According to the 2004 guidelines for acute bacterial rhinosinusitis (ABRS) guidelines, originally developed by the Sinus and Allergy Health Partnership in 2000, common bacterial isolates covered from infected individuals comprised of Streptococcus pneumoniae, Haemophilus influenzae, other streptococcal species, and Moraxella catarrhalis, and antimicrobial activities against these pathogens were discussed separately. Based on available pharmacokinetic and pharmacodynamic (PK/PD) data, oral cefdinir exhibited similar activity against S pneumoniae to second-generation cephalosporins (e.g., cefuroxime axetil, cefpodoxime proxetil). While its activity against H influenzae was comparable to cefuroxime axetil, the activity was lower compared to cefpodoxime proxetil. For adult and pediatric patients with mild disease and no recent antimicrobial use (past 4-6 weeks), cefpodoxime proxetil, cefuroxime axetil, and cefdinir are recommended as initial agents, along with high-dose amoxicillin/clavulanate and amoxicillin. While both cefpodoxime proxetil and cefuroxime axetil outperformed cefdinir for adults and children with ABRS on calculated clinical efficacy and bacteriologic efficacy based on therapeutic outcome model using two surveillance data sets, the presented values do not guarantee clinical success or failure. The suspension formulation of cefdinir had been historically preferred among the pediatric population, given high patient acceptance. The guidelines provide no further head-to-head comparisons between cefdinir and cefpodoxime or cefuroxime in terms of their clinical efficacy. [1]
Though specific subgroup analyses based on individual cephalosporins were not performed, a 2007 meta-analysis involving five randomized controlled trials (N= 1,030) compared the bacterial eradication rates achievable with shortened courses of 2nd- and 3rd-generation cephalosporins compared with 10-day penicillin therapy for Group A streptococcal (GAS) tonsillopharyngitis treatment of adults. One of the evaluated trials compared cefuroxime with penicillin, one compared cefdinir with penicillin, and two compared cefpodoxime with penicillin. Overall, five days of select cephalosporins (cefpodoxime, cefuroxime, cefotiam, and cefdinir) was noninferior to ten days of penicillin (odds ratio [OR] 1.46; 95% confidence interval [CI] 0.96 to 2.22; p= 0.08) with respect to bacterial eradication rate. Individual ORs (95% CIs) vs. penicillin for cefpodoxime, cefuroxime, and cefdinir were 1.81 (0.29 to 11.25) and 1.65 (0.36 to 7.62) from two studies, 1.11 (0.22 to 5.70), and 1.67 (0.97 to 2.87), respectively. Of note, the ORs reported from each study do not account for inter-study variabilities and thus do not represent comparative efficacy among different cephalosporins. [2]
A 2004 meta-analysis included 35 randomized controlled trials (N= 7,125) comparing cephalosporins to penicillin treatment for group A beta-hemolytic streptococcal tonsillopharyngitis in children. Overall, results of the analysis showed that bacterial cure significantly favored cephalosporins (OR 3.02; 95% CI 2.49 to 3.67); individual cephalosporin showed superior bacteriologic cure rates. Compared to penicillin, individual ORs were 3.29 (95% CI 2.01 to 5.4), 3.31 (95% CI 1.47 to 7.45), and 7.06 (95% CI 4.34 to 11.49) for cefpodoxime (n= 396), cefuroxime (n= 510), and cefdinir (n= 455), respectively. Although individual cephalosporins were not compared directly, the overall bacterial cure rates were 93% for cefpodoxime, 92% for cefuroxime, and 94% for cefdinir. Although the individual cephalosporins showed high cure rates compared to penicillin, comparisons between these agents were not made directly, and indirect comparisons of reported cure efficacy rates should be interpreted with caution. [3]