Cefuroxime
M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson in Kucers’ The Use of Antibiotics, 2017
Cefuroxime is still among the drugs of choice for the treatment of acute exacerbations of COPD. H. influenzae, S. pneumoniae, and M. catarrhalis are all frequently implicated. A regimen of 500 mg cefuroxime axetil given twice a day for 10 days was used with a reported clinical success rate of 83.1% (Zervos et al., 2003). More recently, a lower dose of 250 mg twice a day for the same duration achieved an equivalent cure rate of 82.7%. Clinical success in patients infected with H. influenzae isolates was 82.5% (Alvarez-Sala et al., 2006). In a randomized clinical trial comparing levofloxacin with cefuroxime for the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD), treatment was clinically successful in 90.4% of patients in the levofloxacin group and in 90.6% of patients in the cefuroxime group (95% confidence interval: 9.40–10.91), within a noninferiority margin of 10% (Yoon et al., 2013). According to the Agency for Healthcare Research and Quality (2013), second-generation cephalosporins are considered an alternative treatment for mild exacerbations of COPD, with no risk factors for poor outcome.
Cephalosporins
Thomas T. Yoshikawa, Shobita Rajagopalan in Antibiotic Therapy for Geriatric Patients, 2005
The oral cephalosporin cefpodoxime proxetil is an esterified prodrug like cefur-oxime axetil; it is classified as a third-generation cephalosporin because of its broad range of activity that includes S. aureus, S. pneumoniae, M. catarrhalis, Neisseria spp., and many Enterobacteriaceae. It is only 50% absorbed and has a limited spectrum of activity compared with parenteral third-generation cephalosporins, and should not be considered as oral follow-up therapy without serious thought to reliably achievable serum concentrations and sensitivity of the pathogens being treated. Fluoroquinolone antibiotics, for example, have far superior pharmacokinetics and antimicrobial activity, and are significantly less expensive. Cefpodoxime proxetil may be used for follow-up therapy of community-acquired pneumonia in which atypical pathogens are unlikely or for acute exacerbation of chronic obstructive pulmonary disease (COPD).
Chapter 8 Antibiotics: help or hindrance?
Paul Elliott, Julie Storr, Annette Jeanes, Barry Professor Cookson, Benedetta Professor Allegranzi, Marilyn ADJ Professor Cruickshank in Infection Prevention and Control, 2017
The clear message in this document for UK practitioners is only to start antibiotics where a bacterial infection has been clearly identified: once culture has been obtained. Once started, the prescription should be reviewed. Antibiotics should be switched as quickly as possible if necessary when treatment has started prior to cultures being obtained. Intravenous antibiotics should be changed to oral as soon as possible. The programme is focused on use of guidelines, education and audit of practice. Similar guidance is available from the CDC website in the United States. A small study93 suggests that ‘introducing the policy maker’ to the decision to prescribe may damage the doctor–patient relationship. The study, while not focused on antibiotic prescribing, found that doctors may wish to preserve the relationship with the patient by using a flexible approach to guidelines. A study undertaken94 in five European countries and Argentina examined the use of antibiotics in acute exacerbation of chronic obstructive pulmonary disease. The study explored the predictors for prescribing an antibiotic and whether the use of C-reactive protein (CRP) testing reduced prescribing. They found that GPs who used the CRP test were less likely to prescribe an antibiotic. CRP was used as a supplementary test and resulted in fewer antibiotics being prescribed. Tests such as these could be useful in reducing the rate of antibiotic prescribing through clinical presentation alone. Purulent sputum was the highest indicator for a prescription.
Pharmacotherapeutic management of bronchial infections in adults: non-cystic fibrosis bronchiectasis and chronic obstructive pulmonary disease
Published in Expert Opinion on Pharmacotherapy, 2020
Marta Di Pasquale, Stefano Aliberti, Marco Mantero, Andrea Gramegna, Francesco Blasi
Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) represent a key-moment in the progression of COPD and it is associated to a decline in health status and lung function [8,9]. The true incidence of AECOPD is quite difficult to assess because about 50% of exacerbations are not reported by patients [8]. Costs on health care systems increase with exacerbation frequency, severity, need of hospitalization, relapses and with the presence of comorbidities [8,9]. Reducing AECOPD treatment failure and relapse could contribute to reduce the burden of disease and ameliorate the management of COPD patients [10]. Recents studies showed that approximately 80% of patients admitted for AECOPD received antibiotic treatments, even if less than 25% had an evidence of bacterial infection [11]. Studies also suggest that the majority of bronchial infections are primarly viral, nevertheless antibiotic treatment is prolonged during hospitalization, representing inappropriate use [12].
Novel applications for serum procalcitonin testing in clinical practice
Published in Expert Review of Molecular Diagnostics, 2018
Justin J. Choi, Matthew W. McCarthy
Distinguishing between bacterial pneumonia and an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) can be difficult clinically given overlapping clinical features and disease presentations [101]. In both conditions, patients may develop shortness of breath, cough, lethargy, and purulent sputum. Unfortunately, many of the studies involving PCT including patients with respiratory illness and COPD did not include microbiologic assessment to ‘rule-in’ or ‘rule-out’ bacterial infection [102]. Notably, the common cutoff value of 0.25 ng/mL to ‘rule-out’ bacterial infection is based on recovery without antibiotics or with an abbreviated course as a surrogate marker for absence of infection rather than microbiologic data demonstrating absence of infection. The absence of microbiologic data has given many pause is using PCT as a ‘rule-out’ marker [103–105].
Prognostic and diagnostic significance of mid-regional pro-atrial natriuretic peptide in acute exacerbation of chronic obstructive pulmonary disease and acute heart failure: data from the ACE 2 Study
Published in Biomarkers, 2018
Mohammad Osman Pervez, Jacob A. Winther, Jon Brynildsen, Heidi Strand, Geir Christensen, Arne Didrik Høiseth, Peder L. Myhre, Ragnhild Røysland, Magnus Nakrem Lyngbakken, Torbjørn Omland, Helge Røsjø
Acute dyspnea is a common symptom among patients admitted to Emergency Departments (ED). A considerable proportion of patients with dyspnea suffer from acute heart failure (HF) or acute exacerbation of chronic obstructive pulmonary disease (AECOPD), but making the correct diagnosis and provide early risk assessment in these mainly elderly patients can be challenging (Guha and McDonagh 2013).
Related Knowledge Centers
- Cough
- Respiratory Tract Infection
- Shortness of Breath
- Streptococcus Pneumoniae
- Lung
- Chronic Obstructive Pulmonary Disease
- Pneumothorax
- Haemophilus Influenzae
- Sputum
- Shortness of Breath
- Phlegm