title: The role of cefditoren in the treatment of lower community-acquired respiratory tract infections (LRTIs): from bacterial eradication to reduced lung inflammation and epithelial damage.
abstract: OBJECTIVE
  Lower respiratory tract infections (LRTIs), including pneumonia and acute exacerbations of Chronic Obstructive Pulmonary Disease (COPD), are among the most common diagnoses in both outpatient and inpatient settings. Due to the burden of LRTIs healthcare providers must adopt practices focused on improving outcomes with the aim to reduce treatment failure and antibiotic resistances. Moreover, the role of acute and chronic infection in the pathogenesis of COPD has received considerable attention, since chronic infection can contribute to airways inflammation and COPD progression. This review discusses the role of cefditoren for the treatment of LRTIs, compared with the definition of "appropriate" of the WHO as "the cost-effective use of antimicrobials which maximizes clinical therapeutic effect while minimizing both drug-related toxicity and the development of antimicrobial resistance".
  
  
  CONCLUSIONS
  Cefditoren appears to meet the definition of "appropriate" for the treatment of LRTIs. In fact, this molecule shows an adequate pharmacokinetic profile without the need for any adjustment also in aged patients with mild renal impairment or mild-to-moderate hepatic dysfunction. The low drug-drug interaction potential of cefditoren can be an advantage also in poly-treated patients. The antimicrobial spectrum of cefditoren includes both Gram+ and Gram- bacteria, with high activity against Streptococcus pneumoniae, including drug-resistant strains, Haemophilus infuenzae and Moraxella chatarrhalis. Last, recent findings suggested that cefditoren can be a valid alternative to levofloxacin in outpatients with acute exacerbation of COPD; in this setting a treatment with cefditoren showed to be associated with a significant reduction of some key inflammatory markers involved in epithelial damage, including KL-6 and IL-6.
authors.affiliation: Department of Health Sciences, Respiratory Unit, San Paolo Hospital, University of Milan, Italy. fulvio.braido@unige.it.
authors.forename: F
authors.initials: F
authors.lastname: Di Marco
authors.forename: F
authors.initials: F
authors.lastname: Braido
authors.forename: P
authors.initials: P
authors.lastname: Santus
authors.forename: N
authors.initials: N
authors.lastname: Scichilone
authors.forename: F
authors.initials: F
authors.lastname: Blasi
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002511:Cephalosporins / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology; D060740:Disease Eradication; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects; D006801:Humans; D008826:Microbial Sensitivity Tests; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; C073460:cefditoren