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PubMed1991

Symptomatic effect of inhaled fenoterol in acute bronchitis: a placebo-controlled double-blind study.

The symptomatic effect of inhaled fenoterol, a beta 2-agonist, 0.2 mg 4 times daily for 7 days, was evaluated in 80 patients with acute bronchitis examined at the Chest Clinic, Department of Medicine, University Hospital of Tromsø. Seventy-three patients completed the trial. End-point FEV1 (% predicted) showed a mean increase of 5.1% in the fenoterol group and 0.5% in the placebo group (p = 0.006). The corresponding decrease in total symptom score after one week was 67% and 51%, respectively (p = 0.06). In a subgroup of 35 patients with either bronchial hyper-responsiveness, wheezes on auscultation or FEV1 less than 80% of predicted at entry, a statistically significant difference in reduction of total symptom score in favour of fenoterol was demonstrated on the second day of the trial. No difference was found in the 38 patients with normal lung findings. Fenoterol was useful when objective signs of bronchial involvement was present and may be applicable to the treatment of acute bronchitis.

Acute Disease↗
PubMed2005

Antibiotic prescribing by ambulatory care physicians for adults with nasopharyngitis, URIs, and acute bronchitis in Taiwan: a multi-level modeling approach.

BACKGROUND: Imprudent prescribing of antibiotics in ambulatory care in Asia is of great concern. However, an adequate understanding of factors associated with antibiotic prescribing patterns in Asia has not been achieved. OBJECTIVE: Our aim was to identify patient and physician characteristics that influence antibiotic prescribing for adults with nasopharyngitis (common colds), upper respiratory tract infections (URIs) or bronchitis in Taiwan. METHODS: Generalized Estimating Equations (GEE) were used to analyze all 128,260 episodes of common colds, URIs and bronchitis generated by a random sample of 137,935 adult National Health Insurance (NHI) beneficiaries (> or = 18 years old) in Taiwan in 2000. RESULTS: Multivariate analysis results revealed substantial variations across different physician groups. Physician age and accreditation level of the physician's practice setting were the characteristics most associated with prescribing of antibiotics at the initial encounters for these episodes of care. Urban practising physicians (adjusted OR 1.69, 95% CI 1.29-2.21) and those who were self-dispensing or with on-site pharmacists (adjusted OR 1.32, 95% CI 1.19-1.46) were also higher prescribers of antibiotics for adults. Other significant physician predictors included physician specialty, patient volume, and ownership of practice setting. CONCLUSIONS: Results suggest that both accessibility to updated medical information and economic incentives of the attending physician may shape prescribing of antibiotics in ambulatory care in Taiwan. Interventions should be developed to influence these modifiable factors to reduce antibiotic prescriptions of questionable value.

Adult↗
PubMed1982

Prediction of tracheobronchial colonization in current cigarette smokers with chronic obstructive bronchitis.

To help in clarifying the conflicting data on the role of tracheobronchial microflora in chronic bronchitis, the tracheobronchial microflora of a homogeneous group of clinically stable patients with chronic obstructive bronchitis was characterized by transtracheal aspiration. Their mean percentage ratio of forced expiratory volume in 1 sec to the forced vital capacity was 45%. The results were that (1) a bacterial tracheobronchial microflora was present in only 50% of the patients, (2) viridans streptococci were the bacteria most frequently isolated, and (3) the presence or absence of a tracheobronchial microflora was significantly associated with the amount of present cigarette smoking. The fact that patients who smoke less than one pack per day were most likely to have a sterile tracheobronchial tree (P=0.015) implied that there was a critical amount of cigarette smoke that impaired the clearance and/or detoxification of bacteria from the tracheobronchial tree and that it must have been persistently present.

Adult↗
PubMed1985

Aztreonam in patients with acute purulent exacerbations of chronic bronchitis: failure to prevent emergence of pneumococcal infections.

A group of 36 patients, all requiring hospital admission because of acute purulent exacerbations of chronic bronchitis, were treated with 1 or 2 g intramuscular injections of aztreonam for ten days. Patients with Streptococcus pneumoniae infections were excluded from the study. Sputum cultures before treatment revealed the other usual respiratory pathogens but repeat cultures on days 3, 10 and 17 sometimes yielded Str. pneumoniae, occasionally combined with Haemophilus influenzae or Branhamella catarrhalis. Ten patients had to be given other antimicrobial agents for Str. pneumoniae infections which developed during the study or follow-up periods. Pseudomonas aeruginosa failed to respond well to aztreonam. All the H. influenzae strains were sensitive to aztreonam (MIC 0.25 mg/l, or less) but all strains of Str. pneumoniae were resistant (MIC greater than 32 mg/l). Ps. aeruginosa strains were moderately resistant (MIC generally 4-16 mg/l) and Bran. catarrhalis strains only moderately sensitive (MICs generally 0.5-4 mg/l). Peak serum concentrations averaging approximately 37 mg/l were observed after the 1 g injections (55 mg/l after 2 g) and the corresponding mean peak concentrations in the sputum were 1.3 mg/l and 2.5 mg/l, respectively. The penetration from blood to sputum was thus approximately 3.5% and 4.6% after the 1 g and 2 g doses. No unwanted local or general reactions were observed. The disappointing clinical results (only 23 out of 36 patients with excellent or good clinical results) one week after the end of the treatment were mainly due to the emergence of pneumococcal infections during (and immediately after) therapy. Considering that Str. pneumoniae is still one of the most important organisms associated with acute purulent exacerbations of chronic bronchitis, and that conventional sputum cultures may not always reveal its presence, there is considerable doubt if aztreonam has any place in the treatment, especially as the results in Ps. aeruginosa infections have also been much poorer than expected.

Adolescent↗
PubMed1985

A double-blind comparison of amoxycillin with trimethoprim in acute exacerbations of chronic bronchitis.

Thirty-seven patients with untreated acute exacerbations of severe chronic bronchitis (mean FEV1 0.81), were entered into a double-blind randomized trial comparing amoxycillin 250 mg three times a day with trimethoprim 200 mg twice a day, each given for seven days. Seventeen patients received amoxycillin, from which there was one treatment failure, and 18 patients received trimethoprim, amongst which there were six treatment failures. There were no major differences between the treatments, in this small group of patients, although a significant difference (in favour of amoxycillin) was demonstrated in the patients' subjective dyspnoea score. Because of the difficulties in collecting sufficient patients from a single centre, the definition of the possible role of trimethoprim alone in the treatment of acute axacerbations of chronic bronchitis may have to await multicentre trials.

Aged↗
PubMed1988

A randomized double blind controlled trial comparing two amoxycillin regimens in the treatment of acute exacerbations of chronic bronchitis.

A randomized double blind trial comparing two amoxycillin regimens in the treatment of acute exacerbations of chronic bronchitis was performed. Forty-one patients were entered into the study. Twenty patients received amoxycillin sachets 3g twice daily for three days and 21 patients received amoxycillin capsules 500 mg three times daily for seven days. There was no significant difference between the two groups in terms of duration of hospital admission, reduction in sputum volume, clearance of pus from the sputum or the number of treatment failures. No patient developed unwanted effects from the treatment with high dose amoxycillin. Twenty-eight patients were followed for one year and there was no difference in the number of exacerbations experienced by patients treated with short course high dose therapy compared with low dose therapy. It is concluded that short course high dose amoxycillin may be as effective as conventional course amoxycillin in the treatment of acute exacerbations of chronic bronchitis.

Acute Disease↗
PubMed1988

Enoxacin in acute exacerbations of chronic bronchitis: a comparison with amoxycillin.

A total of 43 hospitalized adult patients with acute exacerbations of chronic bronchitis or bronchiectasis due to Gram-negative bacteria were randomized to receive either enoxacin (400 mg bd) or amoxycillin (1,000 mg tid) for 7-12 days. Micro-organisms isolated included 24 Haemophilus influenzae (three beta-lactamases positive), 11 Branhamella catarrhalis (six beta-lactamase positive), two Pseudomonas aeruginosa and two Neisseria meningitidis in 37 evaluable patients. In the enoxacin group (23 patients) 82.6% of the patients were clinically cured or improved against 93% of patients in the amoxycillin group (14 patients). In the enoxacin group 76% of the pathogens were eradicated with two failures (P. aeruginosa), one relapse (H. influenzae) and three superinfections (Streptococcus pneumoniae). In the amoxycillin group, 71% of the pathogens were eradicated with 29% relapses. The differences between the two groups were not statistically significant. An increase in theophylline concentration occurred in 15 of 16 patients receiving simultaneous administration of theophylline, without clinical evidence of toxicity when theophylline dosage was reduced and enoxacin continued. Enoxacin appears to be as effective as amoxycillin in the treatment of acute exacerbations of chronic bronchitis due to susceptible Gram-negative bacteria.

Acute Disease↗
PubMed1989

Controlled prospective study of oral amoxycillin/clavulanate vs ciprofloxacin in acute exacerbations of chronic bronchitis.

This investigation compared the efficacy of oral formulations of amoxycillin/clavulanate and ciprofloxacin in acute exacerbations of chronic bronchitis. Forty patients were randomized to receive either Augmentin (1,000 mg amoxycillin +250 mg clavulanate) tds or ciprofloxacin (500 mg) bd. During and before therapy sputum samples were taken for bacteriology, sputum volume measurement and histamine determination. Lung function was also monitored. From sputum, 143 bacterial isolates and 15 yeast strains were obtained before therapy. During therapy with amoxycillin/clavulanate the incidence of Gram-positive isolates decreased significantly whereas ciprofloxacin left their frequency unchanged. On the other hand, ciprofloxacin more effectively diminished the incidence of Gram-negative isolates. Yeasts were grown from the sputum of several patients before and during therapy. Their number did not increase during amoxycillin/clavulanate therapy while it increased under ciprofloxacin. The groups showed no significant differences with regard to sputum production, histamine concentration or lung function. The majority of patients (28/40) acknowledged improvement of their symptoms. There was no significant difference between the groups. On the basis of these results both amoxycillin/clavulanate and ciprofloxacin appear of similar value for treatment of patients with exacerbations of chronic bronchitis.

Aged↗
PubMed1990

Efficacy and tolerance of cefpodoxime proxetil compared with co-amoxiclav in the treatment of exacerbations of chronic bronchitis.

This European, multicentre trial evaluated the efficacy and tolerance of cefpodoxime proxetil in comparison with co-amoxiclav (amoxycillin plus clavulanic acid) in the treatment of acute exacerbations of chronic bronchitis. The study design was double-blind and double-placebo controlled. Doses of either 200 mg bd of cefpodoxime proxetil or 500 mg/125 mg tds amoxycillin plus clavulanic acid were given orally for 9.6 +/- 1.8 days. Two hundred and fifty-one patients were enrolled in 27 centres in West Germany, France, and Italy. The overall clinical efficacy was 97.2% in the cefpodoxime proxetil group compared with 94.7% in the co-amoxiclav group. Fifty-eight adverse events, mainly gastrointestinal, occurred in 42 patients with no significant difference between the groups. A significant difference in the number of resistant pathogens on pre-treatment culture to the advantage of cefpodoxime was noted. In our experience, both drugs were of similar value in the treatment of respiratory tract infections. Thus, cefpodoxime proxetil should be an effective antibiotic for the treatment of acute exacerbations of chronic bronchitis.

Adult↗
PubMed1991

Comparative study of clarithromycin and ampicillin in the treatment of patients with acute bacterial exacerbations of chronic bronchitis.

This double-blind, randomized (1:1), 33 centre clinical trial compared the safety and efficacy of 250 mg clarithromycin (2 x 125 mg capsules) 12-hourly and 250 mg ampicillin (one capsule) 6-hourly in the treatment of acute bacterial exacerbation of chronic bronchitis. Clinical and bacteriological evaluations were performed during treatment (study days 3-5, 8-10) and within 48 h following the end of therapy. Two hundred and twenty-five patients were included in the safety analysis. Both clarithromycin and ampicillin were effective with clinical success rates of 97% (28/29) and 91% (31/34), respectively. Pathogen eradication rates were 86% (36/42) for clarithromycin and 88% (37/42) for ampicillin. No significant difference in the number of patients reporting one or more adverse events was observed between treatment groups. Eleven clarithromycin and six ampicillin patients prematurely discontinued the study owing to adverse events. Clarithromycin 12-hourly was as safe and effective as ampicillin 6-hourly in the treatment of acute bacterial exacerbation of chronic bronchitis.

Adult↗
PubMed1991

Ceftibuten versus cefaclor for the treatment of bronchitis.

Ceftibuten is an oral third generation cephalosporin with potent antimicrobial activity against Enterobacteriaceae, beta-lactamase positive Haemophilus influenzae, Moraxella catarrhalis, Neisseria meningitidis, Neisseria gonorrheae, penicillin-susceptible pneumococci, and beta-hemolytic streptococci. To study the efficacy and safety of ceftibuten for treatment of bronchitis, 58 patients were randomized to therapy with either ceftibuten 400 mg once a day or cefaclor 250 mg every 8 h at a ratio of two to one. Of 45 clinically evaluable patients, 28 (87.5%) of the 32 ceftibuten patients and 12 (92.3%) of the 13 cefaclor patients were clinically improved or cured. Of 33 microbiologically evaluable patients, 21 (87.5%) of the 24 ceftibuten patients and eight (80%) of the ten cefaclor patients were cured. Of 56 patients evaluable for adverse effects, three (7.9%) of the 38 ceftibuten patients and one (5.6%) of the 18 cefaclor patients had adverse reactions. In this small study, once-daily ceftibuten appeared as safe and as effective as cefaclor for the treatment of bronchitis.

Bacteria↗
PubMed1993

Clarithromycin versus cefaclor for the treatment of mild-to-moderate acute bacterial bronchitis.

Four hundred and eight outpatients with the clinical signs and symptoms of mild-to-moderate acute bronchitis of bacterial aetiology were enrolled in a multicentre, double-blind, randomized clinical trial comparing the efficacy and safety of clarithromycin and cefaclor, both administered orally. Two hundred and seven patients received clarithromycin 250 mg bd and 201 patients received cefaclor 500 mg tds for a maximum of seven days. Clinical and bacteriological evaluations were performed before treatment was initiated, during the course of treatment, and within 72 h of completing therapy; all adverse events were recorded. Two hundred and three patients in the clarithromycin group and 195 in the cefaclor group were evaluable for clinical response and 129 and 124 patients in the clarithromycin and cefaclor groups, respectively, were evaluable for bacteriological response. The clinical response rates three to five days after starting treatment and at the post-treatment assessment were 97% (193/199) and 99.5% (202/203), respectively, for the clarithromycin group and 97.4% (187/192) and 97.9% (191/195), respectively, for the cefaclor group. The bacteriological cure rates were 94.6% (122/129) for the clarithromycin group and 90.3% (112/124) for the cefaclor group. None of the differences between the groups was statistically significant. Adverse events, which were generally mild and predominantly related to the gastrointestinal tract, were reported by 5.8% of clarithromycin-treated patients and 10.4% of cefaclor-treated patients. Adverse reactions caused one patient in the clarithromycin group and three in the cefaclor group to discontinue treatment prematurely. The results of this study indicate that clarithromycin and cefaclor are comparable with respect to efficacy and safety when used as treatment for patients with mild-to-moderate acute bacterial bronchitis.

Acute Disease↗
PubMed1993

Clinical efficacy of dirithromycin in acute exacerbations of chronic bronchitis.

The efficacy and safety of seven days treatment with oral dirithromycin 500 mg given once daily was compared with oral erythromycin 250 mg qid in patients with acute bacterial exacerbations of chronic bronchitis. A total of 393 patients received dirithromycin and 409 erythromycin. Of 101 dirithromycin-treated patients analysed for efficacy, 87 (86%) had favourable clinical responses compared with 72/81 (89%) of those treated with erythromycin. Proven or presumed pathogen elimination was noted in 85/101 (84%) dirithromycin-treated patients and 66/81 (82%) erythromycin treated patients. Late post-therapy responses were also similar between treatment groups. Favourable clinical responses were noted in 89% of patients treated with dirithromycin and 91% of those receiving erythromycin. A favourable bacteriological response was noted in 87.5% and 89.6% of the dirithromycin- and erythromycin-treated groups, respectively. Adverse events were also similar between treatment groups. Gastrointestinal events were the most common events in both groups of patients; erythromycin was associated with a significantly higher incidence of diarrhoea (P = 0.003). Dirithromycin was associated with a higher incidence of lung events (P = 0.043). It is concluded that dirithromycin given once a day is comparable in efficacy and safety to four-times-daily erythromycin in the treatment of acute bacterial exacerbations of chronic bronchitis.

Acute Disease↗
PubMed1999

Five-day dirithromycin therapy is as effective as seven-day erythromycin therapy for acute exacerbations of chronic bronchitis.

In a meta-analysis of two identically designed, well-controlled, randomized, double-blind clinical trials, we compared 5 days of dirithromycin with 7 days of erythromycin for acute exacerbations of chronic bronchitis. Five hundred and thirty-one patients were randomized to receive dirithromycin (500 mg od) for 5 days and 526 patients were randomized to receive erythromycin (250 mg qid) for 7 days. Clinical and bacteriological responses were assessed 3-5 days after therapy and at termination from the study. Adverse events were collected from both groups and compared with each other, before and after treatment. Of the 690 patients clinically appraisable at the post-therapy visit, 298 (84.2%) dirithromycin-treated patients and 270 (80.4%) erythromycin-treated patients showed a favourable response. At termination, 273 (77.1%) dirithromycin-treated patients and 243 (72.3%) erythromycin-treated patients showed a favourable response. The microbiological cure was equivalent in the two groups (75% of dirithromycin-treated patients and 74.1% of erythromycin-treated patients showed a favourable response at termination). After therapy, dirithromycin was as effective as erythromycin in eradicating Streptococcus pneumoniae (77.8% vs 90.9%), Haemophilus influenzae (71.7% vs 72.2%), Moraxella catarrhalis (93.3% vs 88.9%) and Staphylococcus aureus (81.8% vs 82.1%). Although not statistically significant, fewer dirithromycin-treated patients reported adverse events than did erythromycin-treated patients. Nausea (6.8% vs 7.8%), headache (7.3% vs 8.2%) and diarrhoea (6.6% vs 9.5%) were the most frequently reported adverse events in both groups. In the treatment of acute exacerbations of chronic bronchitis, 5 days of dirithromycin is as effective as 7 days of erythromycin.

Adolescent↗
PubMed1999

Clinical and economic considerations in the treatment of acute exacerbations of chronic bronchitis.

Limited data exist to guide physicians in the cost-effective treatment of acute exacerbation of chronic bronchitis (AECB). Therefore, the main objective of this study was to determine the antimicrobial efficacy and related costs for patients with AECB. A retrospective review of 60 outpatient medical records with a diagnosis of chronic obstructive pulmonary disease (COPD) and chronic bronchitis episodes from a pulmonary clinic of a teaching institution was undertaken. The participating patients had a total of 224 episodes of AECB requiring antibiotic treatment. Before review, empirical antibiotic choices were divided into first-line (amoxycillin, co-trimoxazole, tetracyclines, erythromycin), second-line (cephradine, cefuroxime, cefaclor, cefprozil) and third-line (co-amoxiclav, azithromycin, ciprofloxacin) agents. Patients receiving first-line agents failed significantly more frequently than third-line agents (19% vs 7%, P < 0.05). Additionally, patients prescribed first-line agents were hospitalized significantly more often for AECB within 2 weeks of outpatient treatment as compared with patients prescribed third-line agents (18.0% vs 5.3% third-line agents; P < 0.02). Time between subsequent AECB episodes requiring treatment was significantly longer for patients receiving third-line agents compared with first-line and second-line agents (P < 0.005). Pharmacy costs were lowest with first-line agents (first-line US$10.30 +/- 8.76; second-line US$24.45 +/- 25.65; third-line US$45.40 +/- 11.11; P < 0.0001), but third-line agents showed a trend towards lower mean total costs of AECB treatment (first-line US$942 +/- 2173; second-line, US$563 +/- 2296; third-line, US$542 +/- 1946). The use of third-line antimicrobials, co-amoxiclav, ciprofloxacin or azithromycin, significantly reduced the failure rate and need for hospitalization, prolonged the time between AECB episodes, and showed a lower total cost for the management of AECB. Prospective studies are needed to confirm these findings.

Acute Disease↗
PubMed1999

Five day moxifloxacin therapy compared with 7 day clarithromycin therapy for the treatment of acute exacerbations of chronic bronchitis.

In this multinational, randomized, double-blind study, the efficacy and safety of a 5 day course of moxifloxacin 400 mg orally od was compared with that of a 7 day course of clarithromycin 500 mg orally bd. in 750 patients with acute exacerbations of chronic bronchitis, characterized by at least two of the symptoms: sputum purulence, increased sputum volume or increased dyspnoea. Seven days after the end of therapy, clinical cure was achieved for 89% (287 of 322) of efficacy-evaluable patients in the moxifloxacin group and 88% (289 of 327) of patients in the clarithromycin group (95% CI, -3.9%, 5.8%). At follow-up (21-28 days post-treatment), the continued clinical cure rates were 89% (256 of 287) for moxifloxacin and 89% (257 of 289) for clarithromycin. A total of 342 pathogenic bacteria were isolated from the sputum of 287 patients. The most common pathogens were Haemophilus influenzae (37%), Streptococcus pneumoniae (31%) and Moraxella catarrhalis (18%). Seven days post-treatment, a successful bacteriological response was obtained for 77% (89 of 115) of patients in the moxifloxacin group and 62% (71 of 114) of patients in the clarithromycin group, indicating superiority of moxifloxacin (95% CI, 3.6%, 26.9%). Both treatments were well tolerated with few adverse events. This study demonstrated that for the treatment of acute exacerbations of chronic bronchitis a 5 day course of moxifloxacin 400 mg od was clinically equivalent and bacteriologically superior to a 7 day course of clarithromycin 500 mg bd.

Acute Disease↗
PubMed2000

Comparison of a 5 day regimen of cefdinir with a 10 day regimen of cefprozil for treatment of acute exacerbations of chronic bronchitis.

Patients with acute exacerbations of chronic bronchitis were treated with cefdinir 300 mg bd for 5 days or cefprozil 500 mg bd for 10 days in a prospective, randomized, double-blind, multicentre study. Of the 548 patients enrolled, 281 (51%) were evaluable. The clinical cure rates at the test-of-cure visit were 80% (114/142) and 72% (100/139) for the evaluable patients treated with cefdinir and cefprozil, respectively. Respiratory tract pathogens were isolated from 409 (75%) of 548 admission sputum specimens, with the predominant pathogens being Haemophilus parainfluenzae, Haemophilus influenzae, Staphylococcus aureus and Moraxella catarrhalis. The microbiological eradication rates at the test-of-cure visit were 81% (157 of 193 pathogens) and 84% (166 of 198 pathogens) for the evaluable patients treated with cefdinir and cefprozil, respectively. Adverse event rates while on treatment were equivalent between the two treatment groups. The incidence of diarrhoea during therapy was higher for patients treated with cefdinir (17%) than for patients treated with cefprozil (6%) (P < 0.01), but most cases were mild and did not lead to discontinuation of treatment. These results indicate that a 5 day regimen of cefdinir is as effective and safe in the treatment of patients with acute exacerbations of chronic bronchitis as a 10 day regimen of cefprozil.

Acute Disease↗
PubMed1999

Alternative therapies for chronic bronchitis.

Alternative therapies for chronic bronchitis are therapies in which clinical efficacy is not well established. These can be broadly divided into expectorants, mucolytics, mucokinetics, antiproteases, antioxidants, and immunostimulants. Data supporting these therapies may be present in disorders clinically similar to chronic bronchitis, such as cystic fibrosis. Alternatively, these therapies may be based on clinical observations or in vitro studies that suggest a potential therapeutic benefit. Establishment of these therapies is likely to require more extensive investigation before their use is routinely recommended. Until such data is available, the clinician can only use his or her clinical judgement regarding the likely risk-benefit ratio.

Adjuvants, Immunologic↗