Short-course moxifloxacin therapy for treatment of acute bacterial exacerbations of chronic bronchitis

“…Baseline data were pooled from six clinical trials with similar methodologies comparing moxifloxacin with other antimicrobials in patients with an AECB (table 1) to determine the relationship between infection and sputum colour [6][7][8][9][10]. All clinical trials were prospective, randomised, controlled, multicentre studies conducted in Europe and North America.…”

Section: Methodsmentioning

confidence: 99%

Sputum colour and bacteria in chronic bronchitis exacerbations: a pooled analysis

Miravitlles

Kruesmann²,

Haverstock³

et al. 2011

Eur Respir J

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We examined the correlation between sputum colour and the presence of potentially pathogenic bacteria in acute exacerbations of chronic bronchitis (AECBs).Data were pooled from six multicentre studies comparing moxifloxacin with other antimicrobials in patients with an AECB. Sputum was collected before antimicrobial therapy, and bacteria were identified by culture and Gram staining. Association between sputum colour and bacteria was determined using logistic regression.Of 4,089 sputum samples, a colour was reported in 4,003; 1,898 (46.4%) were culture-positive. Green or yellow sputum samples were most likely to yield bacteria (58.9% and 45.5% of samples, respectively), compared with 18% of clear and 39% of rust-coloured samples positive for potentially pathogenic microorganisms. Factors predicting a positive culture were sputum colour (the strongest predictor), sputum purulence, increased dyspnoea, male sex and absence of fever. Green or yellow versus white sputum colour was associated with a sensitivity of 94.7% and a specificity of 15% for the presence of bacteria.Sputum colour, particularly green and yellow, was a stronger predictor of potentially pathogenic bacteria than sputum purulence and increased dyspnoea in AECB patients. However, it does not necessarily predict the need for antibiotic treatment in all patients with AECB.

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“…The known failure rates after ambulatory treatment were derived from clinical trials on antibiotics in chronic bronchitis and ranged 7-12% [30,31]. Nevertheless, these results cannot be extrapolated to everyday practice, since patients included in clinical trials consisted of chronic bronchitis patients (whatever that means) and included subjects with ages ranging 18-90 yrs, a significant proportion of which were never smokers and individuals without ventilatory impairment.…”

Section: Frequency and Outcomes Of Exacerbations: Risk Factors For Rementioning

confidence: 99%

Exacerbations of chronic obstructive pulmonary disease: when are bacteria important?

Miravitlles¹

2002

Eur Respir J

101

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The progressive course of chronic obstructive pulmonary disease (COPD) is often aggravated by exacerbations, the majority of them produced by bronchial infection. Frequent exacerbations have been demonstrated to have a negative impact on quality of life and pulmonary function in patients with COPD, particularly in active smokers. Furthermore, acute exacerbations are the most frequent cause of medical visits, hospital admissions and death among patients with chronic lung disease.Evidence indicates that the number of patients with pathogenic bacteria in respiratory secretions and the bronchial bacterial load increase during exacerbations. Furthermore, the local inflammatory response of the host parallels the increase in bacterial load. From these observations, it can be speculated that, for symptoms of acute exacerbation to appear, there must be a minimum bacterial load in the airways, i.e. a threshold above which the inflammatory reaction is severe enough to elicit clinical symptoms of exacerbation. This threshold may vary from patient to patient owing to different modifying factors. Some of these factors may be the recognised risk factors for relapse, such as increasing age, impairment of lung function, comorbid conditions or frequent exacerbations in the past.Relapse rates after ambulatory treatment of acute exacerbation of COPD may be as high as 20-25% of cases. Relapses are associated with significant mordibity and increased costs.A number of unanswered questions remain regarding exacerbations of chronic obstructive pulmonary disease. These include the role of viral infection, the importance of residual bacterial colonisation and the impact of new antibiotics on the treatment of exacerbations. Chronic obstructive pulmonary disease (COPD) is one of the most prevalent diseases in developed countries. Furthermore, the number of individuals affected has grown since the 1980s [1]. In Spain, the prevalence of COPD is 9% in adults aged 40-70 yrs, although only 22% of these are diagnosed [2]. Tobacco smoking is the main aetiological factor for COPD. In a population-based study in Spain, 25% of the population aged 40-70 yrs were smokers and another 25% former smokers [3]. Only 15-20% of smokers will develop COPD, and smokers with COPD exhibit higher tobacco consumption and greater dependence on nicotine than smokers who do not have COPD, and more than one-third have never tried to stop smoking [3]. These figures indicate that the problem of COPD in most developed countries will continue to increase in the near future.The chronic and progressive course of COPD is often aggravated by short periods of increasing symptoms, particularly increasing cough, dyspnoea and production of sputum which can become purulent.

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Short-course moxifloxacin therapy for treatment of acute bacterial exacerbations of chronic bronchitis

Cited by 113 publications

References 26 publications

Guidelines for the management of adult lower respiratory tract infections

Guidelines for the management of adult lower respiratory tract infections

Sputum colour and bacteria in chronic bronchitis exacerbations: a pooled analysis

Exacerbations of chronic obstructive pulmonary disease: when are bacteria important?

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