Cefixime is an oral third generation cephalosporin antibiotic used to treat infections caused by bacteria such as pneumonia; bronchitis; gonorrhea; and ear, lung, throat, and urinary tract infections.
Azithromycin an azalide, a subclass of macrolide antibiotics used to treat or prevent certain bacterial infections, most often those causing middle ear infections, strep throat, pneumonia, typhoid, and sinusitis.
Rationale of Combination
- Excellent intracellular tissue penetration and a long elimination half life aids in the bacterial eradication.
- Synergy between two antibiotics against bacterial pathogens.
- Wide anti microbial spectrum covering respiratory and urinary tract pathogens.
- Alternative drug therapy for typhoid .
Advantages over Amoxycillin Clavalunate
- This combination therapy is superior to amoxyclav in treating acute LRTI and URTI . In patients with acute bronchitis of a suspected bacterial cause, this combination therapy tends to be more effective in terms of lower incidence of treatment failure .
- Adverse events (diarrhoea, laryngospasm, GI upset) accompanying amoxyclav. therapy is more frequent than cefixime azithromycin therapy.
- Cefixime azithromycin combination is effective at lower MIC values than amoxy clavalunate combination against H.influenzae and other gram -ve bacteria and gram +ve bacteria.
Core features of this combination molecule-
- Wide antibacterial spectrum against gram-positive and gram-negative bacterias with enhanced anti-staphylococcal activity and stability in the presence of several b-lactamases.
Effective in reducing the intracellular viabilities of almost all strains of Salmonella, and enteroinvasive, enteropathogenic, enterotoxigenic, and enter hemorrhagic Escherichia coli.
- Targeted drug-delivery system.
Circulating WBCs serve as a targeted drug-delivery system by concentrating the medication intracellularly, migrating to the infection site, phagocytosing the pathogen, and releasing active drug, thereby increasing local concentrations of drug .
- Long elimination half life
A dosing regimen with short period of administration, improves patient compliance.
- 90% clinical success rate at the end of therapy
This drug regimen ensured over a 90% clinical success rate at the end of therapy for the treatment of RTIs in adults compared to 7-10 days penicillin V, amoxicillin, amoxiclav, cefaclor and clarithromycin.
- Low rate of side effects.
Side effects with this drug therapy are mild to moderate as compared to erythromycin, amoxiclav and clarithromycin.Thus safe and well tolerated .
Indications for Therapy-
- Upper respiratory tract infections example-
Pharyngitis – Inflammation of the pharynx, tonsils .
Nasopharyngitis(or the common cold) – Inflammation of the nares.
Tracheitis – Inflammation of the trachea and subglottic area.
- Lower respiratory tract infections example-
Acute bronchitis defined as acute bacterial infection of the larger airways in patients.
Pneumonia is a breathing (respiratory) condition in which there is an infection of the lung.
- ENT infections
Otitis media, tonsillitis, sinusitis ,etc.
- Uncomplicated gonorrhoea and uncomplicated urinary tract infections
- Alternative therapy for typhoid.