H. influenzae is the most common pathogen associated with acute bacterial exacerbations of chronic bronchitis (ABECB). With increasing H. influenzae resistance to macrolides new treatment options are needed.
Data were pooled from four double-blind, multicenter, randomized trials comparing moxifloxacin (400mg QD x 5–10d) to macrolides (azithromycin 500mg/250mg QD x 5d, or clarithromycin 500mg BID x 5–10d) in the treatment of ABECB. Clinical and bacteriologic success rates for the efficacy-valid population were recorded at the test-of-cure (TOC) visit (7–37 days post-therapy).
Of 910 microbiologically valid patients, 292 (32%) patients had infection with H. influenzae. The treatment groups were balanced based on demographic/baseline medical characteristics (62% male, mean age 55 yr, 58% current smokers, 29% past smokers, 61% <<26>2 ABECB previous year). Comparative bacteriologic eradication and clinical success rates for moxifloxacin and macrolide agents are provided below. Moxifloxacin had consistently higher bacteriologic eradication rates than the macrolides in both patients with <<26>2 or >2 exacerbations in the previous year.
For patients with ABECB due to H. influenzae, moxifloxacin consistently provided superior bacteriologic eradication rates than macrolide therapy.
The superior bacteriologic eradication rates provided by moxifloxacin in the treatment of H. influenzae-associated ABECB may reduce the risk of antibiotic resistant mutants and prolong the infection-free interval in these patients. Drug ComparisonClinical SuccessP-value*Bacteriologic EradicationP-value*Moxifloxacin vs. Macrolides (Clarithromycin+ Azithromycin)90% (128/143) 85% (127/149)P=0.27893% (133/143) 73% (109/149)P=0.001Moxifloxacin vs. Clarithromycin89% (72/81) 88% (74/84)P=0.87390% (73/81) 64% (54/84)P=0.001Moxifloxacin vs. Azithromycin90% (56/62) 82% (53/65)P=0.15697% (60/62) 85% (55/65)P=0.019*
M. Niederman, Bayer