Amoxicillin in Treatment of Acute Uncomplicated Exacerbations of Chronic Bronchitis:A double-blind, placebo-controlled multicentre study in general practice

Abstract

The aim of the study was to evaluate whether a broad-spectrum penicillin, amoxicillin, was superior to placebo in resolving symptoms of acute exacerbations of chronic bronchitis in patients from general practice. 131 general practitioners included 278 patients over a period of 30 months. The patients were randomly assigned to treatment with amoxicillin 750 mg b.i.d. or corresponding placebo for 7 days. Patients with pneumonia, a temperature above 38.5 degrees C or heart rate over 100 were excluded for safety reasons. The main effect parameter--the doctors' overall evaluation of the treatment--did not demonstrate any statistically significant difference between amoxicillin or placebo, 63% versus 64% of the patients. Resolution of symptoms was obtained by 19% (25/132) of the patients in the amoxicillin group compared with 10% (13/136) of the patients in the placebo group, P = 0.03. The present findings do not favour routine use of antibiotics in an attempt to improve the course of acute exacerbations as defined in this study in patients with chronic bronchitis.

New Semiphysiological Absorption Model To Assess the Pharmacodynamic Profile of Cefuroxime Axetil Using Nonparametric and Parametric Population Pharmacokinetics

“…Although 500 mg oral cefuroxime q8h is above the typically recommended oral cefu- (47) studied hospitalized patients and outpatients in 14 countries in Europe, Africa, and South America with acute exacerbation of chronic bronchitis (AECB) and found a 60% bacteriological overall cure rate for 250 mg oral cefuroxime given twice daily (BID). This cure rate is comparable to the placebo response rate for AECB (30,46), depending on the severity of disease. Interestingly, 56% (22 of 39) of the H. influenzae isolates were eradicated.…”

Guidelines for the management of adult lower respiratory tract infections

“…This conclusion and the fact that papers in these meta-analyses included both in-and outpatients, makes it uncertain as to whether antibiotic treatment in exacerbations in all primary care patients is useful. The two studies carried out in primary care failed to show relevant effects [30,31]. However, data on patients with severe exacerbations and exacerbations of mild and severe COPD in primary care were lacking.…”

Common harms from amoxicillin: a systematic review and meta-analysis of randomized placebo-controlled trials for any indication

“…157/1519 19 Shapiro et al 37 Jørgensen et al 11 Wald et al 24 Trehan et al 51 Burke et al 7 Taylor et al 23 Sclafani et al 29 Hoberman et al 10 Wald et al 24 66/1842 Figure 3A). There was high hetero geneity for all studies (I 2 = 68.8%), but not for amoxicillin-clavulanic acid alone (I 2 = 0%).…”

“…Nine trials were registered, but registering harms among the sec ondary outcomes did not guarantee that harms would be reported (Table 1), and registries did not provide any harms data that went unreported in the trials' primary publications. 41 Merenstein et al 19 Meltzer et al 18 Wald et al 24 Jørgensen et al 11 Burke et al 7 Nduba et al 20 Baecher et al 31 Taylor et al 23 Trehan et al 51 Chantelau et al 49 Sclafani et al 29 Wald et al 24 Marchant et al 17 Kaiser et al 12 Hoberman et al 10 Winkel et al 46 Gottfarb et al 8 …”