Sequential therapy with cefuroxime and cefuroxime-axetil for community-acquired lower respiratory tract infection in the oldest old.
OBJECTIVE
Community acquired lower respiratory tract infection (CALRTI) is the most common infection requiring hospitalization in the elderly. Sequential antibiotic therapy offers the potential for earlier functional rehabilitation, shorter length of hospital stay and lower costs. We studied the efficacy and safety of an empiric sequential antibiotic therapy with cefuroxime-cefuroxime axetil in elderly patients hospitalized with a CALRTI.


METHODS
A prospective, randomized, open-label, in-hospital study of cefuroxime IV 750 mg tid for 10 days (IV group) vs cefuroxime 750 mg IV tid for 3 days, followed by cefuroxime-axetil PO 500 mg bid for 7 days (sequence group), when clinical (symptoms improved and fever disappeared) and/or laboratory response [decrease in C-reactive protein (CRP)] occurred.


RESULTS
A total of 142 patients, 71 (mean age: 83.3 (+/-6 SD), M/F ratio: 1.1) in the IV group, and 71 (mean age: 81.5 (+/-7 SD), M/F ratio: 1.5) in the sequence group, were included in the study. Eighty-three (58.4%) presented with radiologically confirmed pneumonia (CAP) and 59 (41.6%) with non-pneumonic LRTI (NPLRTI) (p=ns between study groups). Treatment was considered effective in 84.5% (60/71) of patients in the IV group and 80.3% (57/71) in the sequence group (p=ns). Therapy failed in 15% (21/142) of the study population (p=ns between study groups) and, after day 3 of therapy, 8.45% (6/71) failed in both study groups. By the end of treatment, two patients had died in each study group, and total in-hospital mortality was 8.5% (12/142, p=ns between study groups). The length of hospital stay (LOS) did not differ between the two study groups.


CONCLUSIONS
When a favorable clinical or biochemical response occurs on day 3 of IV cefuroxime therapy, further therapy with oral cefuroxime-axetil is as effective and safe as a full course of cefuroxime IV in elderly patients hospitalized with CALRTI. However, LOS was not reduced after sequential antibiotic therapy in this population.
Flamaing
Johan
J
Department of Geriatric Medicine, University Hospitals Leuven, 3000 Leuven, Belgium. johan.flamaing@uz.kuleuven.be
Knockaert
Daniël
D
Meijers
Björn
B
Verhaegen
Jan
J
Peetermans
Willy E
WE
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D002444:Cefuroxime / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein; D002444:Cefuroxime; C040738:cefuroxime axetil