Determining Factors in the Prescription of Moxifloxacin in Exacerbations of Chronic Bronchitis in the Primary-Care Setting

Marc Miravitlles; Carles Llor


Clin Drug Invest. 2007;27(2):95-104. 

In This Article

Abstract and Introduction

Objective: To describe the characteristics of patients and exacerbations that may determine the choice of an antibacterial in exacerbations of chronic bronchitis (ECB).
Methods: This was a multicentre, observational study in ECB. A group of 225 primary-care practitioners were randomly selected to include 1007 patients. A logistic regression model was used to identify the characteristics of the physicians, patients and exacerbations associated with the choice of an antibacterial.
Results: The mean age of the patients was 67.6 years ( SD 11) and 72.1% were male. In 91.4% of patients, the exacerbation was type I or II according to Anthonisen's classification. Most exacerbations (68.2%) were treated with moxifloxacin while only 31.8% were treated with other antibacterials. The more experienced practitioners (those with the longest professional careers and those who had higher numbers of patient-visits for chronic bronchitis) prescribed moxifloxacin more frequently (per each year of experience: OR 1.05; 95% CI 1.02, 1.07; per each additional patient-visit per week: OR 1.02; 95% CI 1.003, 1.04). The probability of receiving moxifloxacin increased with the severity of baseline dyspnoea (OR 1.94; 95% CI 1.27, 2.96) and decreased in smokers (OR 0.54; 95% CI 0.36, 0.81) and in patients receiving oral corticosteroids (OR 0.61; 95% CI 0.41, 0.90).
Conclusions: Prescription of moxifloxacin in primary care is significantly associated with more years of physician practice and with a higher severity of disease. The use of oral corticosteroids in exacerbations is commonly associated with other antibacterials (non-quinolones), either to improve antibacterial efficacy or because of doubtful bacterial aetiology, thus the preference for a narrow-spectrum antibacterial combined with an anti-inflammatory drug.

Chronic bronchitis and chronic obstructive pulmonary disease (COPD) are two of the main reasons for visits to primary-care centres. It has been estimated that 8-10% of the population aged >40 years has COPD, and this percentage may increase to 20% in males >65 years of age.[1]

In this regard, the future in Spain is not encouraging, since up to 9% of individuals between 20 and 44 years of age have COPD.[2] In addition, considering the aging of the population and the increase in prevalence of smoking among females, the prevalence of COPD is expected to increase in the general population in the next few years. In the US, COPD has been the only potentially preventable cause of death that has increased in the last 15 years.[3]

The clinical course of COPD may be affected by acute worsening of respiratory symptoms - commonly known as exacerbations - which, in a high percentage of cases, are caused by an infection.[4] On average, COPD patients experience two episodes per year, 90% of which are treated with anti-bacterials and 10% lead to hospitalisation.[5]

Exacerbations may greatly affect the quality of life of the patient.[6,7,8] The main objectives of anti-bacterial treatment are to reduce the rates of therapeutic failure and duration of symptoms and to extend the time between episodes.[9] This observational study of antibacterial treatment in exacerbations of chronic bronchitis (ECB) aimed to assess the usefulness of a patient diary of symptoms to monitor the progression of the episodes. As in every observational study, treatment selection was up to the treating physician, and was not dictated by protocol. However, a high number of patients were prescribed moxifloxacin, an antibacterial promoted by the study sponsor. In the present study, we evaluated the patient and exacerbation characteristics associated with the choice of antibacterial treatment, in the context of an observational study sponsored by the pharmaceutical industry.


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