Prophylactic antibiotic therapy for chronic bronchitis

Staykova, Toni; Black, Peter; Chacko, Emme; Poole, Phillippa

doi:10.1002/14651858.cd004105

Cited by 46 publications

(20 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Results of previous trials of prophylactic use of antibiotics in COPD conducted prior to 1970 demonstrate inconsistent and small benefits of such therapy. However, these studies were limited by the small numbers of patients included, the use of low doses of narrow-spectrum antibiotics, and by inadequate efficacy assessment [17]. Though widely used for treatment, respiratory fluoroquinolones have not been investigated in the prevention of COPD exacerbations.…”

Section: Introductionmentioning

confidence: 99%

Pulsed moxifloxacin for the prevention of exacerbations of chronic obstructive pulmonary disease: a randomized controlled trial

Sethi

Jones

Theron³

et al. 2010

Respir Res

162

120

View full text Add to dashboard Cite

BackgroundAcute exacerbations contribute to the morbidity and mortality associated with chronic obstructive pulmonary disease (COPD). This proof-of-concept study evaluates whether intermittent pulsed moxifloxacin treatment could reduce the frequency of these exacerbations.MethodsStable patients with COPD were randomized in a double-blind, placebo-controlled trial to receive moxifloxacin 400 mg PO once daily (N = 573) or placebo (N = 584) once a day for 5 days. Treatment was repeated every 8 weeks for a total of six courses. Patients were repeatedly assessed clinically and microbiologically during the 48-week treatment period, and for a further 24 weeks' follow-up.ResultsAt 48 weeks the odds ratio (OR) for suffering an exacerbation favoured moxifloxacin: per-protocol (PP) population (N = 738, OR 0.75, 95% confidence interval (CI) 0.565-0.994, p = 0.046), intent-to-treat (ITT) population (N = 1149, OR 0.81, 95% CI 0.645-1.008, p = 0.059), and a post-hoc analysis of per-protocol (PP) patients with purulent/mucopurulent sputum production at baseline (N = 323, OR 0.55, 95% CI 0.36-0.84, p = 0.006).There were no significant differences between moxifloxacin and placebo in any pre-specified efficacy subgroup analyses or in hospitalization rates, mortality rates, lung function or changes in St George's Respiratory Questionnaire (SGRQ) total scores. There was, however, a significant difference in favour of moxifloxacin in the SGRQ symptom domain (ITT: -8.2 vs -3.8, p = 0.009; PP: -8.8 vs -4.4, p = 0.006). Moxifloxacin treatment was not associated with consistent changes in moxifloxacin susceptibility. There were more treatment-emergent, drug related adverse events with moxifloxacin vs placebo (p < 0.001) largely due to gastrointestinal events (4.7% vs 0.7%).ConclusionsIntermittent pulsed therapy with moxifloxacin reduced the odds of exacerbation by 20% in the ITT population, by 25% among the PP population and by 45% in PP patients with purulent/mucopurulent sputum at baseline. There were no unexpected adverse events and there was no evidence of resistance development.Trial registrationClinicalTrials.gov number, NCT00473460 (ClincalTrials.gov).

show abstract

Section: Introductionmentioning

confidence: 99%

Pulsed moxifloxacin for the prevention of exacerbations of chronic obstructive pulmonary disease: a randomized controlled trial

Sethi

Jones

Theron³

et al. 2010

Respir Res

162

120

View full text Add to dashboard Cite

show abstract

“…[424] The postulated benefit is a decreased risk of exacerbations while the potential risks include adverse effects of the drugs used, development of resistance, and increased cost. The largest trial available compared azithromycin 250 mg daily with placebo for 1 year.…”

Section: Introductionmentioning

confidence: 99%

Guidelines for diagnosis and management of chronic obstructive pulmonary disease: Joint ICS/NCCP (I) recommendations

et al. 2013

View full text Add to dashboard Cite

Chronic obstructive pulmonary disease (COPD) is a major public health problem in India. Although several International guidelines for diagnosis and management of COPD are available, yet there are lot of gaps in recognition and management of COPD in India due to vast differences in availability and affordability of healthcare facilities across the country. The Indian Chest Society (ICS) and the National College of Chest Physicians (NCCP) of India have joined hands to come out with these evidence-based guidelines to help the physicians at all levels of healthcare to diagnose and manage COPD in a scientific manner. Besides the International literature, the Indian studies were specifically analyzed to arrive at simple and practical recommendations. The evidence is presented under these five headings: (a) definitions, epidemiology, and disease burden; (b) disease assessment and diagnosis; (c) pharmacologic management of stable COPD; (d) management of acute exacerbations; and (e) nonpharmacologic and preventive measures. The modified grade system was used for classifying the quality of evidence as 1, 2, 3, or usual practice point (UPP). The strength of recommendation was graded as A or B depending upon the level of evidence.

show abstract

“…This approach is not new as trials of prophylactic antibiotics in chronic bronchitis were first carried out in the 1960s. A meta-analysis of nine such trials showed some reduction in exacerbation time and a small but non-significant effect on exacerbation frequency 133. The lack of clear efficacy and concerns around the development of antibiotic resistance meant that this approach to antibiotic use in COPD was not pursued until more recently.…”

Section: Antibiotics In Stable Copdmentioning

confidence: 99%

Lung microbiology and exacerbations in COPD

Beasley¹,

Joshi²,

Singanayagam³

et al. 2012

COPD

View full text Add to dashboard Cite

Chronic obstructive pulmonary disease (COPD) is the most common chronic respiratory condition in adults and is characterized by progressive airflow limitation that is not fully reversible. The main etiological agents linked with COPD are cigarette smoking and biomass exposure but respiratory infection is believed to play a major role in the pathogenesis of both stable COPD and in acute exacerbations. Acute exacerbations are associated with more rapid decline in lung function and impaired quality of life and are the major causes of morbidity and mortality in COPD. Preventing exacerbations is a major therapeutic goal but currently available treatments for exacerbations are not very effective. Historically, bacteria were considered the main infective cause of exacerbations but with the development of new diagnostic techniques, respiratory viruses are also frequently detected in COPD exacerbations. This article aims to provide a state-of-the art review of current knowledge regarding the role of infection in COPD, highlight the areas of ongoing debate and controversy, and outline emerging technologies and therapies that will influence future diagnostic and therapeutic pathways in COPD.

show abstract

Prophylactic antibiotic therapy for chronic bronchitis

Cited by 46 publications

References 27 publications

Pulsed moxifloxacin for the prevention of exacerbations of chronic obstructive pulmonary disease: a randomized controlled trial

Pulsed moxifloxacin for the prevention of exacerbations of chronic obstructive pulmonary disease: a randomized controlled trial

Guidelines for diagnosis and management of chronic obstructive pulmonary disease: Joint ICS/NCCP (I) recommendations

Lung microbiology and exacerbations in COPD

Contact Info

Product

Resources

About