Cefuroxime axetil in the treatment of sinusitis. A review
G. E. Pakes, J. A. Graham, A. M. Rauch and J. J. Collins
Glaxo Inc, Glaxo Inc Research Institute, Research Triangle Park, NC.
Cefuroxime axetil is a beta-lactamase-stable, second-generation, oral
cephalosporin that penetrates sinus tissue in concentrations exceeding the
MIC90 values (the minimum concentration of drug needed to inhibit the
growth of 90% of an isolate of a particular microorganism) for pathogens
most commonly associated with acute sinusitis, including Streptococcus
pneumoniae and Haemophilus influenzae. A review of all clinical data
published to date demonstrates that cefuroxime axetil has been evaluated in
the treatment of acute sinusitis and acute exacerbations of chronic
sinusitis ("acute-on-chronic sinusitis") in 18 clinical trials involving
1516 assessable patients. In 12 randomized, comparative trials, the rates
of satisfactory clinical outcomes (cure or improvement, 79% to 100%) and
bacteriologic eradication (84% to 100%) reported with the use of 250 mg of
cefuroxime axetil twice daily were similar to those observed with the use
of amoxicillin, amoxicillin/clavulanate potassium, cefaclor, cefadroxil,
cefixime, clarithromycin, and doxycycline. In these comparisons, no
antibiotic demonstrated any therapeutic advantages over cefuroxime axetil
regarding time to symptom abatement. Cefuroxime axetil was at least as well
tolerated as the other antibiotics. Overall, the role of cefuroxime axetil
in the treatment of sinusitis appears to be as one of the broad-spectrum
antibiotics that can be used for infections due to the most commonly
implicated sinus pathogens, especially those due to the increasing number
of relatively penicillin-resistant strains of S pneumoniae and
beta-lactamase-producing strains of H influenzae and Moraxella catarrhalis.
