Speed of Recovery from Acute Exacerbations of Chronic Obstructive Pulmonary Disease after Treatment with Antimicrobials: Results of a Two-Year Study

Authors: Miravitlles M.¹; Zalacain R.²; Murio C.³; Ferrer M.⁴; Alvarez-Sala J.L.⁵; Masa J.F.⁶; Verea H.⁷; Ros F.⁸; Vidal R.⁹

Source: Clinical Drug Investigation, Volume 23, Number 7, 2003 , pp. 439-450(12)

Publisher: Adis International

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Abstract:

Objective: We performed a multicentre study under a 2-year observational protocol that included data on time to recovery from acute exacerbations of chronic obstructive pulmonary disease (AE-COPD) in patients receiving moxifloxacin and comparator antimicrobials.

Patients and methods: Outpatients with moderate or severe COPD were recruited from respiratory clinics throughout Spain. Moxifloxacin was available in year 2, and was to be prescribed to 50% of patients in that period in a non-randomised allocation. Time to recovery was compared in successfully treated AE-COPD; cross-sectionally for all AE-COPD over 2 years, first AE-COPD and all AE-COPD in year 2, and longitudinally in patients receiving comparator antimicrobials for AE-COPD in year 1 and moxifloxacin in year 2.

Results: 614 AE-COPD were treated in 441 patients over 2 years (mean age 66.7 ± 8.3 years, 98% males, mean forced expiratory volume in 1 second [FEV₁] 35.9 ± 8.8%). Mean time to recovery overall was 4.6 days (SD 3.3) with moxifloxacin 400 mg/day for 5 days, and 5.8 days (SD 4.6) with comparators (p < 0.01), which were most frequently amoxicillin/clavulanic acid 500/125mg/8h, clarithromycin 500mg/12h and cefuroxime axetil 500mg/12h for 7–10 days. Longitudinal analysis showed that 27 patients treated with moxifloxacin in the second year of the study recovered in a mean of 3.7 days (SD 3.1), and the same patients treated with comparator antimicrobials in year one recovered in a mean of 6.8 days (SD 4.6) [p = 0.02]. In contrast, in 66 patients treated with comparator antimicrobials in both years, mean time to recovery was 7.4 days (SD 7.3) in year one and 5.5 days (SD 3.5) in year two (p = 0.24). All subgroup analyses showed a statistically significant reduction of 18–25% in time to recovery with moxifloxacin compared with other antibiotics.

Conclusions: Moxifloxacin significantly reduced time to recovery from AE-COPD in patients with moderate to severe disease by approximately 20% (>1 day) compared with other antimicrobials. Faster recovery should result in earlier return to work or normal activities, and to social and economic savings.

Keywords: Antibacterials, therapeutic use; Moxifloxacin, therapeutic use; Chronic obstructive pulmonary disease, treatment

Document Type: Research article

Affiliations: 1: 1 Servei de Pneumologia, Institut Clínic de Pneumologia i Cirurgia Toràcica (IDIBAPS), Hospital Clinic i Provincial, Barcelona, Spain 2: 2 Unidad de Patología Respiratoria, Hospital de Cruces, Baracaldo, Vizcaya, Spain 3: 3 Unitat de Pneumologia, Hospital General de Catalunya, Barcelona, Spain 4: 4 Health Services Research Unit, Institut Municipal d’Investigació Mèdica, Barcelona, Spain 5: 5 Servicio de Neumología, Hospital Clínico San Carlos, Madrid, Spain 6: 6 Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres, Spain 7: 7 Servicio de Neumología, Hospital Juan Canalejo, La Coruña, Spain 8: 8 R+D Department, QF Bayer, Barcelona, Spain 9: 9 Servei de Pneumologia, Hospital General Vall d’Hebron, Barcelona, Spain

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