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Published online before print February 14, 2007, 10.1183/09031936.00147806
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Eur Respir J 2007; 29:1127-1137
Copyright ©ERS Journals Ltd 2007

Macrolides, quinolones and amoxicillin/clavulanate for chronic bronchitis: a meta-analysis

I. I. Siempos1, G. Dimopoulos1,2, I. P. Korbila1, K. Manta1 and M. E. Falagas1,3,4

1 Alfa Institute of Biomedical Sciences (AIBS), 2 Intensive Care Unit, Attikon University Hospital and, 3 Dept of Medicine, Henry Dunant Hospital, Athens, Greece. 4 Dept of Medicine, Tufts University School of Medicine, Boston, MA, USA.

CORRESPONDENCE: M. E. Falagas, Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23 Marousi, Athens, Greece. Fax: 30 2106839605. E-mail: m.falagas{at}aibs.gr

Keywords: Chronic obstructive pulmonary disease, Haemophilus influenzae, Moraxella catarrhalis, Pseudomonas aeruginosa, Streptococcus pneumoniae

Received: November 14, 2006
Accepted January 20, 2007

The comparative effectiveness and safety of macrolides, quinolones and amoxicillin/clavulanate (A/C) for the treatment of patients with acute bacterial exacerbation of chronic bronchitis (ABECB) was evaluated in the present study.

PubMed, Current Contents and the Cochrane Central Register of Controlled Trials were searched to identify relevant randomised controlled trials (RCTs).

In total, 19 RCTs (20 comparisons) were included in the present analysis. There was no difference regarding treatment success in intention-to-treat and clinically evaluable patients between macrolides and quinolones, A/C and quinolones or A/C and macrolides. The treatment success in microbiologically evaluable patients was lower for macrolides compared with quinolones (odds ratio (OR) 0.47, 95% confidence interval (CI) 0.31–0.69). Fewer quinolone-recipients experienced a recurrence of ABECB after resolution of the initial episode compared with macrolide-recipients during the 26-week period following therapy. Adverse effects in general were similar between macrolides and quinolones. Administration of A/C was associated with more adverse effects (mainly diarrhoea) than quinolones (OR 1.36, 95% CI 1.01–1.85).

Macrolides, quinolones and amoxicillin/clavulanate may be considered equivalent for the treatment of patients with an acute bacterial exacerbation of chronic bronchitis in terms of short-term effectiveness. Quinolones are associated with better microbiological success and fewer recurrences of acute bacterial exacerbation of chronic bronchitis than macrolides, while amoxicillin/clavulanate is associated with more adverse effects than both comparators.




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