HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text (PDF) Free All Versions of this Article: chest.07-0149v1 132/2/447    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dimopoulos, G. Articles by Falagas, M. E. Search for Related Content PubMed PubMed Citation Articles by Dimopoulos, G. Articles by Falagas, M. E.

Comparison of first with second-line antibiotics for acute exacerbations of chronic bronchitis: a meta-analysis of randomized controlled trials

¹Critical Care Department, "Attikon" University Hospital, Athens, Greece ²Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece ³Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA

m.falagas{at}aibs.gr

Abstract

BackgroundAlthough acute exacerbations of chronic bronchitis (AECB) are common, there has been no meta-analysis that focused on the optimum regimen.

MethodsTo evaluate the comparative effectiveness and safety of the first- (namely, amoxicillin, ampicillin, pivampicillin, trimethoprim/sulfamethoxazole, and doxycycline) and second-line (namely, amoxicillin/clavulanic acid, macrolides, second- or third-generation cephalosporins, and quinolones) antimicrobial agents for the treatment of patients with AECB, in an era of increasing antimicrobial resistance among the microbes responsible for AECB, we performed a meta-analysis of randomized controlled trials (RCTs) retrieved through searches of the PubMed and the Cochrane databases.

ResultsTwelve RCTs were included. First-line antibiotics were associated with lower treatment success compared to second-line ones in the clinically evaluable patients [odds ratio (OR) = 0.51, 95% confidence intervals (CI) 0.34-0.75]. There was no difference between the compared regimens regarding mortality (OR=0.64, 95% CI 0.25-1.66) or treatment success in microbiologically evaluable patients (OR=0.56, 95% CI 0.22-1.43) or adverse effects in general (OR=0.75, 95% CI 0.39-1.45) or diarrhea in particular (OR=1.58, 95% CI 0.74-3.35).

ConclusionsCompared to first-line antibiotics, second-line antibiotics are more effective, but not less safe, when administered in patients with AECB. The available data did not allow for stratified analyses according to presence of risk factors for poor outcome, such as increased age, impaired lung function, airway obstruction and frequency of exacerbations; this fact should be taken into consideration when interpreting the findings of this meta-analysis.

Key Words: chronic obstructive pulmonary disease • quinolones • macrolides • amoxicillin/clavulanic acid • penicillins, Streptococcus pneumoniae.

This article has been cited by other articles:

				P. Laohaburanakit, G. Dimopoulos, I. I. Siempos, M. E. Falagas, and R. Irwin Antibiotic Use in Acute Exacerbations of Chronic Bronchitis Chest, December 1, 2007; 132(6): 2063 - 2064. [Full Text] [PDF]