Short-course Fluoroquinolones in Acute Exacerbations of Chronic Bronchitis

Mark H Gotfried; Ronald F Grossman

Disclosures

Expert Rev Resp Med. 2010;4(5):661-672. 

In This Article

Discussion

In this review of clinical trials using 5-day respiratory fluoroquinolones as a treatment regimen for AECB, we found that a short-course fluoroquinolone regimen is at least as effective as standard therapy of 7 days or longer in both clinical and bacteriological outcomes. The choice of 5 days of therapy in this article is based solely on the durations used in the studies cited. Data on short-course, 5-day fluoroquinolone therapy suggest an association with more rapid symptom resolution and faster rate of recovery compared with standard therapy. A greater proportion of patients had faster resolution of AECB symptoms, including purulent sputum production, sputum volume and cough, with 5-day courses of levofloxacin or moxifloxacin.[26,48] A faster rate of recovery was demonstrated in patients treated with 5-day moxifloxacin or gemifloxacin,[45–49] and more than 90% of patients treated with moxifloxacin were cured at day 7.[45] In addition, short-course fluoroquinolone therapy has been shown to reduce the frequency of treatment failure, new exacerbation and future antibiotic treatment,[30,32] and to result in shorter hospitalization stays.[30,34]

Similar observations have been reported by two separate meta-analyses of short-course antibiotic treatment for AECB.[7,50] El Moussaoui and colleagues conducted a meta-analysis of double-blind studies investigating these regimens.[7] Studies captured data on a variety of antibiotics, including nine studies that used fluoroquinolones. This analysis found that clinical cure and bacteriological cure observed with short-course therapy is comparable with that observed with conventional duration therapy. The authors concluded that these results support the effectiveness of short-course therapy for treatment of AECB, and suggested that this adds to the other potential advantages of shorter courses of antibiotics, including improved compliance, reduced costs and lower potential for resistance development. Based on the data of the meta-analysis by El Moussaoui et al.,[7] Wilson suggested that a 5-day, short-course antibiotic regimen should be used in patients without risk factors for poor outcome.[51] A similar meta-analysis of randomized controlled trials that compared different treatment durations of the same antibiotic regimen also was conducted. This research identified seven randomized controlled trials of quinolones, cefixime and clarithromycin, and also confirmed the effectiveness of short-course antimicrobial therapy in patients with AECB.[50]

In addition to demonstrating clinical and bacteriological outcomes similar to those obtained with other antibiotics, fluoroquinolone regimens also may provide an increase in the time between exacerbations.[52] Moreover, in all the studies described, the short-course fluoroquinolone regimens are well tolerated and exhibit no significant differences in drug-related adverse events as compared with standard therapy.

Our analysis supports the effectiveness of short-course fluoroquinolone therapy in the management of AECB. Rapid recovery from AECB symptoms following short-course fluoroquinolone therapy is important due to the improved quality of life and economic benefits that can be expected. Future research should address the identification of patients to receive antibiotic therapy based on risk factors and the need for continuation or follow-up courses of antibiotic therapy in poor responders.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....