COMPARATIVE EFFICACY AND SAFETY OF CEFIXIME AND CIPROFLOXACIN IN THE MANAGEMENT OF ADULTS WITH COMMUNITY-ACQUIRED PNEUMONIA IN IBADAN, NIGERIA

---

O.M. Ige¹ and A.O. Okesola²

1. Department of Medicine, University College Hospital, Ibadan, Nigeria.
2. Dept. of Medical Micro. & Parasitology, College of Medicine, University of Ibadan, Ibadan, Nigeria.

Abstract

Background: Initial antibiotic therapy in upper and lower respiratory tract infections is usually empirical. However, the decreasing susceptibility of respiratory pathogens to anti-bacterials have raised concerns about the decreasing efficacy of currently available antibiotics.

Objective: This study was conducted to compare the efficacy and safety of cefixime and ciprofloxacin in the empirical treatment of community-acquired pneumonia among adult Nigerian patients in Ibadan.

Methods: This was an open-labelled, randomized, parallel-group study of seventy three (73) radiologically and bacteriologically confirmed adult cases of community-acquired pneumonia, between July 1 and September 31, 2011 at two health care facilities in Ibadan, Nigeria. All of these patients had severity index (CURB 65) scores of either 1 or 2. They were treated with either Cefixime, 400mg twice daily or Ciprofloxacin 500mg twice daily for 14 days. They were evaluated four times during the course of their treatment for clinical responses, radiological and bacteriological clearances and safety of therapy.

Results: There were 39 (53.4%) patients in the Cefixime group and 34(46.6%) in
Ciprofloxacin group. On day 7, patients on cefixime had a statistically significant
lower temperature than patients on ciprofloxacin (P<0.01). By day 14, only 10.3% of patients in cefixime group still had persistent residual radiological changes compared to 38.2% in the ciprofloxacin group (P < 0.01). Bacteria cure was obtained in 96% of the patients in the cefixime group and 83% in the ciprofloxacin group.

Conclusion: Cefixime was found to be superior to ciprofloxacin in terms of efficacy in the treatment of community-acquired pneumonia in adults in Nigeria. However, both antibiotics were well-tolerated by all the patients as there were no reports or documentation of adverse events.

Keywords: Cefixime, Efficacy, Safety, Community-acquired pneumonia

Introduction

Respiratory tract infections (RTIs) are amongst the most widespread and serious infections accounting for over 50 million deaths globally each year.¹ They are also the most common reason for physician’s visit and antibiotic prescription.² The prevalence of pneumonia among adults with respiratory symptoms suggesting pneumonitis ranges from only 3% in a general outpatient setting to 28% in emergency department. ^3,4 Community-acquired pneumonia (CAP) is a common cause of hospital admission in Nigeria, and,in TB patients attending a TB clinic in South-Western Nigeria, 6.4% was found to have Streptococcal pneumoniae.⁵

Initial antibiotic therapy in upper and lower respiratory tract infections is usually empirical, focused towards the most common aetiologic agents, which include, Streptococcus pneumoniae, Haemophilus influenzae, Klebsiella pneumoniae and Moraxella catarrhalis.⁶ However, the decreasing susceptibility patterns of these pathogens, particularly S.pneumoniae and H.influenzae, to anti-bacterials have raised concerns about the decreasing efficacy of currently available antibiotics.^7,8 In the United States, almost 100% of clinical M. catarrhalis and up to 50% of H.influenzae isolates produce beta-lactamase. Penicillin-resistant strains have been identified worldwide,⁹ and, resistance to other anti-bacterials such as cephalosporins, fluoroquinolones and macrolides is increasing among isolates of S.pneumoniae.^10-12

Cefixime belongs to the third -generation cephalosporin antibiotics that exert their bactericidal effect by attaching to penicillin-binding proteins and inhibiting peptidoglycan synthesis, thus causing damage to the bacterial cell wall. The third-generation cephalosporins are used all over the world because of their broad spectrum activity against all Gram-negative and positive pathogens and atypical organisms, e.g. Mycoplasma and Chlamydia.⁶

Ciprofloxacin, also a broad-spectrum, early-generation fluoroquinolone, is one of the cheap and most commonly used antibiotics for most infections including RTI in this community, and, it exhibits bactericidal activity primarily by inhibiting bacterial DNA gyrase. These drugs were acceptable standard antibiotics for the treatment of community-acquired pneumonia during the study period. Even though there are many antibiotics that require less frequent administration, some studies indicate that older antibiotics that have fallen out of favour, are still effective for treatment of community-acquired pneumonia.¹³ This study was therefore conducted to evaluate the comparative efficacy and safety of Cefixime and Ciprofloxacin in the empirical treatment of CAP among adult Nigerian patients in Ibadan, Nigeria.