PURPOSE: Efficacy of antimicrobials for acute exacerbations of chronic bronchitis (AECB) episodes to prevent hospitalization and slow decline in pulmonary function in patients with chronic obstructive pulmonary disease (COPD) is controversial.Previously, a study performed at our medical center identified risk factors for antimicrobial failure and further hospitalization for AECB treatment. A similar study in COPD patients to better understand antimicrobial utilization in AECB and its impact on outcome is being described here.
METHODS: All medical records from COPD patients seen at the Pulmonary Clinic, Creighton University Medical Center were retrospectively reviewed from 2000-2006 to capture AECB episodes and antimicrobial selection. Antimicrobial failure was defined as an AECB episode that did not respond to therapy and necessitated a new antimicrobial prescription within 2 weeks.
RESULTS: A total of 1199 medical records were reviewed, of which 45 patients had 108 episodes (mean 2.5 episodes/patient; range 1–19) of AECB requiring antimicrobial with or without corticosteroid therapy. Mean + SD values for age, weight, and body mass index of patients were 60.3 + 10.2 years, 171.2 + 56.7 pounds, and 28.3 + 8.1 kg/m2. Fifty-three episodes (49%) were patients receiving home oxygen and 64% were female. Mean patient FEV1 was 1.30 L (50.1% predicted) and the FEV1/FVC 51.3%. A total of 86% and 55% of AECB episodes were in patients receiving inhaled or oral corticosteroids. Mean antimicrobial length of therapy was 8.6 + 4.0 days. Overall, 81% of all AECB episodes were successfully treated. A significant correlation was determined between antimicrobial length of therapy and increased corticosteroid requirement during AECB (p < 0.03). Antimicrobial failure rates were significantly higher (p<0.05) in AECB episodes treated with macrolides (azithromycin and clarithromycin 39%) compared to fluoroquinolones (levofloxacin and moxifloxacin 16%). AECB episodes treated with amoxicillin/clavulanate had intermediate failure rate (25%).
CONCLUSION: AECB episodes treated with fluoroquinolones were treated successfully more often than those treated with other antimicrobial categories.
CLINICAL IMPLICATIONS: AECB episodes treated with fluoroquinolones are less likely to fail and require additional therapy within 2 weeks.
DISCLOSURE: Julie Chang, No Financial Disclosure Information; No Product/Research Disclosure Information