Comparative Efficacy and Safety of Cefixime and Ciprofloxacin in the Management of Adults with Community-acquired Pneumonia in Ibadan, Nigeria.

BACKGROUND Initial antibiotic therapy in upper and lower respiratory tract infections is usually empirical. However, the decreasing susceptibility of respiratory pathogens to antibacterials have raised concerns about the decreasing efficacy of currently available antibiotics. OBJECTIVE This study was conducted to compare the efficacy and safety of cefixime and ciprofloxacin in the empirical treatment of community-acquired pneumonia among adult Nigerian patients in Ibadan. METHOD This was an open-labelled, randomized, parallel-group study of seventy-three (73) radiologically and bacteriologically confirmed adult cases of community-acquired pneumonia, between July 1 and September 31, 2011 at two health care facilities in Ibadan, Nigeria. All of these patients had severity index (CURB 65) scores of either 1 or 2. They were treated with either Cefixime, 400mg twice daily or Ciprofloxacin 500mg twice daily for 14 days. They were evaluated four times during the course of their treatment for clinical responses, radiological and bacteriological clearances and safety of therapy. RESULTS There were 39 (53.4%) patients in the Cefixime group and 34(46.6%) in Ciprofloxacin group. On day 7, patients on cefixime had a statistically significant lower temperature than patients on ciprofloxacin (P<0.01). By day 14, only 10.3% of patients in cefixime group still had persistent residual radiological changes compared to 38.2% in the ciprofloxacin group (P < 0.01). Bacteria cure was obtained in 96% of the patients in the cefixime group and 83% in the ciprofloxacin group. CONCLUSION Cefixime was found to be superior to ciprofloxacin in terms of efficacy in the treatment of community-acquired pneumonia in adults in Nigeria. However, both antibiotics were well-tolerated by all the patients as there were no reports or documentation of adverse events.