Effectiveness and safety evaluation of oral cefixime and moxifloxacin fixed dose combination in lower respiratory tract infections
DOI:
https://doi.org/10.18203/2349-3933.ijam20195232Keywords:
Antibiotic resistance, Cefixime, Fixed drug combination, Lower respiratory tract infection, MoxifloxacinAbstract
Background: Scientific literature advocates the need for combination therapies in combatting lower respiratory tract infection (LRTI). Cefixime (400 mg) and moxifloxacin (400 mg) fixed dose combination (FDC) is currently approved in India for the management of LRTI, but data related to its real world usage is lacking. The present study was designed to understand the real world use (effectiveness and safety) of this FDC in LRTI.
Methods: This retrospective study was conducted at out-patient departments of 5 hospitals between August 2018 and January 2019. After ethics committee approval, data of adults LRTI patients who received FDC of cefixime (400 mg) and moxifloxacin (400 mg) for at least 72 hours was collected. Improvement in LRTI symptoms (cough, sputum volume and purulence, fever, dyspnea, pleuritic chest pain, sleep disturbance, fatigue) were scored at baseline and follow-up using a 5-point severity scale. White blood cell (WBC) counts at baseline and end-of-treatment were compared.
Results: Data of 190 patients having mean age 42.33+16.15 years was evaluated. Majority were males (61.58%), with commonest LRTI infection being community acquired pneumonia (CAP) (84.21%). Commonest clinical symptom reported (97.37%) was cough. All patients showed improvement in symptoms and significant improvement in all mean symptom scores were noted (p<0.05). Of the 30 patients having WBC above normal range, 29 showed a decrease in count at end of treatment. No adverse events were reported.
Conclusions: Oral FDC of cefixime (400 mg) and moxifloxacin (400 mg) was efficacious in improving all symptoms reported by LRTI patients without causing any adverse event.
References
Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, et al. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet. 2016;388(10053):1459-544.
Brar NK, Niederman MS. Management of community-acquired pneumonia: a review and update. Therapeut Advances in Respirat Dis. 2011;5(1):61-78.
Yoon HK. Changes in the epidemiology and burden of community-acquired pneumonia in Korea. The Korean J Internal Med. 2014;29(6):735.
Caballero J, Rello J. Combination antibiotic therapy for community-acquired pneumonia. Annals Intensive Care. 2011;1(1):48.
Laxminarayan R, Chaudhury RR. Antibiotic resistance in India: drivers and opportunities for action. PLoS Med. 2016;13(3):1001974.
Van Boeckel TP, Gandra S, Ashok A, Caudron Q, Grenfell BT, Levin SA, et al. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. The Lancet Infect Dis. 2014;14(8):742-50.
Brunton S. Treating community-acquired bacterial respiratory tract infections: update on etiology diagnosis, and antimicrobial therapy. J Family Pract. 2005;54(4):357-65.
Mehta KC, Dargad RR, Borade DM, Swami OC. Burden of antibiotic resistance in common infectious diseases: role of antibiotic combination therapy. J clinic diagnos research: JCDR. 2014;8(6):05.
Pena-Miller R, Laehnemann D, Jansen G, Fuentes-Hernandez A, Rosenstiel P, Schulenburg H, et al. When the most potent combination of antibiotics selects for the greatest bacterial load: the smile-frown transition. PLoS Biolog. 2013;11(4):1001540.
Rahmel T, Asmussen S, Karlik J, Steinmann J, Adamzik M, Peters J. Moxifloxacin monotherapy versus combination therapy in patients with severe community-acquired pneumonia evoked ARDS. BMC Anesthesiol. 2017;17(78):1-9.
Lee MT, Lee SH, Chang SS, Chan YL, Pang L, Hsu SM, et al. Comparative treatment failure rates of respiratory fluoroquinolones or β-lactam+ macrolide versus β-lactam alone in the treatment for community-acquired pneumonia in adult outpatients: An analysis of a nationally representative claims database. Medicine. 2015;94(39).
An MM, Zou Z, Shen H, Gao PH, Cao YB, Jiang YY. Moxifloxacin monotherapy versus β-lactam-based standard therapy for community-acquired pneumonia: a meta-analysis of randomised controlled trials. Intern J Antimicro Agents. 2010;36(1):58-65.
Ige OM, Okesola AO. Comparative efficacy and safety of cefixime and ciprofloxacin in the management of adults with community-acquired pneumonia in Ibadan, Nigeria. Annals Ibadan Postgraduate Med. 2015;13(2):72-8.
Vardakas KZ, Trigkidis KK, Apiranthiti KN, Falagas ME. The dilemma of monotherapy or combination therapy in community‐acquired pneumonia. European J Clinic Investig. 2017;47(12):12845.
Raz-Pasteur A, Shasha D, Paul M. Fluoroquinolones or macrolides alone versus combined with β-lactams for adults with community-acquired pneumonia: Systematic review and meta-analysis. Intern J Antimicro Agents. 2015;46(3):242-8.
