A meta-analysis of the efficacy of cefaclor in upper respiratory tract infections

SummaryAntibiotics are over-prescribed for upper respiratory tract infection. Cefaclor is less damaging to commensal flora than some other antibiotics and has fewer gastrointestinal effects. A meta-analysis was performed to determine if the efficacy of cefaclor in the treatment of upper respiratory tract infection was similar to other agents. A total of 4320 patients received cefaclor and 4953 patients received a comparator in 63 studies. Three trials reported a statistically significant difference in efficacy in favour of cefaclor, two compared with penicillin V. In two trials, bacteriological efficacy was reduced compared with co-trimoxazole and co-amoxiclav but clinical efficacy was not significantly different. Meta-analysis suggested significantly lower efficacy for cefaclor than comparators (χ2 6, p<0.03) but there was a significant heterogeneity. Application of the quality index rendered both the difference in efficacy and the heterogeneity non-significant. There was no significant difference in efficacy between amoxycillin, cefixime or cefuroxime axetil and cefaclor. Cefaclor remains an appropriate treatment of upper respiratory infection in view of its safety, reduced effect on colonization resistance and cost.