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| |  CHEST: Bacterial Eradication and Clinical Response Linked in Antibiotic Treatment of Acute Exacerbations of Chronic Bronchitis By Alison Palkhivala Special to DG News PHILADELPHIA, PA -- November 8, 2001 -- Researchers have found a clear linear relationship between clinical outcomes and bacteriological eradication in patients with acute exacerbations of chronic bronchitis treated with antibiotics. The various classes of antibiotics for the treatment of acute exacerbations of chronic bronchitis appear to provide only minor differences with respect to clinical response and bacterial eradication rates. Given concerns about antibiotic resistance, the decision to use an antibiotic for acute exacerbations of chronic bronchitis (AECB) and selection of specific antibiotics for this condition are not easy to make. To shed light on this issue, Fernando J. Martinez, MD, from the department of pulmonary and critical care medicine at the University of Michigan in Ann Arbor, Michigan, and colleagues examined the effect of various antibiotic classes on clinical response and bacteriologic eradication in individuals with AECB. Dr. Martinez presented their findings yesterday (Nov. 7) at the annual meeting of the American College of Chest Physicians (CHEST). "In the majority of studies that have been published, including pharmaceutically-sponsored studies comparing agents, there’s an efficacy of about 80 percent [for antibiotics for the treatment of AECB]," Dr. Martinez said. "… There’s always between 13 to 20 percent of clinical failures, and there are a whole series of reasons for that, whether it’s inadequate in vitro coverage, antimicrobial resistance, or problems with the antibiotics used." For this meta-analysis of several randomized trials of individuals with AECB, the researchers compared the effect on clinical response and bacteriologic eradiation of the following antibiotic therapies: penicillins/trimethoprim (n=18), amoxicillin/clavulonate (n=9), macrolides (n=26), cephalosporins (n=13), ciprofloxacin (n=11), newer quinolones (n=27), tetracyclines (n=6), and placebo (n=7). Few differences were noted among the antimicrobial classes and their effects on clinical response or bacteriologic eradication. A direct relationship was noted between clinical response rate and bacteriologic eradication, and this varied by antibiotic class. "In general, the clinical response with antibiotics is higher [compared to placebo, despite a high incidence of spontaneous resolution of symptoms]," Dr. Martinez said."When you try to compare the different antimicrobial agents, they’re all equivalent … because all of these studies are powered for clinical equivalence. … The only significant difference is in the cephalosporin class, [which produces poorer results] in the sicker patient population." According to Dr. Martinez, "you can conclude [from this research] that clinical response is very similar amongst all these classes. … There are some [minor] differences in bacteriologic eradication rate, and there really is a linear relation between clinical response and eradication."
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