Oral cephalosporins in perspective

Area of Science:

• Infectious Diseases
• Pharmacology
• Clinical Medicine

Background:

• Oral cephalosporins have been used for 25 years to treat various infections.
• Newer agents show increased in vitro activity against specific bacteria like Haemophilus influenzae and Branhamella catarrhalis.
• These newer agents are often prescribed for pediatric otitis media and respiratory tract infections.

Purpose of the Study:

• To evaluate the clinical efficacy of newer oral cephalosporins compared to older therapies.
• To determine the optimal role of oral cephalosporins in ambulatory patient infections.
• To assess the cost-effectiveness and therapeutic positioning of different oral antibiotic classes.

Main Methods:

• Review of published clinical trials comparing oral cephalosporins with other antibiotics.
• Analysis of in vitro activity data against common respiratory and skin pathogens.
• Evaluation of treatment outcomes for infections of the respiratory tract, middle ear, skin, urinary tract, and musculoskeletal system.

Main Results:

• Clinical trials have not demonstrated clear superiority of newer oral cephalosporins over older treatments for common infections.
• Newer cephalosporins (cefaclor, cefuroxime axetil, cefixime) exhibit enhanced activity against beta-lactamase-producing H. influenzae and B. catarrhalis.
• Efficacy of newer cephalosporins is comparable to older agents when treating infections caused by susceptible organisms.

Conclusions:

• Oral cephalosporins, particularly newer agents, should be reserved for second- or third-line therapy.
• Reserve use is recommended when first-line agents like amoxicillin or trimethoprim/sulfamethoxazole fail or cause intolerance.
• Less expensive and equally efficacious alternatives like erythromycin/sulfisoxazole and amoxicillin/clavulanate potassium exist for second-line treatment.