Reinfection was deemed to have occurred if any new pathogen was seen between the TOC visit and the LTFU visit with an accompanying worsening of clinical condition. Patients were deemed clinically evaluable if they had clinical evidence of AECB without radiographic evidence of pneumonia, had no resistant organisms at baseline, took study drug as prescribed, did not take non-study systemic antibacterial therapy for concurrent infections and were clinically assessed on the days specified in the protocol.
Therapy duration and prior antibacterial rules described above for evaluable patients also applied for clinically evaluable patients. Patients were not excluded from this data set as a result of inadequate microbiological data i. Patients in the intent-to-treat population were all those randomized to treatment. The study was designed with a sample size of evaluable patients per treatment group.
All statistical tests were performed with SAS software. Of the patients enrolled, were randomized to the cefdinir group and to the cefprozil group.
Patients were evenly distributed by gender, race and age across both treatment groups. The median time for which patients took study medication was 5 days for cefdinir and 10 days for cefprozil. The presence and severity of clinical signs and symptoms at study admission were similar for patients in the two treatment groups data not shown.
Most of the patients in both treatment arms were current or former smokers. Evaluable patients were classified according to sputum production, sputum purulence and dyspnoea at admission using the criteria proposed by Anthonisen et al.
For the most prevalent of these isolates, their susceptibilities to the study drugs are shown in Table III. These rates include S. Twenty-five per cent of the H. Patients were most frequently excluded from the evaluable subset because no respiratory tract pathogen was isolated from the admission sputum specimen 83 cefdinir-treated patients, 56 cefprozil-treated patients.
Other common reasons for exclusion included clinical and microbiological assessments having been done at different times from those specified in the protocol, both occurring slightly more frequently in the cefprozil treatment group. Patients could have been excluded for more than one reason. No admission strains of H. Three admission strains of H. All three of these patients were classified as cures at the TOC visit; two of the three strains were eradicated at the TOC visit.
Six admission strains of H. Four admission isolates of S. One of these strains was isolated from a patient randomized to cefdinir. This patient was lost to follow up. Three of the admission MRSAs were isolated from patients randomized to cefprozil. Two of these three patients were classified as a cure at TOC and one was a failure.
All three strains were eradicated at TOC. One admission isolate of S. This strain was isolated from a cefprozil-treated patient and was susceptible to cefprozil. Ten admission isolates of S. Four of these isolates were from four patients randomized to cefdinir. Three of these four strains were susceptible to cefdinir; one was intermediately susceptible to cefdinir.
Six admission isolates of S. All of these isolates were susceptible to cefprozil. Four of these six patients were classified as failures at TOC, one was a cure and one was unknown. Five of the six strains persisted at TOC; the status of the sixth strain was unknown.
The most prevalent superinfecting pathogen was H. None of these superinfecting H. Reinfections were seen in eight patients in the cefdinir arm and five patients in the cefprozil arm. Ten cefdinir-treated patients satisfied all evaluability criteria except that they had at least one admission pathogen that was susceptible to cefdinir and resistant to cefprozil. Six of the 10 patients were assessed as clinical cures at the TOC visit. Safety of the drugs was analysed for all patients who received study medication.
The most frequent adverse events on therapy for both cefdinir- and cefprozil-treated patients were diarrhoea and headache. The most common adverse events given as reasons for discontinuing cefdinir were diarrhoea and abdominal pain.
Two patients died during the study, one in the cefdinir arm and one in the cefprozil arm. Neither death was related to study medication. The clinical laboratory changes from admission to the first visit after therapy showed no clinically significant changes except for a trend toward lower leucocyte and polymorphonuclear leucocyte counts, as well as lower urine leucocyte counts and urine ketone concentrations, for both treatment groups. Cefprozil patients also tended to have lower urine protein, urine blood and urine bilirubin concentrations at the first visit after therapy compared with admission values.
This study demonstrated that a 5 day course of cefdinir was associated with improved clinical outcome and equivalent microbiological outcome, compared with a conventional 10 day course of cefprozil. These results confirm those of several other studies which have shown that AECB can be treated successfully with short-course therapy.
In one study, a favourable clinical response cure or improvement was seen in Langan and colleagues treated AECB patients with cefuroxime axetil for 5 days. Staphylococcus aureus was one of the most common isolates from patients in this study. Traditionally, this organism has not been considered a common respiratory tract pathogen in patients with AECB.
However, there are now many reports in the literature suggesting that the organism is isolated regularly from patients with AECB. Anthonisen and colleagues have proposed a grading scale for chronic bronchitis exacerbations: 12 type 1 exacerbations are those in which increased dyspnoea, sputum volume and sputum purulence all occur; type 2 exacerbations are those where two of the three above symptoms are present; type 3 exacerbations are those in which only one of the three above symptoms is present with at least one of several additional respiratory tract findings.
Similar findings were observed in our evaluable patient population: The incidence of adverse events or drug-associated adverse events experienced by patients while on treatment, and the incidence of treatment discontinuations owing to adverse events, did not differ between the two treatment groups. Significantly more patients in the cefdinir group experienced diarrhoea during study therapy than in the cefprozil group, but most cases were mild and did not lead to discontinuation of treatment.
In this study, clinical outcomes were better in cefdinir-treated patients than in cefprozil-treated patients. Cefdinir and cefprozil were microbiologically equivalent in the eradication of admission pathogens. The advantage of less drug exposure leading to a decreased risk of selecting resistant organisms , the convenience of 5 day dosing and the greater in vitro antimicrobial activity of cefdinir compared with cefprozil, 28 make cefdinir an attractive agent for the treatment of AECB.
Susceptibilities of the most prevalent admission pathogens to cefdinir and cefprozil. Corresponding author. Griffin wl. Baz and Ajit S. Urbanski, Philadelphia, PA. Funding for this study was provided by a grant from Parke-Davis Pharmaceutical Research. Chow, A. Evaluation of new anti-infective drugs for the treatment of respiratory tract infections. Clinical Infectious Diseases 15, Suppl. Carbon, C. Acute and chronic bronchitis. Microbial Drug Resistance 1 , — Honig, E. Chronic bronchitis, emphysema, and airways obstruction.
McGraw—Hill, New York. Ball, P. Acute exacerbations of chronic bronchitis: an international comparison. Chest , Suppl. Grossman, R. If you don't believe that the antibiotic being prescribed is "strong enough," speak with your healthcare provider.
This is especially true if you have a new healthcare provider or don't see a healthcare provider all that often. If you've had recurrent infections in the past for which amoxicillin hasn't helped, let the healthcare provider know. The more your healthcare provider knows about your previous antibiotic use, the better choices he or she can make.
Looking to avoid getting the flu? Our free guide has everything you need to stay healthy this season. Sign up and get yours today. J Korean Med Sci. Amoxicillin-potassium clavulanate, a beta-lactamase-resistant antibiotic combination. Clin Pharm. Thomas VM, Thomas-eapen N. Korean J Fam Med. Millard G. Further experience with augmentin in the treatment of skin infections.
Scott Med J. Blaser M. Antibiotic overuse: Stop the killing of beneficial bacteria. Amoxil , Moxatag amoxicillin dosing, indications, interactions, adverse effects, and more. Your Privacy Rights. To change or withdraw your consent choices for VerywellHealth. At any time, you can update your settings through the "EU Privacy" link at the bottom of any page. These choices will be signaled globally to our partners and will not affect browsing data. We and our partners process data to: Actively scan device characteristics for identification.
I Accept Show Purposes. It should be noted there are a few infections for which amoxicillin and Augmentin are prescribed equally: Pyelonephritis kidney infections Erysipelas, a type of skin infection Chronic strep "carriers". See Photo. How to Avoid Antibiotic Resistance Always take an antibiotic as prescribed. Complete the entire course even if you feel better.
Do not save antibiotics for future use. Do not use someone else's antibiotics. Cefdinir What is Cefdinir? It is available as an oral capsule and liquid suspension that can be administered once or twice daily depending on the dosage. Sign up for Cefdinir price alerts and find out when the price changes! Get price alerts. Amoxicillin is a penicillin-type antibiotic that has a structure closely related to that of penicillin ; however, unlike penicillin, amoxicillin covers more bacterial strains.
Amoxicillin is often combined with clavulanic acid, a beta-lactamase inhibitor, which makes it a stronger antibiotic against certain bacteria. Amoxicillin What is Amoxicillin? It is available as an oral capsule, tablet, chewable tablet, and liquid oral suspension. Amoxicillin is typically taken two or three times per day depending on the dosage and infection being treated. Dosing depends on the infection being treated mg every 12 hours or mg every 8 hours. Dosing depends on the infection being treated How long is the typical treatment?
Duration depends on the infection being treated Who typically uses the medication? Adults, children, and infants 6 months and older Adults, children, and infants 3 months and older Want the best price on amoxicillin? Sign up for amoxicillin price alerts and find out when the price changes!
Cefdinir is FDA-approved to treat acute otitis media, or middle ear infection , as well as skin and soft tissue infections.
Cefdinir is also approved to treat upper and lower respiratory tract infections. Upper respiratory tract infections include sinusitis, pharyngitis, and tonsillitis. Lower respiratory tract infections include community-acquired pneumonia, which cefdinir can treat in adults and children 13 years of age and older.
Amoxicillin is approved to treat ear, nose, and throat infections like sinusitis, pharyngitis, and tonsillitis. Amoxicillin is also approved to treat lower respiratory tract infections such as community-acquired pneumonia caused by streptococcus pneumonia. Unlike cefdinir, amoxicillin is also commonly used to treat gonorrhea and H. Cefdinir is effective against infections caused by gram-positive bacteria including Staphylococcus aureus , Streptococcus pneumoniae penicillin-susceptible strains only , and Streptococcus pyogenes.
Cefdinir is also effective against gram-negative bacteria such as Haemophilus influenzae , Haemophilus parainfluenzae , and Moraxella catarrhalis. Amoxicillin is effective against infections caused by gram-positive bacteria such as Streptococcus and Staphylococcus species.
Amoxicillin is also active against gram-negative bacteria including Haemophilus influenzae , Escherichia coli , Helicobacter pylori , and Neisseria gonorrhoeae. There are not many strong studies that have been performed to show a direct comparison of cefdinir and amoxicillin. The effectiveness of these antibiotics will depend on which bacteria is causing the infection. Talk to your doctor or healthcare provider about which antibiotic will work best for you.
As generic antibiotics, cefdinir and amoxicillin are widely available. Almost all Medicare Part D and insurance plans will cover cefdinir and amoxicillin. Amoxicillin is available in generic and brand-name versions.
The most common side effects associated with cefdinir and amoxicillin are diarrhea, nausea, and vomiting.
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