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Efficacy and safety of single-dose 2.0 g azithromycin in the treatment of acute exacerbation of chronic obstructive pulmonary disease

Abstract

To evaluate the efficacy and safety of single-dose 2.0 g azithromycin (ZSR) in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AE-COPD), we retrospectively reviewed all patients with AE-COPD who were treated with ZSR. In comparison with patients who received intravenous therapy for AE-COPD, the clinical cure rate, length of stay in hospital, and medical costs were evaluated. A total of 29 patients thus were eligible for this study. Clinical cure rates of ZSR and intravenous therapy for the treatment of AE-COPD were 83.3% (n = 12) and 88.2% (n = 17), respectively, between the groups (P = 1.000). No severe adverse events were found in either group. The ZSR and intravenous groups averaged 9.9 and 12.5 days of admission, respectively. Length of admission for clinical success cases was much shorter for patients who received ZSR than patients who received intravenous therapy (6.2 vs. 11.9 days, P = 0.038). Medical costs were less for the group receiving ZSR than for the intravenous therapy group. We suggest ZSR can achieve near-perfect compliance and could be one of the tools in the treatment of AE-COPD.

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References

  1. World Health Organization. World health report. Geneva: World Health Organization; 2000.

  2. Murray CJL, Lopez AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet. 1997;349:1269–76.

    PubMed  Article  CAS  Google Scholar 

  3. Soler-Cataluña JJ, Martinez-Garcia MA, Roman Sanchez P, Salcedo E, Navarro M, Ochando R. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax. 2005;60:925–31.

    PubMed  Article  Google Scholar 

  4. Katsura H. Economic evaluation of acute exacerbation of COPD. Respir Med 2004;5:324–329 (in Japanese).

    Google Scholar 

  5. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 2006: p. 64–5.

  6. Anthonisen NR, Manfreda J, Warren CPW, Hershfield ES, Harding GK, Nelson NA. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med. 1987;106:196–204.

    PubMed  CAS  Google Scholar 

  7. Higashiyama Y, Watanabe A, Aoki N, Niki Y, Kono S. Clinical evaluation of levofloxacin versus oral β-lactams for acute exacerbation of COPD. Jpn J Chemother 2008;56:33–48 (in Japanese).

    Google Scholar 

  8. Andre-Alves MR, Jardim JR, Frare e Silva R, Fiss E, Freire DN, Teixeira PJ. Comparison between azithromycin and amoxicillin in the treatment of infectious exacerbation of chronic obstructive pulmonary disease. J Bras Pneumol. 2007;33:43–50.

    PubMed  Article  Google Scholar 

  9. Umut S, Tutluoglu B, Aydin Tosun G, Müsellim B, Erk M, Yildirim N, et al. Determination of the etiological organism during acute exacerbations of COPD and efficacy of azithromycin, ampicillin-sulbactam, ciprofloxacin and cefaclor. J Chemother. 1999;11:211–4.

    PubMed  CAS  Google Scholar 

  10. Hisada T, Ishizuka T, Aoki H, Yanagitani N, Ono A, Imai H, et al. Clinical evaluation of garenoxacin on acute exacerbations of chronic obstructive pulmonary disease. J New Rem Clin 2009;58:1808–1820 (in Japanese).

    Google Scholar 

  11. D’Ignazio J, Camere MA, Lewis DE, Jorgensen D, Breen JD. Novel, single-dose microsphere formulation of azithromycin versus 7-day levofloxacin therapy for treatment of mild to moderate community-acquired pneumonia in adults. Antimicrob Agents Chemother. 2005;49:4035–41.

    PubMed  Article  Google Scholar 

  12. Koch CC, Esteban DJ, Chin AC, Olson ME, Read RR, Ceri H, et al. Apoptosis, oxidative metabolism and interleukin-8 production in human neutrophils exposed to azithromycin: effects of Streptococcus pneumoniae. J Antimicrob Chemother. 2000;46:19–26.

    PubMed  Article  CAS  Google Scholar 

  13. Amsden GW. Anti-inflammatory effects of macrolides—an underappreciated benefit in the treatment of community-acquired respiratory tract infections and chronic inflammatory pulmonary conditions? J Antimicrob Chemother. 2005;55:10–21.

    PubMed  Article  CAS  Google Scholar 

  14. Milstone AP. Use of azithromycin in the treatment of acute exacerbation of COPD. Int J Chronic Obstruct Pulm Dis. 2008;3:515–9.

    CAS  Google Scholar 

  15. Branthwaite A, Pechere JC. Pan-European survey of patients’ attitudes to antibiotics and antibiotic use. J Int Med Res. 1996;24:229–38.

    PubMed  CAS  Google Scholar 

  16. Sclar DA, Tartaglione TA, Fine MJ. Overview of issues related to medical compliance with implications for the outpatient management of infectious disease. Infect Agents Dis. 1994;3:266–73.

    PubMed  CAS  Google Scholar 

  17. Cockburn J, Gibberd RW, Reid AL, Sanson-Fisher RW. Determinants of non-compliance with short-term antibiotic regimens. BMJ. 1987;295:814–8.

    PubMed  Article  CAS  Google Scholar 

  18. Colcher IS, Bass JW. Penicillin treatment of streptococcal pharyngitis: a comparison of schedules and the role of specific counseling. JAMA. 1972;222:657–9.

    PubMed  Article  CAS  Google Scholar 

  19. Pichicero ME. Short course antibiotic in acute otitis media and sinusitis infections. J Int Med Res. 1998;17:828–33.

    Google Scholar 

  20. Pichicero ME. Short course antibiotic therapy for respiratory infections: a review of the evidence. Pediatr Infect Dis J. 2000;19:929–37.

    Article  Google Scholar 

  21. Daniel RR. Comparison of azithromycin and co-amoxiclav in the treatment of otitis media in children. J Antimicrob Chemother 1993;31(suppl E):65–71.

    Google Scholar 

  22. Bernstein JM. Treatment of community-acquired pneumonia—IDSA guidelines. Chest. 1999;115:9S–13S.

    PubMed  Article  CAS  Google Scholar 

  23. Mandell LA. Epidemiology and etiology of community-acquired pneumonia. Infect Dis Clin N Am. 2004;18:761–76.

    Article  Google Scholar 

  24. Inoue M, Farrell DJ, Kaneko K, Akizawa K, Fujita S, Kaku M, et al. Antimicrobial susceptibility of respiratory tract pathogens in Japan during PROTEKT year 1–5 (1994–2004). Microb Drug Resist. 2008;14:109–17.

    PubMed  Article  CAS  Google Scholar 

  25. Inoue M, Kaneko K, Akizawa K, Fujita S, Kaku M, Igari J, et al. Antimicrobial susceptibility of respiratory tract pathogens in Japan during PROTEKT years 1–3 (1999–2002). J Infect Chemother. 2006;12:9–21.

    PubMed  Article  CAS  Google Scholar 

  26. Miravitlles M, Espinosa C, Fernández-Laso E, Martos JA, Maldonado JA, Gallego M. Relationship between bacterial flora in sputum and functional impairment in patients with acute exacerbations of COPD. Chest. 1999;116:40–6.

    PubMed  Article  CAS  Google Scholar 

  27. Baldwin DR, Wise R, Andrews JW, Ashby JP, Honeybourne D. Azithromycin concentrations at the sites of pulmonary infection. Eur Respir J. 1990;3:886–90.

    PubMed  CAS  Google Scholar 

  28. Donaldson GC, Seemungal TA, Bhowmik A, Wedzicha JA. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax. 2002;57:847–52.

    PubMed  Article  CAS  Google Scholar 

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Acknowledgments

We are grateful for the diligent and thorough critical reading of our manuscript by Mr. John Wocher, Executive Vice President and Director, International Affairs/International Patient Services, Kameda Medical Center (Japan).

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Correspondence to Nobuhiro Asai.

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Asai, N., Ohkuni, Y., Iwasaki, T. et al. Efficacy and safety of single-dose 2.0 g azithromycin in the treatment of acute exacerbation of chronic obstructive pulmonary disease. J Infect Chemother 17, 793–798 (2011). https://doi.org/10.1007/s10156-011-0260-z

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  • DOI: https://doi.org/10.1007/s10156-011-0260-z

Keywords

  • Acute exacerbation
  • Chronic obstructive pulmonary disease
  • Antibiotic therapy
  • Azithromycin
  • Medication compliance
  • Oral antibiotics