Table 5.
Recent Respiratory Antibiotic Trials in Acute Exacerbations of Chronic Bronchitis and Acute Exacerbations of Chronic Obstructive Pulmonary Disease
| Study | Mean Age | Antibiotic * , † | Comparative Agent * , † | Outcome |
|---|---|---|---|---|
| Anzueto et al. 67 | 58.3, 57.2 | CL‐extend (1,000 qd × 7 d) | A/C (875 bid × 10 d) | CC—85% vs 87% (NS) AE—20% vs 24% (NS) Adverse gastrointestinal severity score >A/C than CL‐exten (P=0.016) |
| Llor et al. 68 | 71.9, 70.8 | A (500 tid × 10 d) | A/C (500/125 tid × 10 d) | CC—90.9% vs. 92.8% (NS) AE—4.4% vs. 11.6% (NS) |
| Petitpretz et al. 69 | 64.3, 64.2 | L (500 qd × 10 d) | Cef (250 bid × 10 d) | CC—94.6% vs 93.3% (NS) No difference RRR |
| Amsden et al. 70 | 58.3–59.0, 59.1–54.0 | L (500 qd × 7 d) | Az (500 qd × 1d, 250 qd × 4 d) | CC—70.3% vs 67.6% (NS) |
| Grossman et al. 71 | 58.7 (37%≥65) | L (750 qd × 5 d) | A/C (875/125 bid × 10 d) | Earlier clinical resolution L vs A/C CC—No difference AE—No difference |
| Martinez et al. 46 | UC 50.7, 51.0 CB 59.0, 59.3 | UC L (750 qd × 3 d) CB L (750 qd × 5 d) | AZ (500 qd × 1 d, 250 qd × 4 d) A/C (875/125 bid × 10 d) | UC—CC—93.0% vs 90.1% (NS) CB—CC—79.2% vs 81.7% (NS) L superior to AZ in microbiological eradication |
| Urueta‐Robledo et al. 72 | 59, 61 | M (400 qd × 5 d) | L (500 qd × 7 d) | CC—91.0% vs 94.0% (NS) Equal microbiology eradication |
| Starakis et al. 73 | 54, 49 | M (400 qd × 5d) | A/C (625 tid × 7 d) | CC—90.0% vs 89.4% (NS) Equal microbiological eradication |
| Wilson et al. 65 | 63.8, 62.6 | M (400 qd × 5d) | A (500 tid × 7 d) or CL (500 bid × 7 d) or Cef (750 bid × 7 d) | CC—70.9 vs 62.8 (P<.05) Fewer follow‐up antibiotics required with M Mean time to next exacerbation longer with M (132.8 d vs 118.0 d, P=.03) |
| Zervos et al. 74 | 55.5, 56.4 | M (400 qd × 5d) | Az (500 qd × 3 d) | CC—82% vs 81% (NS) Equal microbiological eradication |
| Grassi et al. 75 | 69.6, 69.1 | M (400 qd × 5d) | Ceft (1,000 qd × 7 d) | CC—90.6% vs 89.0% (NS) Equal microbiological eradication Cost savings with M vs Ceft |
| Schaberg et al. 76 | 61.3, 59.3 | M (400 qd × 5d) | A/C (625 tid × 7 d) | CC—96.2% vs 91.6% (NS) Equal microbiological eradication |
| Wilson et al. 66 | 68.1, 67.1 | G (320 qd × 5d) | Ceft (1,000 qd × 1–3 d) followed by Cef (500 bid 4–6 d) maximum 7 d total treatment | CC—82.6% vs 72.1% (P<.05) G 9 d vs Ceft/Cef 11 d to hospital discharge, (P=.04) Equal microbiological eradication |
*
All doses=mg.
†
† Dose of clavulanate was not always specified.
Az=azithromycin; M=moxifloxacin; A=amoxicillin; CL=clarithromycin; Ceft=ceftriaxone; L=levofloxacin; A/C=amoxicillin/clavulanate; Cef=Cefuroxime; G=gemifloxacin; qd=daily; tid=three times daily; bid=twice daily; UC=uncomplicated chronic bronchitis; CB=complicated chronic bronchitis; CC=clinical cure—per protocol; RRR=relapse response rate; NS=not significant; AE=adverse events; Exten=extended release.