Abstract
Due to the lack of availability of respiratory fluoroquinolones, treatment using amoxicillin- clavulanate is recommended for community acquired pneumonia (CAP) in Iran. Cefixime offers advantages such as lower cost and improved patients compliance. The current study was designed to compare the therapeutic effects of amoxicillin- clavulanate and cefixime in patients with CAP. In a randomized controlled trial, 280 inpatients with CAP were randomized to receive either amoxicillin- clavulanate or cefixime (n = 140). Clinical signs, symptoms and chest radiography reports of patients were compared between two groups on the first visit and weeks two and four after treatment. Cure was defined as resolution of signs and symptoms in the first week and resolution of chest x-ray infiltration in the 4th week. Improvement was defined as resolution of fever on 1st and 2nd day, cough and sputum on 4th to 5th day and lung consolidation sounds in the first week. Sever and complicated CAP were excluded and considered as side effects. The amoxicillin- clavulanate group had more patients with cough in the 2nd and 4th week (p = 0.008 and 0.001, respectively), sputum and infiltrate on chest x-ray in the 4th week (p = 0.008 and 0.004, respectively) compared to cefixime. Clinical status at the end of the treatment showed cure (71.25%), improvement (24.61%) and side effects (3.87%) in the cefixime group and 66.67, 30.07, and 3.26%, respectively in the amoxicillin-clavulanate group [p = non-significant (NS)]. In our study, cefixime was more effective than amoxicillin-clavulanate in resolution of signs and symptoms of CAP. Cefixime may be an option for the treatment of CAP in countries with limited drug options. Key words: Community acquired pneumonia (CAP), cefixim, co-amoxiclave, community acquired pneumonia, switch therapy.  
Highlights
Community-acquired pneumonia (CAP) is a potentially serious illness that is defined as an acute infection of the pulmonary parenchyma in a patient who has acquired the infection in the community (File et al, 2011)
Due to the lack of availability of respiratory fluoroquinolones, treatment using amoxicillin- clavulanate is recommended for community acquired pneumonia (CAP) in Iran
Due to drug limitations and lack of respiratory fluoroquinolones in our country, Iran, treatment using amoxicillin- clavulanate for 14 days is recommended for CAP in our hospitals
Summary
Community-acquired pneumonia (CAP) is a potentially serious illness that is defined as an acute infection of the pulmonary parenchyma in a patient who has acquired the infection in the community (File et al, 2011). Common antibiotics used for CAP include the cephalosporins, aminopenicillins (with or without clavulanic acid), the macrolides, the tetracycline, and the respiratory fluoroquinolones (Nicolau et al, 2000). Due to drug limitations and lack of respiratory fluoroquinolones in our country, Iran, treatment using amoxicillin- clavulanate for 14 days is recommended for CAP in our hospitals. Cefixime offers advantages such as once daily dosing, lower cost and appropriate spectrum of activity.
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