Levofloxacin<i>versus</i>clarithromycin in COPD exacerbation: focus on exacerbation-free interval

Lode, H.; Eller, J; Linnhoff, A; Ioanăş, M

doi:10.1183/09031936.04.00009604

Cited by 48 publications

(38 citation statements)

References 39 publications

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“…The results of these trials are not concordant so there is continuing uncertainty on this topic [136][137][138][139]. The recent available data support the prescription of antibiotics in the presence of purulent sputum, although a proportion of the latter will not benefit [140][141][142].…”

Section: Antibioticsmentioning

confidence: 99%

Exacerbations of chronic obstructive pulmonary disease

Celli

Barnes²

2007

Eur Respir J

369

165

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Exacerbations of chronic obstructive pulmonary disease are of major importance in terms of their prolonged detrimental effects on patients, the acceleration in disease progression and high healthcare costs.There is still debate about how exacerbations should be defined and graded, and their mechanisms are poorly understood. The major causal agents are either bacteria or viral infections, or a combination of the two. Noninfective causes include air pollution and pulmonary embolus but, in some patients, no cause is identified.Exacerbations represent an increase in the inflammation that is present in the stable state, with increased numbers of inflammatory cells (particularly neutrophils), cytokines, chemokines and proteases in the airways, and increased concentrations of certain cytokines and C-reactive protein in the blood. There are presently no reliable biomarkers with which to predict exacerbations.Exacerbations have a long-lasting adverse influence on health status. High doses of bronchodilators are the mainstay of treatment and systemic corticosteroids have some benefit. The routine use of antibiotics remains controversial but they are of benefit with exacerbations of a bacterial origin. Noninvasive ventilation is beneficial in preventing the need for intubation and its important complications but it is not certain whether its use in stable patients prevents exacerbations. Although important advances have been made, more effective treatments are needed in the future for prevention and treatment of exacerbations.

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Section: Antibioticsmentioning

confidence: 99%

Exacerbations of chronic obstructive pulmonary disease

Celli

Barnes²

2007

Eur Respir J

369

165

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“…In nine RCTs, data regarding the use of systemic corticosteroids before the occurrence of ABECB [26,27,30,33,[37][38][39][40]42] were not provided, while in four RCTs the use of systemic corticosteroids at a dose of o10 mg of prednisone [25,41] or at any dose [34,36] was an exclusion criterion. In the six RCTs [24,28,29,31,32,35] in which relevant data were provided, there was no statistically significant difference regarding the use of systemic corticosteroids at baseline between the compared groups.…”

Section: Selected Rctsmentioning

confidence: 99%

“…Similarly, in one RCT [23] in which azithromycin was compared with A/C for the treatment of patients with various acute lower tract respiratory infections (including ABECB), specific data on clinical outcomes of patients with ABECB could not be extracted. Thus,19 RCTs that compared macrolides with quinolones (n58) [24][25][26][27][28][29][30][31] and A/C with quinolones (n54) [24,[32][33][34] or macrolides (n58) [35][36][37][38][39][40][41][42] were included in the meta-analysis. In one RCT [24] the quinolone levofloxacin was compared with both a macrolide (azithromycin) and A/C.…”

Section: Selected Rctsmentioning

confidence: 99%

Macrolides, quinolones and amoxicillin/clavulanate for chronic bronchitis: a meta-analysis

Siempos

Dimοpoulos²,

Korbila³

et al. 2007

Eur Respir J

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The comparative effectiveness and safety of macrolides, quinolones and amoxicillin/ clavulanate (A/C) for the treatment of patients with acute bacterial exacerbation of chronic bronchitis (ABECB) was evaluated in the present study.PubMed, Current Contents and the Cochrane Central Register of Controlled Trials were searched to identify relevant randomised controlled trials (RCTs).In total, 19 RCTs (20 comparisons) were included in the present analysis. There was no difference regarding treatment success in intention-to-treat and clinically evaluable patients between macrolides and quinolones, A/C and quinolones or A/C and macrolides. The treatment success in microbiologically evaluable patients was lower for macrolides compared with quinolones (odds ratio (OR) 0.47, 95% confidence interval (CI) 0.31-0.69). Fewer quinolonerecipients experienced a recurrence of ABECB after resolution of the initial episode compared with macrolide-recipients during the 26-week period following therapy. Adverse effects in general were similar between macrolides and quinolones. Administration of A/C was associated with more adverse effects (mainly diarrhoea) than quinolones (OR 1.36, 95% CI 1.01-1.85).Macrolides, quinolones and amoxicillin/clavulanate may be considered equivalent for the treatment of patients with an acute bacterial exacerbation of chronic bronchitis in terms of shortterm effectiveness. Quinolones are associated with better microbiological success and fewer recurrences of acute bacterial exacerbation of chronic bronchitis than macrolides, while amoxicillin/clavulanate is associated with more adverse effects than both comparators.

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“…These fi ndings remain associations since antibiotic use may simply be a marker of some other aspect of benefi cial care. Another fl uoroquinolone study did not fi nd this difference [14].…”

Section: Competing Interestsmentioning

confidence: 95%

Antibiotics in COPD exacerbations: practice and evidence

Woodhead¹

2009

breathe

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Levofloxacinversusclarithromycin in COPD exacerbation: focus on exacerbation-free interval

Cited by 48 publications

References 39 publications

Exacerbations of chronic obstructive pulmonary disease

Exacerbations of chronic obstructive pulmonary disease

Macrolides, quinolones and amoxicillin/clavulanate for chronic bronchitis: a meta-analysis

Antibiotics in COPD exacerbations: practice and evidence

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