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

Abstract

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.

Pathogen-directed Therapy in Acute Exacerbations of Chronic Obstructive Pulmonary Disease

“…In addition, these studies have involved a wide variety of study designs with response assessed well after therapy was completed, which limits the ability to interpret differences in efficacy between antimicrobial classes. A recent systematic review of 19 of these trials suggests equivalent clinical outcomes in randomized studies comparing quinolones, macrolides, and amoxicillin-clavulonate tested against each other (112). Interestingly, in microbiologically evaluable patients, macrolides performed worse than quinolones (112).…”

“…A recent systematic review of 19 of these trials suggests equivalent clinical outcomes in randomized studies comparing quinolones, macrolides, and amoxicillin-clavulonate tested against each other (112). Interestingly, in microbiologically evaluable patients, macrolides performed worse than quinolones (112).…”

“…More recent AE-COPD clinical trials have assessed how different antibiotics affect the DFI (117). Although the data are somewhat conflicting, quinolones seem to be associated with a longer DFI (112,117). Additional data are required to better establish this novel endpoint as a primary basis for future comparative studies.…”

From the authors

“…Thus, we have critically appraised the evidence derived from systematic reviews [9]. For example, in our meta-analysis of the various antimicrobials for ABECB, we insisted on assessing its potential limitations [1]; a great proportion of the Discussion section is devoted to this. We emphasised that ''antimicrobial resistance is a moving target and only data from local surveillance studies on this major clinical and public health problem provide information that helps the clinician in decision making regarding the choice of the appropriate antibiotic for a given patient with ABECB'' [1].…”

“…Thus, meta-analyses are consistently used as the basis for a grade A recommendation in clinical practice guidelines, including those dealing with antimicrobial therapy [4]. Convinced by the principles of evidence-based medicine, we attempted to perform several meticulous meta-analyses in the field of antimicrobial treatment for acute bacterial exacerbations of chronic bronchitis (ABECB) [1,5], as well as for other lower respiratory tract infections [6,7].…”