Randomized, double-blind study of grepafloxacin versus amoxycillin in patients with acute bacterial exacerbations of chronic bronchitis

Langan, Charles E.; Cranfield, Roger; Breisch, Sally A.; Pettit, Ross E.

doi:10.1093/jac/40.suppl_1.63

Cited by 56 publications

(26 citation statements)

References 12 publications

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“…The clinical cure or improvement rates reported at follow-up in this study (88 and 89% in the grepafloxacin and clarithromycin groups, respectively) were similar to those observed in previous clinical comparisons of 10-day treatments for ABECB with grepafloxacin and amoxicillin (82 vs 85%) [21] and grepafloxacin and ciprofloxacin (87 vs 80%). [22] Collectively, these studies confirm the clinical efficacy of grepafloxacin in the treatment of ABECB.…”

Section: Discussionsupporting

confidence: 88%

Efficacy and Tolerability of Once-Daily Grepafloxacin Compared with Clarithromycin in the Treatment of Acute Bacterial Exacerbations of Chronic Bronchitis*

DeAbate¹,

Myers

Henry

et al. 1999

Clinical Drug Investigation

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Objectives: The clinical and bacteriological efficacies and tolerability of grepafloxacin 400mg once daily for 10 days were compared with clarithromycin 500mg twice daily for 10 days in patients with acute bacterial exacerbations of chronic bronchitis (ABECB). Patients and Study Design: 379 patients with signs and symptoms of ABECB were enrolled in a randomised, double-blind clinical trial conducted at 15 outpatient centres in the USA. Eligible patients were randomly assigned to receive either grepafloxacin plus matched clarithromycin placebo (n = 192) or clarithromycin plus matched grepafloxacin placebo (n = 187). Results: The two treatment groups were equivalent with respect to clinical efficacy, and no statistically significant differences in the incidence of drugrelated adverse events were seen between the two groups. A satisfactory clinical outcome was achieved in 88% (130 of 148) and 89% (134 of 150) of clinically evaluable patients treated with grepafloxacin or clarithromycin, respectively. The primary pathogens isolated from pretreatment sputum specimens were Haemophilus parainfluenzae, H. influenzae, Moraxella catarrhalis, Streptococcus pneumoniae and Staphylococcus aureus (31, 18, 6, 5 and 4% of isolates, respectively). Pathogens were eradicated or presumed to be eradicated in 88% (113 of 129) and 78% (97 of 125) of bacteriologically evaluable patients treated with grepafloxacin or clarithromycin, respectively. Both treatments were associated with a low incidence of drug-related adverse events. Conclusion: These results indicate that grepafloxacin 400mg once daily for 10 days is as well tolerated and as clinically effective as clarithromycin 500mg twice daily for 10 days in patients with ABECB.

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Section: Discussionsupporting

confidence: 88%

Efficacy and Tolerability of Once-Daily Grepafloxacin Compared with Clarithromycin in the Treatment of Acute Bacterial Exacerbations of Chronic Bronchitis*

DeAbate¹,

Myers

Henry

et al. 1999

Clinical Drug Investigation

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“…Levofloxacin and moxifloxacin are active against most of the strains of S. pneumoniae and H. influenzae and achieve high concentrations in bronchial secretions several times higher than the required MIC to treat these microorganisms [215][216][217][218][219]. In addition, they are active against Gram negative bacilli other than P. aeruginosa.…”

Section: Recommendationmentioning

confidence: 99%

Guidelines for the management of adult lower respiratory tract infections

Woodhead¹

2005

Eur Respir J

685

555

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“…The observation that patients clear M. catarrhalis quickly, even in the absence of antibiotic therapy (median, 42 days), demonstrates that host mechanisms effectively clear M. catarrhalis from the respiratory tract. These data have important implications in interpreting results of cultures in antibiotic trials; for example, the apparent eradication of ␤-lactamase-producing strains of M. catarrhalis by amoxicillin is not surprising in view of this new information (26,27).…”

Section: Discussionmentioning

confidence: 97%

Moraxella catarrhalis in Chronic Obstructive Pulmonary Disease

Murphy

Brauer

Grant

et al. 2005

Am J Respir Crit Care Med

258

273

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Keywords: chronic bronchitis; mucosal immunity; respiratory tract infectionBacterial infection of the respiratory tract has long been recognized as playing a role in the course and pathogenesis of chronic obstructive pulmonary disease (COPD) (1-3). However, the precise role of bacteria is poorly understood and controversial. Bacteria cause many of the exacerbations that characterize the disease and, through chronic colonization, contribute to airway inflammation that is a hallmark of the disease (4, 5). COPD is the fourth most common cause of death in the world and is associated with enormous morbidity and health care costs (6, 7). Elucidating the dynamics of bacterial infection and characteriz- Studies performed decades ago emphasized the role of Haemophilus influenzae and Streptococcus pneumoniae in COPD (8-12). Interestingly, in classic studies by May (8) and Howell (9), Moraxella catarrhalis (then known as Neisseria catarrhalis) was isolated more often than H. influenzae and S. pneumoniae from sputum of adults with COPD. However, the bacterium was described as an "organism whose pathogenic propensities are known to be slight or non-existent" (8) and was thus ignored for decades. Point prevalence studies indicate that M. catarrhalis colonizes the respiratory tract of 5 to 32% of adults with COPD at any one time (8,9,(13)(14)(15)(16). Little is known about the duration of carriage, the relative frequency of M. catarrhalis as a cause of exacerbations or the human immune response, and its relationship to the clinical expression of carriage and disease. Studies of the human immune response to M. catarrhalis have been limited by the use of heterologous laboratory strains in immunoassays. The use of immunoassays that detect antibodies that bind to epitopes on the bacterial surface of the homologous infecting strain is important to detect potentially protective immune responses.We are conducting a prospective study in which we obtain clinical information, sputum, and serum samples monthly and during exacerbations in a cohort of patients with COPD. In previous work, on the basis of 57 months of follow-up, we have demonstrated that acquisition of a new strain of H. influenzae, M. catarrhalis, or S. pneumoniae is associated with the occurrence of an exacerbation (17). Furthermore, in previous work, we studied serum and sputum supernatants from 21 patients with exacerbations associated with M. catarrhalis to develop immunoassays to measure serum IgG and sputum IgA to antigens on the bacterial surface (18). The present study has elucidated the dynamics of carriage of M. catarrhalis in COPD on the basis of 81 months of follow-up, measured the systemic and mucosal antibody responses in 106 sets of serum and sputum samples to homologous infecting strains of M. catarrhalis, and related these immune responses to clinical aspects of carriage. Results of clinical data, colonization patterns, and immunoassays were analyzed to elucidate the dynamics of carriage and the role of M. catarrhalis in the clinical course of COPD. METHOD...

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Randomized, double-blind study of grepafloxacin versus amoxycillin in patients with acute bacterial exacerbations of chronic bronchitis

Cited by 56 publications

References 12 publications

Efficacy and Tolerability of Once-Daily Grepafloxacin Compared with Clarithromycin in the Treatment of Acute Bacterial Exacerbations of Chronic Bronchitis*

Efficacy and Tolerability of Once-Daily Grepafloxacin Compared with Clarithromycin in the Treatment of Acute Bacterial Exacerbations of Chronic Bronchitis*

Guidelines for the management of adult lower respiratory tract infections

Moraxella catarrhalis in Chronic Obstructive Pulmonary Disease

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