Skip to main content
SpringerLink
Log in

Sequential therapy with cefuroxime and cefuroxime-axetil for community-acquired lower respiratory tract infection in the oldest old

  • Original Article
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Background and aims: Community-acquired lower respiratory tract infection (CALRTI) is the most common infection requiring hospitalization in the elderly. Sequential antibiotic therapy offers the potential for earlier functional rehabilitation, shorter length of hospital stay and lower costs. We studied the efficacy and safety of an empiric sequential antibiotic therapy with cefuroxime-cefuroxime axetil in elderly patients hospitalized with a CALRTI. Methods: A prospective, randomized, open-label, in-hospital study of cefuroxime IV 750 mg tid for 10 days (IV group) vs cefuroxime 750 mg IV tid for 3 days, followed by cefuroxime-axetil PO 500 mg bid for 7 days (sequence group), when clinical (symptoms improved and fever disappeared) and/or laboratory response [decrease in C-reactive protein (CRP)] occurred. Results: A total of 142 patients, 71 (mean age: 83.3 (±6 SD), M/F ratio: 1.1) in the IV group, and 71 (mean age: 81.5 (±7 SD), M/F ratio: 1.5) in the sequence group, were included in the study. Eighty-three (58.4%) presented with radiologically confirmed pneumonia (CAP) and 59 (41.6%) with non-pneumonic LRTI (NPLRTI) (p=ns between study groups). Treatment was considered effective in 84.5% (60/71) of patients in the IV group and 80.3% (57/71) in the sequence group (p=ns). Therapy failed in 15% (21/142) of the study population (p=ns between study groups) and, after day 3 of therapy, 8.45% (6/71) failed in both study groups. By the end of treatment, two patients had died in each study group, and total in-hospital mortality was 8.5% (12/142, p=ns between study groups). The length of hospital stay (LOS) did not differ between the two study groups. Conclusions: When a favorable clinical or biochemical response occurs on day 3 of IV cefuroxime therapy, further therapy with oral cefuroxime-axetil is as effective and safe as a full course of cefuroxime IV in elderly patients hospitalized with CALRTI. However, LOS was not reduced after sequential antibiotic therapy in this population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Greenberg SB. Viral respiratory tract infections in elderly patients and patients with chronic obstructive pulmonary disease. Am J Med 2002; 112: 28S–32S.

    Article  PubMed  Google Scholar 

  2. Flamaing J, Engelmann I, Joosten E, Van Ranst M, Verhaegen J, Peetermans WE. Viral lower respiratory tract infection in the elderly: a prospective in-hospital study. Eur J Clin Microbiol Infect Dis 2003; 22: 720–5.

    Article  PubMed  CAS  Google Scholar 

  3. Johnson D, Carriere KC, Sin Y, Marrie T. Appropriate antibiotic utilization in seniors prior to hospitalization for community acquired pneumonia is associated with decreased in-hospital mortality. J Clin Pharm Ther 2004; 29: 231–9.

    Article  PubMed  CAS  Google Scholar 

  4. Ramirez JA, Vargas S, Ritter GW, et al. Early switch from intravenous to oral antibiotics and early hospital discharge: a prospective observational study of 200 consecutive patients with community-acquired pneumonia. Arch Intern Med 1999; 159: 2449–54.

    Article  PubMed  CAS  Google Scholar 

  5. Lelekis M, Gould IM. Sequential antibiotic therapy for cost containment in the hospital setting: why not? J Hosp Infect 2001; 48: 249–57.

    Article  PubMed  CAS  Google Scholar 

  6. Vogel F. Intravenous/oral sequential therapy in patients hospitalised with community-acquired pneumonia: which patients, when and what agents? Drugs 2002; 62: 309–17.

    Article  PubMed  CAS  Google Scholar 

  7. Janssens JP, Krause KH. Pneumonia in the very old. Lancet Infect Dis 2004; 4: 112–24.

    Article  PubMed  Google Scholar 

  8. Siegel RE, Halpem NA, Almenoff PL, Lee A, Cashin R, Greene JG. A prospective randomized study of inpatient iv antibiotics for community-acquired pneumonia: the optimal duration of therapy. Chest 1996; 110: 965–71.

    Article  PubMed  CAS  Google Scholar 

  9. Iakovlev SV, Suvorova MP, Dvoretskii LI, Vlasenko NA, Shakhova TV. Stepwise therapy of community-acquired pneumonia: results of cefuroxime and cefuroxime axetil study. Antibiot Khimioter 1998; 43: 7–11.

    PubMed  CAS  Google Scholar 

  10. Vogel F, Droszcz W, Vondra V, Rasenberg K, Marr C, Staley H. Sequential therapy with cefuroxime followed by cefuroxime axetil in acute exacerbations of chronic bronchitis. J Antimicrob Chemother 1997; 40: 863–71.

    Article  PubMed  CAS  Google Scholar 

  11. Van den Brande P, Vondra V, Vogel F, Schlaeffer F, Staley H, Holmes C. Sequential therapy with cefuroxime followed by cefuroxime axetil in community-acquired pneumonia. Chest 1997; 112: 406–15.

    Article  PubMed  Google Scholar 

  12. Siegel RE, Alicea M, Lee A, Blailock R. Comparison of 7 versus 10 days of antibiotic therapy for hospitalized patients with uncomplicated community acquired pneumonia: a prospective, randomized, double blind study. Am J Ther 1999; 6: 217–22.

    Article  PubMed  CAS  Google Scholar 

  13. Brambilla C, Kastanakis S, Knight S, Cunningham K. Cefuroxime and cefuroxime axetil versus amoxicillin plus clavulanic acid in the treatment of lower respiratory tract infections. Eur J Clin Microbiol Infect Dis 1992; 11: 118–24.

    Article  PubMed  CAS  Google Scholar 

  14. File TM, Segreti J, Dunbar L, et al. A multicenter, randomized study comparing the efficacy and safety of intravenous and/or oral lev-ofloxacin versus ceftriaxone and/or cefuroxime axetil in the treatment of adults with community acquired pneumonia. Antimicrob Agents Chemother 1997; 41: 1965–72.

    PubMed  CAS  Google Scholar 

  15. Vergis EN, Indorf A, File TM, et al. Aäthromycin vs cefuroxime plus erythromycin for empirical treatment of community-acquired pneumonia in hospitalized patients: a prospective, randomized, multicenter trial. Arch Intern Med 2000; 160: 1294–300.

    Article  PubMed  CAS  Google Scholar 

  16. Stille W, Sass R, Klinge R, Loos U, Althoff PH, KuBmann KH. Ceftriaxone i.v./cefetametpivoxil versus cefuroxim i.v./cefuroximaxetil: pharmacoeconomic comparison of intravenous-oral sequential therapy in patients with community-acquired pneumonia. Chemotherapie J 2000; 9: 87–92.

    Google Scholar 

  17. Wilson R, Langan C, Ball P, Bateman K, Pypstra R, The Gemifloxacin 207 Clinical Study Group. Oral gemifloxacin once daily for 5 days compared with sequential therapy with i.v. ceftriaxone/oral cefuroxime (maximum of 10 days) in the treatment of hospitalized patients with acute exacerbations of chronic bronchitis. Resp Med 2003; 97: 242–9.

    Article  CAS  Google Scholar 

  18. Fine MJ, Medsger AR, Stone RA, et al. The hospital discharge decision for patients with community-acquired pneumonia. Results from the Pneumonia Patient Outcome Research Team cohort study. Arch Intern Med 1997; 157: 47–56.

    CAS  Google Scholar 

  19. Torres OH, Munoz J, Ruiz D, et al. Outcome predictors of pneumonia in elderly patients: importance of functional assessment. J Am Geriatr Soc 2004; 52: 1603–9.

    Article  PubMed  Google Scholar 

  20. Mundy LM, Leed TL, Darst K, Schnitzler MA, Dunagan WC. Early mobilization of patients hospitalized with community-acquired pneumonia. Chest 2003; 124: 883–9.

    Article  PubMed  Google Scholar 

  21. Louis TJ. Intravenous to oral stepdown antibiotic therapy: another cost-effective strategy in an era of shrinking health care dollars. Can J Infect Dis 1994; 5: 45C-50C.

    Google Scholar 

  22. Verhaegen J, Van de Ven J, Verbiest N, Van Eldere J, Verbist L. Evolution of Streptococcus pneumoniae serotypes and antibiotic resistance in Belgium — update (1994–1998). Clin Microbiol Infect 2000; 6: 308–15.

    Article  PubMed  CAS  Google Scholar 

  23. Jacobs MR, Felmingham D, Appelbaum PC, Grüneberg RN, The Alexander Project Group. The Alexander Project 1998–2000: susceptibility of pathogens isolated from community-acquired respiratory tract infection to commonly used antimicrobial agents. J Antimicrob Chemother 2003; 52: 229–46.

    Article  PubMed  CAS  Google Scholar 

  24. Scott LJ, Ormrod D, Goa KL. Cefuroxime axetil: an updated review of its use in the management of bacterial infections. Drugs 2001; 61: 1455–500.

    Article  PubMed  CAS  Google Scholar 

  25. Delmée M, Carpentier M, Glupczynski Y, et al. In vitro susceptibilities of 180 clinical isolates of Haemophilus influenzae to ampicillin, amoxicillin/clavulanate, cefaclor, cefuroxime, cefotaxime, clarithromycin. and azithromycin. Acta Clin Belg 1996; 51: 237–43.

    Google Scholar 

  26. Veyssier P, Darchis JP, Devillers A. Pharmacokinetics of cefuroximeaxetil after oral administration during six days treatment in elderly patients. Therapie 1988; 43: 355–9.

    PubMed  Google Scholar 

  27. Kaplan V, Clermont G, Griffin MF, et al. Pneumonia: still the old man’s friend? Arch Intern Med 2003; 163: 317–23.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    Johan Flamaing MD & Björn Meijers

  2. Department of General Internal Medicine and Infectious Diseases, University Hospitals Leuven, Leuven, Belgium

    Daniël Knockaert & Willy E. Peetermans

  3. Department of Microbiology, University Hospitals Leuven, Leuven, Belgium

    Jan Verhaegen

Authors
  1. Johan Flamaing MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniël Knockaert
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Björn Meijers
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jan Verhaegen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Willy E. Peetermans
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Johan Flamaing MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Flamaing, J., Knockaert, D., Meijers, B. et al. Sequential therapy with cefuroxime and cefuroxime-axetil for community-acquired lower respiratory tract infection in the oldest old. Aging Clin Exp Res 20, 81–86 (2008). https://doi.org/10.1007/BF03324752

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03324752

Keywords

Search

Navigation