First author [Ref.] | Publication yr | Study design | Population# | Regimen 1¶ | Regimen 2 | Additional antibiotics allowed | Systemic corticosteroid before ABECB | Enrolled patients n | ITT patients n | Study quality score+ |
Macrolides versus quinolones | ||||||||||
Martinez 24 | 2005 | MC, DB, RCT | Aged ≥18 yrs with CB and type I or II ABECB | Azithromycin 500 mg q24 h day 1 and 250 mg q24 h days 2–5 | Levofloxacin 750 mg q24 h for 3 days | None | 15/151 (10) versus 16/143 (11) | 394 | 202 versus 192 | 4 |
Lode 25 | 2004 | MC, DB, RCT | Aged >35 yrs with CB and type I or II ABECB | Clarithromycin 250 mg q12 h for 10 days | Levofloxacin 500 mg q24 h for 7 days | None | NA§ | 511 | 254 versus 250 | 4 |
Amsden 26 | 2003 | MC, DB, RCT | Aged 35–75 yrs with CB and type I or II ABECBƒ | Azithromycin 500 mg q24 h day 1 and 250 mg q24 h days 2–5 | Levofloxacin 500 mg q24 h for 7 days | None | NA | 235 | 118 versus 117 | 3 |
Weiss 27 | 2002 | MC, RCT | Aged ≥18 yrs with CB and type I or II ABECB | Clarithromycin 500 mg q12 h for 10 days | Levofloxacin 500 mg q24 h for 10 days | None | NA | 191 | 97 versus 94 | 1 |
Wilson 28 | 2002 | MC, DB, RCT | Aged >40 yrs with CB and type I ABECB | Clarithromycin 500 mg q12 h for 7 days | Gemifloxacin 320 mg q24 h for 5 days | None | 76/358 (21) versus 74/351 (21)§ | 712 | 358 versus 351 | 3 |
Chodosh 29 | 2000 | MC, DB, RCT | Aged ≥18 yrs with CB or COPD with type I,II or III ABECB | Clarithromycin 500 mg q12 h for 10 days | Moxifloxacin 400 mg q24 h for 5 or 10 days | None | 74/312 (24) versus 134/614 (22) | 936 | 312 versus 614 | 5 |
DeAbate 30 | 2000 | MC, DB, RCT | Aged ≥18 yrs with CB or COPD with type I, II or III ABECB | Azithromycin 500 mg q24 h day 1 then 250 mg q24 h for 4 days | Moxifloxacin 400 mg q24 h for 5 days | None | NA | 567 | 284 versus 283 | 5 |
Wilson 31 | 1999 | MC, DB, RCT | Aged ≥18 yrs with CB and type I or II ABECB | Clarithromycin 500 mg q12 h for 7 days | Moxifloxacin 400 mg q24 h for 5 days | None | 128/327 (39) versus 160/322 (50)## | 750 | 371 versus 374 | 4 |
A/C versus quinolones | ||||||||||
Martinez 24 | 2005 | MC, RCT | Aged≥18 yrs with CB and type I or II ABECB | A/C 875/125 mg q12 h for 10 days | Levofloxacin 750 mg q24 h for 5 days | None | 17/126 (14) versus 20/120 (17) | 369 | 182 versus 187 | 2 |
Starakis 32 | 2004 | RCT | Aged ≥18 yrs with CB and type II ABECB | A/C 500/125 mg q8 h for 7 days | Moxifloxacin 400 mg q24 h for 5 days | None | 32/74 (43) versus 38/79 (48) | 162 | 79 versus 83 | 2 |
Schaberg 33 | 2001 | MC, RCT | Aged ≥18 ys with CB and type I or II ABECB | A/C 500/125 mg q12 h for 7 days | Moxifloxacin 400 mg q24 h for 5 days | None | NA | 577 | 283 versus 292 | 1 |
File 34 | 2000 | MC, DB, RCT | Aged ≥40 yrs with CB and type I ABECB | A/C 500/125 mg q8 h for 7 days | Gemifloxacin 320 mg q24 h for 5 days | None | 0/296 (0) versus 0/304 (0)¶¶ | 600 | 296 versus 304 | 4 |
A/C versus macrolides | ||||||||||
Anzueto 35 | 2001 | MC, IB, RCT | Aged ≥40 yrs with COPD (FEV1≤70% pred) and type I ABECB | A/C 875/125 mg q12 h for 10 days | Clarithromycin 1000 mg q24 h for 7 days | None | Treatment groups with comparable steroid use++ | 287 | 143 versus 140 | 4 |
Martinot 36 | 2001 | MC, IB, RCT | Aged ≥35 yrs with CB and type I or II ABECB | A/C 500/125 mg q8 h for 7 days | Clarithromycin 500 mg q24 h for 7 days | None | 0/123 (0) versus 0/127 (0)¶¶ | 250 | 123 versus 127 | 4 |
Hoepelman 37 | 1997 | MC, DB, RCT | Aged ≥18 yrs with CB and type I ABECB | A/C 500/125 mg q8 h for 10 days | Azithromycin 500 mg q24 h for 3 days | None | NA | 123 | 61 versus 62 | 4 |
Van Royen 38 | 1997 | MC, RCT | Aged ≥18 yrs with CB and type I or II ABECB | A/C 500/125 mg q8 h for 7 or 10 days | Dirithromycin 500 mg q24 h for 5 days | None | NA | 334 | 165 versus169 | 3 |
Biebuyck 39 | 1996 | MC, RCT | Aged ≥18 yrs with CB and type I ABECB | A/C 500/125 mg q8 h for 5 or 10 days | Azithromycin 250 mg q12 h for 3 days | None | NA | 139 | 45 versus 94 | 2 |
Gris 40 | 1996 | MC, DB, RCT | Aged ≥18 yrs with CB and type I or II ABECB | A/C 500/125 mg q8 h for 10 days | Azithromycin 500 mg q24 h for 3 days | None | NA | 61 | 28 versus 33 | 4 |
Beghi 41 | 1995 | MC, RCT | Aged ≥18 yrs with CB and type I or II ABECB§§ | A/C 875/125 mg q12 h for 8 days | Azithromycin 500 mg q24 h for 3 days | None | Allowed, ≤25 mg·day−1++ | 142 | 73 versus 69 | 2 |
Dautzenberg 42 | 1992 | MC, RCT | Aged ≥18 yrs with CB and type II ABECB | A/C 500/125 mg q8 h for 14 days | Roxithromycin 150 mg q12 h for 14 days | None | NA | 65 | 33 versus 32 | 1 |
Data are presented as n (patients affected)/total number of patients in the study (%), unless otherwise stated. ABECB: acute bacterial exacerbation of chronic bronchitis (CB); ITT: intention-to-treat; A/C: amoxicillin/clavulanate; MC: multicentre; DB: double-blind; NA: not applicable; COPD: chronic obstructive pulmonary disease; IB: investigator blinded; FEV1: forced expiratory volume in one second; % pred; % predicted. #: ABECB classified according to Anthonisen et al. 2; ¶: all antibiotics were administered per os; +: according to a modified Jadad score; §: use of systemic corticosteroids at a dose of >10 mg prednisone or the equivalent was an exclusion criterion; ƒ: patients with COPD other than CB were excluded from this RCT; ##: refers to clinically evaluable patients who received inhaled, oral or i.v. corticosteroids; ¶¶: use of systemic corticosteroids at any dose was an exclusion criterion; ++: according to the authors; §§: both hospitalised patients and outpatients were included. In the RCT by Martinez et al. 24 the quinolone levofloxacin was compared with both a macrolide (azithromycin) and A/C.