinetics of cefuroxime axetil and cefaclor: relationship of concentrations in serumto MICs for common respiratory pathogens. Antimicrobial Agents and Chemotherapy 35,1860-3.Knapp, C. C. & Washington, J. A. (1988). In vitro activities of LY163892, cefaclor, andcefuroxime. Antimicrobial Agents and Chemotherapy 32, 131-3.Riding, K. H. & Irvine, R. (1987). Sinusitis in children. Journal of Otolaryngology 16, 239-43 .Shapiro, G. G., Virant, F. S., Furukawa, C. T., Pierson, W. E. & Bierman, C. W. (1991).Immunologic defects in patients with refractory sinusitis. Pediatrics 87, 311-6.Sommers, D., Van Wyk, M., Williams, P. E. & Harding, S. M. (1984). Pharmacokinetics andtolerance of cefuroxime axetil in volunteers during repeated do sing. Antimicrobial Agents andChemotherapy 25, 344-7 .Sydnor, A., Gwaltney, J. M., Cocchetto, D. M. & Scheld, W. M. (1989). Comparative evaluationof cefuroxime axetil and cefaclor for treatment of acute bacterial maxillary sinusitis. ArchivesOtolaryngologv Head & Neck Surgery 115, 1430-3.Wald, E. R. (1992). Sinusitis in children. New England Journal of Medicine 326, 319-23 .W ald, E. R., Chipon is, D. & Lades ma -M edina , J. (1986). Co mp arative effectiveness of amoxicillinand amoxicillin-clavulanate potassium in acute paranasal sinus infections in children: adouble-blind, placebo-controlled trial. Pediatrics 77, 795-800.Wald, E. R., Milmoe, G. J. , Bowen, A., Ledesma-Medina, J. , Salamon, N. & Bluestone, C. D.(1981). Acute maxillary sinusitis in children. New England Journal of Medicine 304, 749-54.Wald, E. R., Reilly, J. S., Casselbrant, M., Ledesma-Medina, J. , Milmoe, G. J. , Bluestone, C. D.et al. (1984). Treatment of acute maxillary sinusitis in childhood: a comparative study ofamoxicillin and cefaclor. Journal of Pediatrics 104, 297-302.

(Received 18 October 1995; returned 19 February 1996; revised 9 April 1996;accepted 10 June 1996)

byguestonJuly31,201

3

http://jac.oxfordjo

urnals.org/

Downloadedfrom

Cefuroxime Case Study

Documents

Transcript of Cefuroxime Case Study