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Real-Life Treatment of Acute Exacerbations of Chronic Bronchitis with Moxifloxacin or Macrolides

A Comparative Post-Marketing Surveillance Study in General Practice

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Abstract

Objective: To compare the real-life treatment of acute exacerbations of chronic bronchitis (AECBs) using moxifloxacin tablets or one of the oral macrolides azithromycin, clarithromycin or roxithromycin in terms of symptom relief, time until improvement and cure, overall efficacy and tolerability.

Methods: This prospective, non-interventional, multicentre study included outpatients with AECB whose last exacerbation was treated with a macrolide. The current AECB was treated either with moxifloxacin or with one of the macrolides azithromycin, clarithromycin or roxithromycin. Data were obtained on the patient’s characteristics, disease and treatment history, the course of the current AECB including time to improvement and cure, and the final assessments of efficacy and tolerability. All adverse events were recorded in patients treated with moxifloxacin; for patients receiving macrolides, only drug-related adverse events were reported.

Results: 464 physicians treated 904 patients with moxifloxacin and 846 patients with one of the macrolides. Age, sex and body mass index were well matched between the two treatment groups. However, more moxifloxacin than macrolide patients presented with a generally bad condition (62.8% vs 48.6%). About 42% of patients in both groups had had chronic bronchitis for 1–5 years, and about 27% for 5–10 years. The mean number of AECBs in the previous 12 months was 2.7 and 2.6, respectively. Moxifloxacin was administered to most patients for 5 (43.8%) or 7 days (42.4%). Patients in the macrolide group were treated in most cases with clarithromycin 500mg for 4-7 days, roxithromycin 300mg for 6-7 days or azithromycin 500mg for 3 days. Physicians assessed overall efficacy and tolerability as ‘very good’ or ‘good’ in 96.1% and 98.1%, respectively, of moxifloxacin-treated patients and in 67.5% and 91.7%, respectively, of macrolide-treated patients. The mean duration until improvement and cure of AECB was 3.2 days (± SD 1.5) and 6.2 days (± 2.6) in moxifloxacin-treated patients compared with 4.5 days (± 1.8) and 7.5 days (± 3.0) in macrolide-treated patients (p < 0.0001).

Conclusion: The results of this study conducted under real-life treatment conditions in patients with AECBs who were previously treated with a macrolide showed faster symptom relief and higher recovery rates with moxifloxacin compared with macrolides. The two treatment groups had comparably good safety and tolerability profiles.

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References

  1. Anthonisen NR, Manfreda J, Warren GP, et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 1987; 106: 196–204

    PubMed  CAS  Google Scholar 

  2. Sethi S. Infectious etiology of chronic bronchitis. Chest 2000; 117Suppl. 2: 380S–5S

    Article  PubMed  CAS  Google Scholar 

  3. Seemungal TAR, Donaldson GC, Bhowmik A, et al. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000; 161: 1608–13

    PubMed  CAS  Google Scholar 

  4. Kanner RE, Anthonisen NR, Connett JE. Lower respiratory illnesses promote FEV1 decline in current smokers but not ex-smokers with mild chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001; 164: 358–64

    PubMed  CAS  Google Scholar 

  5. Donaldson GC, Seemungal TAR, Bhowmik A, et al. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax 2002; 57: 847–52

    Article  PubMed  CAS  Google Scholar 

  6. Seemungal TAR, Donaldson GC, Paul EA, et al. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998; 157: 1418–22

    PubMed  CAS  Google Scholar 

  7. Mathers CD, Bernard C, Moesgaard Iburg K, et al. Global burden of disease in 2002: data sources, methods and results. Global Programme on Evidence for Health Policy Discussion Paper No. 54. Geneva: World Health Organization, 2003

  8. Doll H, Grey-Amante P, Duprat-Lomon I, et al. Quality of life in acute exacerbation of chronic bronchitis: results from a German population study. Respir Med 2002; 96: 39–51

    Article  PubMed  CAS  Google Scholar 

  9. Garibaldi RA. Epidemiology of community acquired respiratory tract infections in adults. Incidence, etiology, and impact. Am J Med 1985; 78Suppl. 6B: 149–56

    Google Scholar 

  10. Snow V, Lascher S, Mottur-Pilson C. Evidence base for management of acute exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 2001; 134: 595–9

    PubMed  CAS  Google Scholar 

  11. Grossman RF. Guidelines for the treatment of acute exacerbations of chronic bronchitis. Chest 1997; 112(6 Suppl.): 310–3

    Article  Google Scholar 

  12. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease, updated 2005 [online]. Available from URL: http://www.goldcopd.org/Guidelineitem.asp?.ll = 2&12 = 1&intId = 996 [Accessed 2006 Mar 1]

  13. Baiter MS, La Forge J, Low DE, et al. Canadian guidelines for the management of acute exacerbations of chronic bronchitis. Can Respir J 2003; 10Suppl. B: 3B–32B

    Google Scholar 

  14. Woodhead M, Blasi F, Ewig S, et al. Guidelines for the management of adult lower respiratory tract infections. ERS Task Force in collaboration with ESCMID. Eur Respir J 2005; 26: 1138–80

    Article  PubMed  CAS  Google Scholar 

  15. Höffken G, Lorenz J, Kern W, et al. Epidemiologie, Diagnostik, antimikrobielle Therapie und Management von erwachsenen Patienten mit ambulant erworbenen tiefen Atemwegsinfektionen (akute Bronchitis, akute Exazerbation einer chronischen Bronchitis, Influenza und andere respiratorische Virusinfektionen) sowie ambulant erworbener Pneumonie. S3-Leitlinie der Paul-Ehrlich-Gesellschaft für Chemotherapie e. V., der Deutschen Gesellschaft für Pneumologie, der Deutschen GeSeilschaft für Infektiologie und vom Kompetenznetzwerk CAPNETZ. Pneumologie 2005; 59: 612–64

    Article  PubMed  Google Scholar 

  16. Eller J, Ede A, Schaberg T, et al. Infective exacerbations of chronic bronchitis: relation between bactériologic etiology and lung function. Chest 1998; 113: 1542–8

    Article  PubMed  CAS  Google Scholar 

  17. Jones ME, Staples AM, Critchley I, et al. Benchmarking the in vitro activity of moxifloxacin against recent isolates of Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae: a European multi-centre study. Diagn Microbiol Infect Dis 2000; 37: 203–11

    Article  PubMed  CAS  Google Scholar 

  18. Dorai-John T, Thomson CJ, Amyes SGB. Moxifloxacin sensitivity of respiratory pathogens in the United Kingdom. J Chemother 2002; 14: 19–24

    PubMed  CAS  Google Scholar 

  19. Deshpande LM, Jones RN. Antimicrobial activity of advanced-spectrum fluoroquinolones tested against more than 2000 contemporary bacterial isolates of species causing community-acquired respiratory tract infections in the United States (1999). Diagn Microbiol Infect Dis 2000; 37: 139–42

    Article  PubMed  CAS  Google Scholar 

  20. Souli M, Wennersten CB, Eliopoulos GM. In vitro activity of BAY 12-8039, a new fluoroquinolone, against species representative of respiratory tract pathogens. Int J Antimicrob Agents 1998; 10: 23–30

    Article  PubMed  CAS  Google Scholar 

  21. Blondeau JM. A review of the comparative in vitro activities of 12 antimicrobial agents, with a focus on five new respiratory quinolones. J Antimicrob Chemother 1999; 43Suppl. B: 1–11

    Article  PubMed  CAS  Google Scholar 

  22. Morrissey I, Colclough A, Viljoen L, et al. The comparative in vitro activity of moxifloxacin against respiratory tract pathogens isolated during 2003 from LIBRA Targeted Surveillance [abstract no. P527]. 14th European Congress of Clinical Microbiology and Infectious Diseases; 2004 May 1–4; Prague

  23. Dalhoff A, Korfmann G, Jacobs E. Prospective, multicenter in vitro study to determine resistance rates and comparative activity of moxifloxacin vs clinical bacterial isolates from patients with respiratory tract infections (MOXIAKTIV Study). ECCMID; 2005 Apr 2–5; Copenhagen: Poster No. 1195

  24. Liebowitz LD, Slabbert M, Huisamen A. National surveillance programme on susceptibility patterns of respiratory pathogens in South Africa: moxifloxacin compared with eight other antimicrobial agents. J Clin Pathol 2003; 56: 344–7

    Article  PubMed  CAS  Google Scholar 

  25. Critchley IA, Sahm DF, Thornsberry C, et al. Antimicrobial susceptibilities of Streptococcus pyogenes isolated from respiratory and skin and soft tissue infections: United States LIBRA surveillance data from 1999. Diagn Microbiol Infect Dis 2002; 42: 129–35

    Article  PubMed  CAS  Google Scholar 

  26. Jones ME, Staples AM, Critchley I, et al. Benchmarking the in vitro activities of moxifloxacin and comparator agents against recent respiratory isolates from 377 medical centers throughout the United States. Antimicrob Agents Chemother 2000; 44: 2645–52

    Article  PubMed  CAS  Google Scholar 

  27. Sethi S, Muscarella K, Evans N, et al. Airway inflammation and etiology of acute exacerbations of chronic bronchitis. Chest 2000; 118: 1557–65

    Article  PubMed  CAS  Google Scholar 

  28. Soler N, Ewig S, Torres A, et al. Airway inflammation and bronchial microbial patterns in patients with stable chronic obstructive pulmonary disease. Eur Respir J 1999; 14: 1015–22

    Article  PubMed  CAS  Google Scholar 

  29. Wilson R, Jones P, Schaberg T, et al. for the MOSAIC Study Group. Antibiotic treatment and factors influencing short and long-term outcomes of acute exacerbations of chronic bronchitis. Thorax 2006; 61: 337–42

    Article  PubMed  CAS  Google Scholar 

  30. Bauer T, Landen H. Rapid resolution of symptoms with moxifloxacin therapy in 7223 patients with acute exacerbation of chronic bronchitis: comparison with prior macrolide treatment. Clin Drug Invest 2002; 22: 641–51

    Article  CAS  Google Scholar 

  31. Barth J, Landen H. Efficacy and tolerability of moxifloxacin in 2338 patients with acute exacerbation of chronic bronchitis. Clin Drug Invest 2003; 23(1): 1–10

    Article  CAS  Google Scholar 

  32. Kreis SR, Herrera N, Golzar N, et al. A comparison of moxifloxacin and azithromycin in the treatment of acute exacerbations chronic bronchitis. J Clin Outcomes Manag 2000; 7: 33–7

    Google Scholar 

  33. Wilson R, Kubin R, Ballin J, et al. Five day moxifloxacin therapy compared with 7 day clarithromycin therapy for the treatment of acute exacerbations of chronic bronchitis. J Antimicrob Chemother 1999; 44: 501–13

    Article  PubMed  CAS  Google Scholar 

  34. Hautamaki D, Bruya T, Kureishi A, et al. Short-course (5-day) moxifloxacin versus 7-day levofloxacin therapy for the treatment of acute exacerbations of chronic bronchitis. Today’s Ther Trends 2001; 19: 117–36

    Google Scholar 

  35. Schaberg T, Ballin I, Huchon G, et al. A multinational, multicentre, non-blinded, randomized study of moxifloxacin oral tablets compared with co-amoxiclav oral tablets in the treatment of acute exacerbation of chronic bronchitis. J Int Med Res 2001; 29: 314–28

    PubMed  CAS  Google Scholar 

  36. Grassi C, Casali L, Curti E, et al. Efficacy and safety of short course (5-day) moxifloxacin vs 7-day ceftriaxone in the treatment of acute exacerbations of chronic bronchitis (AECB). J Chemother 2002; 14: 597–608

    PubMed  CAS  Google Scholar 

  37. Starakis I, Gogos CA, Bassaris H. Five-day moxifloxacin therapy compared with 7-day co-amoxiclav therapy for the treatment of acute exacerbation of chronic bronchitis. Int J Antimicrob Agents 2004; 23: 129–37

    Article  PubMed  CAS  Google Scholar 

  38. DeAbate CA, Mathew CP, Warner JH, et al. The safety and efficacy of short course (5-day) moxifloxacin vs. azithromycin in the treatment of patients with acute exacerbation of chronic bronchitis. Respir Med 2000; 94: 1029–37

    Article  PubMed  CAS  Google Scholar 

  39. Miravitlles M, Zalacain R, Murio C, et al. on behalf of the IMPAC Study Group. Speed of recovery from acute exacerbations of COPD after treatment with antimicrobials: result of a two-year study. Clin Drug Invest 2003; 23: 439–50

    Article  CAS  Google Scholar 

  40. Wilson R, Allegra L, Huchon G, et al. Short-term and long-term outcomes of moxifloxacin compared to standard antibiotic treatment in acute exacerbations of chronic bronchitis. Chest 2004; 125: 953–64

    Article  PubMed  CAS  Google Scholar 

  41. Miravitlles M, Anzueto A, Legnani D, et al. Interim results of the greatest international anti-infective trial (GIANT) in patients with AECB. ERS Annual Congress 2005 Sep 17–21; Copenhagen: Poster No. 4043

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Acknowledgements

This post-marketing surveillance study was supported and funded by Bayer HealthCare AG, Leverkusen, Germany. Dr Landen and Mrs Stauch are employees of Bayer HealthCare. Prof. Dr Schaberg, Prof. Dr File and Dr Möller have no conflicts of interest that are directly relevant to the content of this study.

The statistical analysis was performed by Institute Dr Schauerte, Oberhaching, Germany. Dr Christoph Müller-Löbnitz, Forchheim, Germany, helped to prepare the manuscript.

The authors would like to thank all the physicians who participated in this study.

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Authors and Affiliations

  1. Zentrum für Pneumologie, Lungenklinik Unterstedt, Unterstedt, Germany

    T. Schaberg

  2. Hanau, Germany

    M. Möller

  3. Infectious Disease Service Summa Health System, Akron, Ohio, USA

    T. File

  4. Post-Marketing Surveillance, Bayer HealthCare AG, Leverkusen, Germany

    K. Stauch &  H. Landen

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  1. T. Schaberg
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Correspondence to H. Landen.

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Schaberg, T., Möller, M., File, T. et al. Real-Life Treatment of Acute Exacerbations of Chronic Bronchitis with Moxifloxacin or Macrolides. Clin. Drug Investig. 26, 733–744 (2006). https://doi.org/10.2165/00044011-200626120-00007

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