Abstract
In this double-blind, randomised trial conducted in 22 centres in the USA, azithromycin given over five days, as a once-a-day regimen, (500 mg on day 1, 250 mg on days 2–5) was compared with cephalexin (500 mg b.i.d.) given for ten days in the treatment of patients with skin and skin structure infections. A total of 366 patients entered the study and 179 of these were eligible for the efficacy analysis. The overall clinical response to azithromycin was 94.0 %, compared with 95.8 % for cephalexin. The clinical cure rates were 53.0 % for azithromycin and 59.4 % for cephalexin; the respective improvement rates were 41.0 % and 36.5 %. Distribution of response (cured, improved, failed) was similar in each group (p=0.37). The bacteriological eradication rate for azithromycin-treated patients was 94.2 % and for cephalexin-treated patients was 90.3 % (p=0.34). Clinical and bacteriological response was similar in each group for all primary diagnoses. The two antibiotics were well tolerated, the overall incidence of side effects being 13.7 % with approximately 60 % due to gastrointestinal disturbances. In all but one case (cephalexin) the severity of the reported side effects was mild or moderate. Six patients withdrew from the study due to treatment-related events; five had been treated with azithromycin and one with cephalexin. In summary, a five-day, once-daily regimen of azithromycin was as effective as a ten-day, twice-daily regimen of cephalexin in the treatment of patients with skin and skin structure infections.
Similar content being viewed by others
References
Bright GM, Nagel AA, Bordner J, Desai KA, Dibring JN, Nowakowska J, Vincent L, Watrous RM, Sciavolino FC: Synthesis, in vitro and in vivo activity of novel 9-deoxo-9a-aza-9a homoerythromycin A derivatives: a new class of macrolides, the azalides. Journal of Antibiotics 1988, 41: 1029–1047.
Girard AE, Girard D, English AR, Gootz TD, Cimochowski CR, Faiella JA, Haskell SL, Retsema JA: Pharmacokinetic and in vivo studies with azithromycin (CP-62,993), a new macrolide with extended half-life and excellent tissue distribution. Antimicrobial Agents and Chemotherapy 1987, 31: 1948–1954.
Foulds G, Shepard RM, Johnson RB: The pharmacokinetics of azithromycin in human serum and tissues. Journal of Antimicrobial Chemotherapy, 1990, 25, Supplement A: 73–82.
Retsema J, Girard A, Schelkly W, Manousos M, Anderson M, Bright G, Borovoy R, Brennan L, Mason R: Spectrum and mode of action of azithromycin (CP-62,993), a new 15-membered-ring macrolide with improved potency against gram-negative organisms. Antimicrobial Agents and Chemotherapy 1987, 31: 1939–1947.
Elwell LP, Shipley PL: Plasmid-mediated factors associated with virulence of bacteria to animals. In: Starr MP (ed): Annual review of microbiology. Annual Reviews, Palo Alto, 1980, p. 465–496.
Falkow S: Historical perspective — drug resistance and R-factors. In: Lagnado JR (ed): Infectious multiple drug resistance. Pion, London, 1975, p. 1–229.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kiani, R. Double-blind, double-dummy comparison of azithromycin and cephalexin in the treatment of skin and skin structure infections. Eur. J. Clin. Microbiol. Infect. Dis. 10, 880–884 (1991). https://doi.org/10.1007/BF01975848
Issue Date:
DOI: https://doi.org/10.1007/BF01975848