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AECB

Clinical Efficacy of FACTIVE: Acute Exacerbations of Chronic Bronchitis (AECB)

FACTIVE is a powerful new quinolone indicated for the treatment of acute exacerbations of chronic bronchitis (AECB) caused by a range of the most common causative pathogens. For AECB, FACTIVE has a convenient, short dosing regimen of one 320-mg tablet taken once daily for 5 days.

With broad-spectrum coverage, including S pneumoniae, a short dosing regimen, and proven efficacy, FACTIVE is an excellent new option for the treatment of patients with AECB.

Once-daily, 5-day FACTIVE had excellent clinical success rates in the treatment of AECB as shown in the following study.

[AECB: Clinical Response]
: Excellent Clinical Success with Once-Daily, 5-day FACTIVE vs. 7-day Levofloxacin1

These success rates are particularly important because physicians are increasingly looking for safe and effective alternatives to levofloxacin given the literature reports on levofloxacin-resistant strains of S pneumoniae. This study did not include any isolates of S pneumoniae resistant to levofloxacin. A randomized, double-blind, double-dummy, multicenter, parallel group of patients receiving FACTIVE (n=152) or levofloxacin (n=148). The clinical efficacy of FACTIVE 320 mg once daily for 5 days in AECB was at least as good as levofloxacin 500 mg once daily for 7 days.

[AECB: Clinical Response]
: Excellent Clinical Success with Once-Daily, 5-day FACTIVE vs. 7-day Clarithromycin2

Once-daily, 5-day FACTIVE demonstrated excellent clinical success rates in the treatment of AECB at the end of therapy and follow-up visits compared with clarithromycin in a randomized, double-blind, double-dummy, multicenter, parallel group of patients receiving FACTIVE (n=278) or clarithromycin (n=283). The clinical success rates at follow-up (21-28 days post-therapy) in the clinical per-protocol population (the primary endpoint) were 86.8% (105/121) for gemifloxacin vs. 81.3% (91/112) for ceftriaxone/cefuroxime (treatment difference = 5.5,95% CI 3.9,14.9). The corresponding clinical results in the clinical intention-to-treat (ITT) population were 82.6% (114/138) vs. 72.1% (98/136), respectively (treatment difference = 10.5,95% CI 0.7, 20.4). Thus, FACTIVE had significantly higher clinical success rates than ceftriaxone/cefuroxime. The median time to discharge was 9 days in the gemifloxacin group vs.11 days in the ceftriaxone/cefuroxime group (P = 0.04, Wilcoxon test).

[AECB: Long-Term Clinical Success Rates1,2]

FACTIVE has excellent long-term clinical success rates in the treatment of AECB. Long-term follow-up in the ITT population of Factive was statistically significant compared with levofloxacin (95% CI: 1.18, 18.78).

FACTIVE eradicated H influenzae in 100% of those cultured by the first day of treatment compared to clarithromycin which could not demonstrated complete eradication of H influenzae by day 6.

[AECB: Persistence of H Influenzae in patients1.2]

This rapid eradiation is particularly important since longer regimens generally promote resistance.

The clinical relevance of bacterial persistence during the course of therapy has not been established. There was no significant difference in the clinical response between the treatment arms. H influenzae is a key causative pathogen of AECB. Lack of bacterial persistence may be an important component of clinical success. Eliminating bacterial persistence may help patients remain exacerbation-free.

References

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Important Safety Information

THE SAFETY AND EFFECTIVENESS OF FACTIVE IN CHILDREN, ADOLESCENTS (<18 YEARS OF AGE), PREGNANT WOMEN, AND LACTATING WOMEN HAVE NOT BEEN ESTABLISHED.

FACTIVE is contraindicated in patients with a history of hypersensitivity to gemifloxacin, fluoroquinolone antibiotic agents, or any of the product components. Serious hypersensitivity and/or anaphylactic reactions have been reported in patients receiving fluoroquinolone therapy, including FACTIVE. Hypersensitivity reactions reported in patients receiving fluoroquinolone therapy have occasionally been fatal. These reactions may include serious, sometimes fatal skin reactions such as toxic epidermal necrolysis or Stevens-Johnson Syndrome; effects on the liver, including hepatitis, jaundice, and acute hepatic necrosis or failure; renal toxicities including interstitial nephritis and/or acute renal insufficiency or failure; and hematologic effects, including agranulocytosis, thrombocytopenia, and other hematologic abnormalities. These reactions may occur following the first dose or multiple doses. FACTIVE should be discontinued immediately at the first sign of an immediate type I hypersensitivity skin rash or any other manifestation of hypersensitivity reaction.

Fluoroquinolones, including FACTIVE, are associated with an increased risk of tendinitis and tendon rupture in all ages. This risk is further increased in older patients usually over 60 years of age, in patients taking corticosteroid drugs, and in patients with kidney, heart, or lung transplants. Call your healthcare professional right away at the first sign of tendon pain, swelling, or inflammation. You should stop taking FACTIVE until tendinitis or tendon rupture have been ruled out, and avoid exercise and using the affected area.

Fluoroquinolones may prolong the QT interval in some patients. FACTIVE should be avoided in patients with a history of prolongation of the QTc interval, patients with uncorrected electrolyte disorders (hypokalemia or hypomagnesemia), and patients receiving Class IA or Class III antiarrhythmic agents.

Rare cases of peripheral neuropathy have been reported in patients receiving quinolones.

In clinical studies with FACTIVE, central nervous system (CNS) effects have been reported infrequently. As with other fluoroquinolones, FACTIVE should be used with caution in patients with known or suspected CNS diseases. If CNS reactions occur, FACTIVE should be discontinued and appropriate measures instituted.

Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibiotic agents, including FACTIVE. If diarrhea occurs, evaluate for CDAD and treat appropriately.

In clinical trials, rash occurred more often with FACTIVE than therapy with comparator agents (2.8% vs. 0.6%). Increasing incidence of rash was associated with younger age (especially below 40), female gender, use of hormone replacement therapy, and longer duration of therapy.

Moderate to severe photosensitivity/phototoxicity reactions can be associated with the use of quinolones after sun or UV light exposure. Excessive exposure to the sun or UV light should be avoided.

Magnesium- and/or aluminum-containing antacids, products containing ferrous sulfate (iron), multivitamin preparations containing zinc or other cations, or Videx® (didanosine) chewable/buffered tablets or the pediatric powder for oral solution should not be taken within 3 hours before or 2 hours after FACTIVE. Sucralfate should not be taken within 2 hours of FACTIVE.

In clinical trials, the most common adverse drug reactions (≥2%) were diarrhea, rash, nausea, headache, abdominal pain, vomiting, and dizziness.

This product is available by prescription only.

* Videx® is a registered trademark of Bristol-Myers Squibb Company.

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You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

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You are encouraged to report negative side effects of prescription drugs, please click here or call 82-2-6924-3620.

Please note that the information contained on this site is intended for international health care providers and may not be appropriate for your country of origin. Please see the full FACTIVE prescribing information for your country for approved product indications, dosing, and important safety considerations. Click on the "Global Countries" tab above to learn how to obtain country-specific prescribing information.

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