A Comparative Trial of Minocin (Minocycline Hydrochloride) and Ampicillin in the Treatment of Acute Exacerbations of Chronic Bronchitis

Burrow, G R F; Fox, A S; Daniel, R.

doi:10.1177/030006057500300503

Cited by 4 publications

(1 citation statement)

References 6 publications

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“…A common reason to justify a head-to-head trial was that antibiotics are effective against organisms most commonly associated with purulent sputum in chronic bronchitis, such as Haemophilus influenzae and Streptococcus pneumoniae . Thus rather than citing evidence from placebo-controlled trials, they referred to the in-vitro activity of antibiotics (for example [ 18 , 19 ]). Yet another group of head-to-head trials referred to placebo-controlled trials to justify their head-to-head trials but selectively cited only those trials with positive results [ 20 , 21 ].…”

Section: Resultsmentioning

confidence: 99%

Where is the supporting evidence for treating mild to moderate chronic obstructive pulmonary disease exacerbations with antibiotics? A systematic review

Puhan

Vollenweider

Steurer

et al. 2008

BMC Med

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Background: Randomised trials comparing different drugs head-to-head are extremely valuable for clinical decision-making. However, it is scientifically and ethically sensible to demand strong evidence that a drug is effective by showing superiority over a placebo before embarking on head-to-head comparisons of potentially ineffective drugs. Our aim was to study the evolvement of evidence from placebo-controlled and head-to-head trials on the effects of antibiotics for the treatment of mild to moderate exacerbations of chronic obstructive pulmonary disease.

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Section: Resultsmentioning

confidence: 99%

Where is the supporting evidence for treating mild to moderate chronic obstructive pulmonary disease exacerbations with antibiotics? A systematic review

Puhan

Vollenweider

Steurer

et al. 2008

BMC Med

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Antibiotics for exacerbations of chronic obstructive pulmonary disease

Vollenweider

Jarrett

Steurer-Stey

et al. 2012

Cochrane Database of Systematic Reviews

241

122

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BACKGROUND: Many patients with an exacerbation of chronic obstructive pulmonary disease (COPD) are treated with antibiotics. However, the value of antibiotics remains uncertain as systematic reviews and clinical trials have shown conflicting results. OBJECTIVES: To assess the effects of antibiotics in the management of acute COPD exacerbations on treatment failure as observed between seven days and one month after treatment initiation (primary outcome) and on other patient-important outcomes (mortality, adverse events, length of hospital stay). SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and other electronically available databases up to September 2012. SELECTION CRITERIA: Randomised controlled trials (RCTs) in people with acute COPD exacerbations comparing antibiotic therapy and placebo with a follow-up of at least seven days. DATA COLLECTION AND ANALYSIS: Two review authors independently screened references and extracted data from trial reports. We kept the three groups of outpatients, inpatients and patients admitted to the intensive care unit (ICU) separate for benefit outcomes and mortality because we considered them to be clinically too different to be summarised in one group. We considered outpatients to have a mild to moderate exacerbation, inpatients to have a severe exacerbation and ICU patients to have a very severe exacerbation. Where outcomes or study details were not reported we requested missing data from the authors of the primary studies. We calculated pooled risk ratios (RR) for treatment failure, Peto odds ratios (OR) for rare events (mortality and adverse events) and weighted mean differences (MD) for continuous outcomes using fixed-effect models. We used GRADE to assess the quality of the evidence. MAIN RESULTS: Sixteen trials with 2068 participants were included. In outpatients (mild to moderate exacerbations), there was evidence of low quality that antibiotics did statistically significantly reduce the risk for treatment failure between seven days and one month after treatment initiation (RR 0.75; 95% CI 0.60 to 0.94; I(2) = 35%) but they did not significantly reduce the risk when the meta-analysis was restricted to currently available drugs (RR 0.80; 95% CI 0.63 to 1.01; I(2) = 33%). Evidence of high quality showed that antibiotics statistically significantly reduced the risk of treatment failure in inpatients with severe exacerbations (ICU not included) (RR 0.77; 95% CI 0.65 to 0.91; I(2) = 47%) regardless of whether restricted to current drugs. The only trial with 93 patients admitted to the ICU showed a large and statistically significant effect on treatment failure (RR 0.19; 95% CI 0.08 to 0.45; high-quality evidence).Evidence of low-quality from four trials in inpatients showed no effect of antibiotics on mortality (Peto OR 1.02; 95% CI 0.37 to 2.79). High-quality evidence from one trial showed a statistically significant effect on mortality in ICU patients (Peto OR 0.21; 95% CI 0.06 to 0.72). Length of hospital stay (in da...

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Antibiotics for exacerbations of chronic obstructive pulmonary disease

Vollenweider¹,

Frei

Steurer-Stey

et al. 2018

Cochrane Database of Systematic Reviews

102

108

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Background Many patients with an exacerbation of chronic obstructive pulmonary disease (COPD) are treated with antibiotics. However, the value of antibiotics remains uncertain, as systematic reviews and clinical trials have shown conflicting results. Objectives To assess e ects of antibiotics on treatment failure as observed between seven days and one month a er treatment initiation (primary outcome) for management of acute COPD exacerbations, as well as their e ects on other patient-important outcomes (mortality, adverse events, length of hospital stay, time to next exacerbation).

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A Comparative Trial of Minocin (Minocycline Hydrochloride) and Ampicillin in the Treatment of Acute Exacerbations of Chronic Bronchitis

Cited by 4 publications

References 6 publications

Where is the supporting evidence for treating mild to moderate chronic obstructive pulmonary disease exacerbations with antibiotics? A systematic review

Where is the supporting evidence for treating mild to moderate chronic obstructive pulmonary disease exacerbations with antibiotics? A systematic review

Antibiotics for exacerbations of chronic obstructive pulmonary disease

Antibiotics for exacerbations of chronic obstructive pulmonary disease

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