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A Clinical and Economic Comparison of ft Roxithromycin 150mg Twice Daily vs Amoxicillin 500mg/Clavulanic Acid 125mg Three Times Daily for the Treatment of Lower Respiratory Tract Infections in General Practice

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Summary

242 patients over 16 years of age with community-acquired lower respiratory tract infection (LRTI) were randomised to receive either roxithromycin 150mg twice daily or amoxicillin 500mg/clavulanic acid 125mg three times daily for 7 days, with a further 7 days if insufficient response was seen. Patients in each group were found to be well matched for age and gender. Intention-to-treat analysis showed that clinical response at 7 days was 69% for roxithromycin and 56% for amoxicillin/clavulanic acid (p = 0.05) and at study end was 91% for both treatment groups. There were fewer second treatment courses in the roxithromycin group (26 vs 38%, p = 0.04) and a shorter mean treatment duration (8.29 days vs 9.34 days, p>0.05). 12 patients (9.8%) on roxithromycin and 19 (17.1%) on amoxicillin/clavulanic acid had adverse effects possibly or probably related to the antibiotic (p>0.05). A prospective economic analysis showed that the benefit (difference between the 2 treatment costs) per clinical success was $A 17.04 in favour of roxithromycin. Roxithromycin appears to be a more appropriate choice than amoxicillin/clavulanic acid for the treatment of LRTI in the community given the more appropriate in vitro spectrum, the efficacy against all common pathogens, greater cost-effectiveness, the more convenient dosage regimen, and because it is better tolerated.

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References

  1. Young RA, Gonzalez JP, Sorkin EM. Roxithromycin: a review of it’s antibacterial activity, pharmacokinetic properties and clinical efficacy. Drugs 1989; 37: 8–41

    Article  PubMed  CAS  Google Scholar 

  2. Saikku P. The epidemiology and significance of Chlamydia pneumoniae. J Infect 1992; 25Suppl. 1: 27–34

    Article  PubMed  Google Scholar 

  3. Foy HM. Infections caused by Mycoplasma pneumoniae and possible carrier state in different populations of patients. Clin Infect Dis 1993; 17Suppl. 1: S37–46

    Article  PubMed  Google Scholar 

  4. Neu HC, Wilson APR, Gruneberg RN. Amoxycillin/clavulanic acid: a review of its efficacy in over 38,500 patients from 1979 to 1992. J Chemother 1993; 5: 67–93

    PubMed  CAS  Google Scholar 

  5. Dautzenberg B, Scheimberg A, Brambilla C, et al. Comparison of 2 oral antibiotics, roxithromycin and amoxycillin plus clavulanic acid, in lower respiratory tract infections. Diagn Microbiol Infect Dis 1992; 15: 85S–89S

    Article  PubMed  CAS  Google Scholar 

  6. Lousbergh D, Jochems G, Everaert L, et al. Roxithromycin versus amoxycillin-clavulanic acid in the treatment of respiratory tract infections. Diagn Microbiol Infect Dis 1992; 15: 91S–95S

    Article  PubMed  CAS  Google Scholar 

  7. Bartlett JG, Ryan KJ, Smith TF, et al. editors. Cumitech 7A. The laboratory diagnosis of lower respiratory tract infections. American Society for Microbiology, Washington D.C: 1987

    Google Scholar 

  8. National Committee for Clinical Laboratory Standards (NCCLS). Performance standards for antimicrobial susceptibility testing. 3rd Informational Supplement. NCCLS Document M100-S3, Vol. 11, No. 17, December 1991

  9. Lang SDR, editor. Antibiotic Guide — Medlab 1993. Adis International Limited, Auckland, New Zealand, 1993

    Google Scholar 

  10. Victorian Antibiotic Guidelines. 8th ed, Victorian Medical Postgraduate Foundation Inc. Australia: Interprint, 1994: 30–4

  11. Scott WG, McKendry CG, Scott HM. Methodologies for economic evaluation of high technology in health care. Department of Health, Wellington: 1992

    Google Scholar 

  12. Commonwealth of Australia. Health Insurance regulations (1992–1993) General Medical Services Table. Commonwealth Government Printer, Canberra, 1992

  13. Schedule of Pharmaceutical Benefits for approved pharmacists and medical practitioners, April 1992. Australian Government Publishing Service, Canberra: 1992

  14. Dunlay J, Reinhard R, Donn Roi L. A placebo controlled double-blind study of erythromycin in adults with acute bronchitis. J Fam Pract 1987; 25: 137–41

    PubMed  CAS  Google Scholar 

  15. Brickfield FX, Carter WH, Johnson RE. Erythromycin in the treatment of acute bronchitis in a community practice. J Fam Pract 1986; 23: 119–22

    PubMed  CAS  Google Scholar 

  16. Franks P, Gleiner JA. The treatment of acute bronchitis with trimethoprim and sulphamethoxazole. J Fam Pract 1984; 19: 185–90

    PubMed  CAS  Google Scholar 

  17. Anthonisen NR, Manfreda J, Warren CPW, et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 1987; 106: 196–204

    PubMed  CAS  Google Scholar 

  18. Brown RB, Sands ML, Morris AB. Community acquired pneumonia caused by mixed aerobic pathogens. Infect Dis Clin Pract 1993; 2: 32–9

    Article  Google Scholar 

  19. Mandell GL, Douglas RG, Bennett JE. Principles and practice of infectious disease, 3rd ed. London: Churchill, 1990

    Google Scholar 

  20. Grayston JT. Infections caused by Chlamydia pneumoniae strain TWAR. Clin Infect Dis 1992; 15: 757–63

    Article  PubMed  CAS  Google Scholar 

  21. Lentino JR, Lucks DA. Non-value of sputum culture in the management of lower respiratory tract infection. J Clin Microbiol 1987; 25: 758–62

    PubMed  CAS  Google Scholar 

  22. Barker CE, Sillis M, Wreghitt TG. Evaluation of Serodia Myco II particle agglutination test for detecting Mycoplasma pneumoniae antibody: comparison with μ-capture ELISA and indirect immunofluorescence. J Clin Pathol 1990; 43: 163–5

    Article  PubMed  CAS  Google Scholar 

  23. Scott WG, Tilyard MW, Dovey SM, et al. Roxithromycin versus cefaclor in lower respiratory tract infection. A general practice pharmacoeconomic study. PharmacoEconomics 1993; 4: 122–30

    Article  PubMed  CAS  Google Scholar 

  24. Saito A. Bacteriological and clinical evaluation of roxithromycin in pneumonia. JAMA 1990; 6Suppl. SEA: 20–3

    Google Scholar 

  25. Cooper BC, Mullins PR, Jones MR, et al. Clinical efficacy of roxithromycin in the treatment of adults with upper and lower respiratory tract infection due to Haemophilus influenzae. Drug Investigation 1994; 7: 299–314

    Article  Google Scholar 

  26. Marsac JH. Clinical features and diagnosis of community-acquired pneumonia. JAMA 1990; 6Suppl. SEA: 6–9

    Google Scholar 

  27. De Rose V, Ferrara A, Mangiarotti P, et al. Penetration of roxithromycin into bronchial secretions. Int J Clin Pharmacol Res 1988; 8: 107–10

    PubMed  Google Scholar 

  28. Todd PA, Benfield P. Amoxycillin/clavulanic acid. An update of its antibacterial activity, pharmacokinetic properties and therapeutic use. Drugs 1990; 39: 264–307

    Article  PubMed  CAS  Google Scholar 

  29. Simon C, Gatzemeier U. Serum and sputum levels of cefaclor. Postgrad Med J 1979; 55Suppl 4: 30–4

    PubMed  CAS  Google Scholar 

  30. Anderson R, Van Rensburg CEJ, Joone G, et al. An in-vitro comparison of the intraphagocytic bioactivity of erythromycin and roxithromycin. J Antimicrob Chemother 1987; 20Suppl. B: 57–68

    PubMed  Google Scholar 

  31. Carlier MB, Zenebergh A, Tulkens PM. Cellular uptake and subcellular distribution of roxithromycin and erythromycin in phagocytic cells. J Antimicrob Chemother 1987; 20Suppl. B: 47–56

    PubMed  CAS  Google Scholar 

  32. Tulkens PM, Scorneaux B. Activity of roxithromycin against macrophage associated Haemophilus influenzae. Poster No. 216, 16th ICC, Jerusalem: 1989

    Google Scholar 

  33. Scott WG, Cooper BC, Scott HM, Karalus NC, Garrett J, et al. Roxithromycin and lower respiratory tract infections. N Z Med J 1994; 107: 208

    Google Scholar 

  34. Sanson-Fisher R, Bowman J, Armstrong S. Factors affecting nonadherence with antibiotics. Diagn Microbiol Infect Dis 1992; 15: 103S–109S

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Departments of Respiratory Medicine and Pathology, Waikato Hospital, Private Bag, Hamilton, New Zealand

    Noel C. Karalus, R. A. Leng & R. T. M. Cursons

  2. Department of Respiratory Medicine, Greenlane Hospital, Auckland, New Zealand

    J. E. Garrett

  3. Department of Microbiology, Medlab, Auckland, New Zealand

    S. D. R. Lang

  4. WG Scott and Associates, Economists, and Wellington Polytechnic, Wellington, New Zealand

    W. G. Scott & H. M. Scott

  5. Castle Hill, Sydney, Australia

    G. N. Kostalas

  6. Delpharm Ltd, Auckland, New Zealand

    B. C. Cooper

Authors
  1. Noel C. Karalus
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  2. J. E. Garrett
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  3. S. D. R. Lang
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  4. W. G. Scott
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  5. R. A. Leng
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  6. G. N. Kostalas
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  7. R. T. M. Cursons
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  8. B. C. Cooper
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  9. H. M. Scott
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Karalus, N.C., Garrett, J.E., Lang, S.D.R. et al. A Clinical and Economic Comparison of ft Roxithromycin 150mg Twice Daily vs Amoxicillin 500mg/Clavulanic Acid 125mg Three Times Daily for the Treatment of Lower Respiratory Tract Infections in General Practice. Drug Invest 8, 179–190 (1994). https://doi.org/10.1007/BF03259434

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  • DOI: https://doi.org/10.1007/BF03259434

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