A substantial number of Americans h...

A substantial number of Americans have chronic obstructive pulmonary disease (COPD) in various stages of severity. greatest in quantity of these patients have stage 1 disease, according to the American Thoracic Society, which means their forced expiratory tome in one second (FE[V.sub.1]) is at least 50 percent of the predicted value. Stage 2 is defined as an FEV1 value of 35 to 49 percent of the predicted value, and stage 3 is defined as an FE[Vsub1] value of les than 35 percent of the predicted value. A question common to all patients with COPD regardless of disease severity, is acute exacerbation of chronic bronchitis, with any or all of the cardinal symptoms of increased dyspnea, increased sputum mass and increased sputum purulence. Treatment for exacerbation remains controversial. an authors suggest that acute exacerbation is noninfectious in nature and does not require treatment. Other studies have shown that treating acute exacerbations of chronic bronchitis with an antibiotic decreases the duration of illness and improves peak roll on measurements. The selection of antibiotic is important because the same study showed that second-line agents perform better than first-line agents. In addition, the advanced-generation macrolide and fluoroquinolone agents provide a broader image of coverage and improved results in patients with acute exacerbation of chronic bronchitis of bacterial origin. However, novel increases in Streptococcus pneumoniae resistance to macrolides have called this strategy into question. Amsden and associates compared the safety and efficacy of oral azithromycin and levofloxacin in the outpatient treatment of patients with acute bacterial exacerbation of chronic bronchitis.

The trial was a randomized, double-blind, double-dummy, multicenter trial. Patients included in the research were between 35 and 75 years of age with a history of chronic bronchitis, had corrupt sputum that was positive for bacteria either on Gram stain or culture, and had at least couple of the three cardinal symptoms of acute exacerbation of chronic bronchitis. Before enrollment each participant's clinical findings, beating [i]or[/i] throbbing of an artery oximetry values, arterial blood gas measurements, and FE[Vsub1] values were recorded. The patients were randomized to receive azithromycin in a dosage of 500 mg upon day 1 and 250 mg by means of day on days 2 [i]or[/i] part of to the other 5, or levofloxacin in a dosage of 500 mg daily for seven days. Patients were reassessed upon day 4 of therapy for clinical and laboratory answers and for adverse reactions to the medication. This same assessment was repeated forward day 24 after the initial screen

Of the 235 patients registered in the study, 118 received azithromycin and 117 received levofloxacin. the two medications were well tolerated, with 21 patients (18 percent) in the azithromycin assemblage and 23 patients (20 percent) in the levofloxacin cluster reporting mild to moderate adverse reactions. The majority of these reactions were gastrointestinal symptoms. from day 4 of therapy, 89 percent of the patients receiving azithromycin and 92 percent of those receiving levofloxacin had favorable clinical results At day 24, 82 percent and 86 percent had favorable answers to azithromycin and levofloxacin, respectively. Azithromycin and levofloxacin also had similar bacterial eradication rates.

The authors infer that in the treatment of acute bacterial exacerbation of chronic bronchitis the standard five-day regimen of azithromycin be deriveds in outcomes similar to those resulting from a seven-day course of levofloxacin. These agents remain an effective and safe treatment option in patients with this condition, despite affects about macrolide resistance.

KARL E MILLER, MD

Amsden GW et al. Efficacy and safety of azithromycin v levofloxacin in the outpatient treatment of acute bacterial exacerbations of chronic bronchitis. Chest March 2003; 123:772-7

COPYRIGHT 2003 American Academy of Family Physicians

COPYRIGHT 2003 Gale Group