Cefetamet pivoxil: a review of clinical experience

Abstract

Summary CEfetamet pivoxil is an oral third-generation cephalosporin whose broad spectrum of antibacterial activity and favourable pharmacokinetic profile make it particularly suitable for the treatment of upper and lower respiratory tract infections as well as of infections of the urinary tract. Cefetamet displays a high in vitro activity against both gram-positive and gram-negative bacteria, i.e. Streptococcus pneumoniae, Streptococcus spp., Haemophilus influenzae, Moraxella catarrhalis, Escherichia coli, Proteus spp., Klebsiella spp. and Neisseria gonorrhoeae . It is not active against Staphylococci, Enterococci, Pseudomonas spp. or Bacteroides fragilis but does inhibit most bile-sensitive (oral) Bacteroides spp. The clinical efficacy and tolerability of cefetamet pivoxil have been evaluated in the treatment of 4899 patients out of whom 1002 were children. The standard doses of cefetamet pivoxil 500 mg twice daily in adults resp. 10 mg/kg bid in children were at least as effective and in many cases clinically superior to most currently recommended antibiotics for the treatment of urinary tract infections and complicated infections in high risk patients. High efficacy has also been demonstrated in patients with pneumonia, in acute exacerbation of chronic bronchitis and infections of the ear, nose and throat. Clinical trials have shown that a 7-day treatment period with cefetamet pivoxil is as effective as a 10-day course of phenoxymethylpenicillin in the treatment of pharyngotonsillitis. Cefetamet pivoxil in the standard dose has been well tolerated in clinical trials with less than 1.2 % of premature treatment withdrawals. The most common adverse events are gastrointestinal (diarrhoea, nausea, vomiting) which occur in less than 10 % of the patients. Many current antibiotic treatment regimens require the administration of three daily doses. However, standard doses of cefetamet pivoxil of 500 mg (adults) twice daily resp. 10 mg/kg (children) bid provide unbound plasma concentrations of cefetamet which generally exceed the MIC 90 for susceptible organism throughout the dosing interval and are clinically effective, well tolerated and should result in good compliance.