Abstract
BackgroundThe role of antibiotics in the treatment of chronic obstructive pulmonary disease (COPD) exacerbations and their effectiveness in combination have not been clearly established. To determine whether using a combination of fluoroquinolones and beta-lactams improves the clinical and microbiological efficacy of antibiotics on day 20 of treatment, we conducted an open-label randomized trial based on clinical outcomes, microbiological clearance, spirometry tests, and signs of systemic inflammation in patients hospitalized with acute exacerbations of COPD.MethodsWe enrolled 139 subjects with COPD exacerbations, defined as acute worsening of respiratory symptoms leading to additional treatment. Patients were divided randomly into two groups: 79 patients using beta-lactam antibiotics alone and 60 using beta-lactam antibiotics plus fluoroquinolones. Clinical and microbiological responses, spirometry tests, symptom scores, and serum C-reactive protein (CRP) levels were evaluated.ResultsClinical success, lung function, and symptoms were similar in patients with or without fluoroquinolone administration on days 10 and 20. Combination therapy was superior in terms of microbiological outcomes and reduction in serum CRP value. Although equivalent to monotherapy in terms of clinical success, the combination showed superiority in terms of microbiological success and a decrease in CRP. The combination therapy group had a higher microbiological success rate with gram-negative bacteria than the monotherapy group with Pseudomonas aeruginosa (100% vs. 33.3%, respectively) and Acinetobacter baumanii (100% vs. 20%, respectively) (P < 0.05).ConclusionsConcomitant use of fluoroquinolone and beta-lactam antibiotics for bacterial infections during COPD exacerbations caused by gram-negative bacteria appear to be effective and should be applied in clinical practice.
Highlights
The role of antibiotics in the treatment of chronic obstructive pulmonary disease (COPD) exacerbations and their effectiveness in combination have not been clearly established
The mortality rate for patients treated with beta-lactam-aminoglycoside combination therapy was not significantly reduced compared with that of patients with gram-negative bacillary sepsis treated with beta-lactam monotherapy [9,10,11]
The participants comprised patients aged over 45 years, diagnosed with COPD stages I–IV as stated by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) [15], with acute exacerbations, and who had used antibiotics for at least 1 day
Summary
The role of antibiotics in the treatment of chronic obstructive pulmonary disease (COPD) exacerbations and their effectiveness in combination have not been clearly established. The most commonly isolated bacteria in the lower respiratory tract of patients with COPD are Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae, with increasing evidence of the importance of Pseudomonas aeruginosa infection in severe COPD [6]. These bacteria exhibit high resistance to many antibiotics, and empirical treatment for serious systemic infections often involves a two-drug regimen [7, 8]. The mortality rate for patients treated with beta-lactam-aminoglycoside combination therapy was not significantly reduced compared with that of patients with gram-negative bacillary sepsis treated with beta-lactam monotherapy [9,10,11] Another potentially favorable combination is a beta-lactam plus a fluoroquinolone. Despite the increasing use of fluoroquinolones due to their relatively broad spectrum of antimicrobial activity and their accepted safety, to the best of our knowledge, the inclusion of fluoroquinolones in a combined antibacterial regimen for gram-negative bacilli has not been studied on a per-drug basis
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