2011, Number 3
<< Back Next >>
Acta Pediatr Mex 2011; 32 (3)
Study to compare efficacy and safety of azitromicine vs amoxiciline + clavulanic acid for the treatment of acute bacterial rhinosinusitis
Vargas-Jiménez JL, Lago-Acosta A, Silva-Hernández R, Parada-Tapia MG
Language: Spanish
References: 36
Page: 169-174
PDF size: 355.15 Kb.
ABSTRACT
Introduction. The cornerstone for the treatment of acute bacterial rhinosinusitis (ABRS) is the use of penicillins and macrolides.
Objective. To prove that azithromycine provides the same or better results than amoxicillin / clavulanic acid in children with ABRS.
Methodology. Comparative, randomized, prospective and experimental phase IV study (post-marketing) of 50 patients, 3 to 11 years of age with symptoms of ABRS (25 patients per group of treatment), according to the Sinusitis Committee of the American Academy of Otolaryngology and Head and Neck Surgery, i.e.: the presence of 2 major factors or one major and two minor factors of this pathology. The response and therapeutic effectiveness were determined with the following criteria: cure, improvement or failure. Patients were randomized to receive azithromycine for 3 days or amoxicillin + clavulanic acid for 10 days.
Results. Every patient had major and minor factors of ABRS. At the end of treatment and of follow-up, 96% of patients in the azithromycine group were cured. In the group who received amoxicillin/clavulanate, 92% were cured. There were only 3 instances of side effects, one in the azithromycine group unrelated to the drug and two in the group treated with amoxicillin/clavulanate: mild abdominal pain and loose stools.
Conclusions. Efficacy of azithromycine and amoxicillin/clavulanate is similar for the treatment of uncomplicated ABRS in children. The advantage of a 3 day treatment with azithromycine is an important factor for the adherence.
REFERENCES
Narro Robles J, Ribero Serrano O. Diagnóstico y tratamiento en la práctica médica. México: Editorial Manual Moderno; 2006. p. 169-76.
Sinus and Allergy Health Partnership. Antimicrobial treatment guidelines for acute bacterial rhinosinusitis. Otolaryngol Head Neck Surg 2000;123:S4-S30.
Benninger MS, Anon J, Mabry N. The medical management of rhinosinusitis. Otolaryngol Head Neck Surg 1997;117:S41-S49.
Arrollo CM. Tratamiento de sinusitis aguda en adultos con azitromicina. Rev Bras Med 1996;53 Ediçao especial.
Hickner J, Bartlett J. Principles of appropriate antibiotic use for acute rhinosinusitis in adults: background. Ann Int Med 2001;133:499-505.
Schwartz B, Marcy M, Phillips W. Pharyngitis- Principles of judicious use of antimicrobial agents. Pediatrics 1998;101:171-4.
O’Brien K, Dowell S, Schwartz B et al. Acute sinusitis - Principles of judicious use of antimicrobial agents. Pediatrics 1998;101:174-7.
Jacobs R. Judicious use of antibiotics for common pediatric respiratory infections. Pediatr Infect Dis J 2000;19:937-43.
Dowell S, Marcy M, Phillips W, et al. Principles of judicious use of antimicrobial agents for pediatric upper respiratory tract infections. Pediatrics 1998;101:163-5.
Dan CH. Randomized Double-Blind Study Comparing 3- and 6-Day Regimens of Azithromycin with a 10-Day Amoxicillin-Clavulanate Regimen for Treatment of Acute Bacterial Sinusitis Antimicrob Agents. Chemother 2003;47(9):2770–4.
Rodríguez Ríos S, De la Torre C, Sánchez C et al. Estudio comparativo de Amoxicilina versus eritromicina-sulfisoxazol en el tratamiento de la sinusitis aguda en la infancia. Presentado en el 28th Interscience Conference on Antimicrobial Agents and Chemotherapy. Los Angeles, Cal. octubre 1988.
Healy GB. Acute sinusitis in childhood. N Eng J Med 1981;294:779-81.
Fanga FA, Palmerb NJ. Pharmacokinetics of azithromycin in plasma and sinus mucosal tissue following administration of extended-release or immediate-release formulations in adult patients with chronic rhinosinusitis. 2009;34:67-71
Ehnhage A, Rautiainen M, Fang AF, Sanchez SP. Pharmacokinetics of azithromycin in serum and sinus fluid after administration of extended-release and immediate-release formulations in patients with acute bacterial sinusitis. Int J Antimicrob Agents 2008;31(6):561-6.
Veber B, Valee E, Desmonts JM, Pocidalo JJ, Azoulay-Dupuis E. Correlation between macrolide pharmacokinetics and therapeutic efficacy in a mouse model of pneumococcal pneumonia. J Antimicrob Chemother 1993;31:473–82.
Campos O. Sinusitis Aguda. Tratamiento con azitromicina en esquema de 3 días. Experiencia Venezolana. Enf Infecc Microbiol 1994;14(6 suppl):59-67.
Foulds G, Shepard RM, Johnson RB. The pharmacokinetics of Azithromycin in human serum and tissues. J Antimicrobial Chemother 1990;33:1056-60.
Wildfeuer A, Reisert I, Laufen H. Uptake and subcellular distribution of Azithromycin in human phagocytic cells. Arzneimittel Forschung/Drug Res 1993;43:484-6.
Karma P, Pukander J, Penttila M. Azithromycin concentration in sinus fluid and mucosa after oral administration. Eur J Clin Microbiol Infect Dis 1991;10:856-9.
Friedel Peters DH, Mc Tiavish D. Azithromycin a review of its antimicrobial activity pharmacokinetic properties and clinical efficacy. Drugs 1992;44:750-99.
Williams JW Jr, Holleman DR Jr, Samsa GP, et al. Randomized controlled trial of 3 vs. 10 days of trimethoprim/ sulfamethoxazole for acute maxillary sinusitis. JAMA 1995;273:1015–21.
Flores García A, Ordóñez Íñiguez AP, Romero García F. La azitromicina como alternativa terapéutica en la sinusitis. Rev Mex Pediatr 2001;68(5):181-3.
Fica A, Díaz J C. Enfoque diagnóstico y terapéutico de los pacientes adultos con sospecha de sinusitis aguda. Rev Chil Infect 2003;20:184-92.
Anon JB. Acute bacterial rhinosinusitis in pediatric medicine. Current Issues in diagnosis and management. Pediatrics Drugs 2003;5(Suppl 1):25-32.
Craig W. Clinical implications of antimicrobial pharmacokinetics, infectious diseases. Clin North Am 2003;17(3):479-674.
Bravo Escobar GA, González Olvera SI, et al. Rinosinusitis bacteriana aguda. Rev Hosp Gral Dr. M Gea González 2001;4:27-30.
Friedel Peters DH, Mc Tiavish D. Azithromycin a review of its antimicrobial activity pharmacokinetic properties and clinical efficacy. Drugs 1992;44:750-99
Sclar DA, Tartaglione TA, Fine MJ. Overview of issues related to medical compliance with implications for the outpatient management of infectious diseases. Infect Agents Dis 1994;3:266–73.
Higuera RF. Estudio multicéntrico sobre la eficacia y la seguridad de azitromicina en el tratamiento de infecciones de las vías aéreas superiores. Enf Infec Microbiología 1994;14(suppl 6):13-20.
Dale A, Newton MD. Sinusitis in children and adolescents. Primary Care Clinics in Office Practice 1996;23:4.
Gutiérrez E. Azitromicina en el tratamiento de la otitis media en niños. Estudio multicéntrico. Enfer Infecc Microbiol 1994;14(suppl 6):54-8.
Hopkins S. Clinical safety and tolerance of azithromycin in children. J Antimicrob Chemother 1993;30(suppl E):111-7.
Sih TM. Diagnóstico y abordaje terapéutico de la sinusitis en los niños. III Manual de Otorrinolaringología Pediátrica de la IAPO. São Paulo: IAPO; 2003. p. 146-70.
Piccirillo JF, Mager DE, Frisse ME, Bophy RH, Goggin A. Impact of first-line vs second-line antibiotics for the treatment of acute uncomplicated sinusitis. JAMA 2001;286:1849-55.
American Academy of Pediatrics. Subcommittee on Management of Sinusitis and Committee on Quality Improvement. Clinical practice guideline: management of sinusitis. Pediatrics 2001;108(3):798-808.
Amoxicillin; Clavulanic Acid. Drug Information. Gold Standard M. Inc. 2008.