Original Article

Equal Effectiveness of Older Traditional Antibiotics and Newer Broad-Spectrum Antibiotics in Treating Patients with Acute Exacerbations of Chronic Bronchitis

Authors: Catherine C. Peng, PHARMD, Sherrie L. Aspinall, PHARMD, BCPS, Chester B. Good, MD, MPH, Charles W. Atwood, Jr., MD, Chung-Chou H. Chang, PHD

Abstract

Background Choice of antibiotic therapy for acute exacerbations of chronic bronchitis (AECB) is important because of cost and concerns about development of resistance. Methods A retrospective cohort study was conducted in outpatients with chronic obstructive pulmonary disease and documented AECB treated with antibiotics. Results We compared outcomes and costs of AECB treated with first-line antibiotics having partial coverage against organisms associated with AECB (eg, amoxicillin), first-line antibiotics with full coverage against organisms associated with AECB (eg, sulfamethoxazole-trimethoprim), and newer broad-spectrum antibiotics (eg, azithromycin). There were no significant differences among the three antibiotic groups in failure rate, hospitalization rate, or time until subsequent AECB. Pharmacy costs were significantly less with first-line antibiotics ($3.18 ± 0.64, $3.00 ± 0.48, and $36.70 ± 16.29, respectively; P <0.0001), but there was no significant difference among all three groups with regard to total costs. Conclusion We found no difference in outcome between older traditional antibiotics with adequate coverage against organisms associated with AECB and newer broad-spectrum antibiotics.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Anthonisen NR, Manfreda J, Warren CP, et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 1987; 106: 196–204.
 
2. Saint S, Bent S, Vittinghoff E, et al. Antibiotics in chronic obstructive pulmonary disease exacerbations: A meta-analysis. JAMA 1995; 273: 957–960.
 
3. Niederman MS, McCombs JS, Unger AN, et al. Treatment cost of acute exacerbations of chronic bronchitis. Clin Ther 1999; 21: 576–591.
 
4. Adams SG, Anzueto A. Treating acute exacerbations of chronic bronchitis in the face of antibiotic resistance. Cleve Clin J Med 2000; 67: 625–628, 631–633.
 
5. Anzueto A, Angel L. Update in pulmonary disease. Ann Intern Med 2000; 133: 360–366.
 
6. Destache CJ. Optimizing economic outcomes in acute exacerbations of chronic bronchitis. Pharmacotherapy 2002; 22: 12S–17S, 30S–32S.
 
7. Destache CJ, Dewan N, O'Donohue WJ, et al. Clinical and economic considerations in the treatment of acute exacerbations of chronic bronchitis. J Antimicrob Chemother 1999; 43 (Suppl A): 107–113.
 
8. American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1995; 152; S77–S121.
 
9. Adams SG, Melo J, Luther M, et al. Antibiotics are associated with lower relapse rates in outpatients with acute exacerbations of COPD. Chest 2000; 117: 1345–1352.
 
10. Doern GV, Brueggemann AB, Pierce G, et al. Antibiotic resistance among clinical isolates ofHaemophilus influenzae in the United States in 1994 and 1995 and detection of β-lactamase-positive strains resistant to amoxicillin-clavulanate: Results of a national multicenter surveillance study. Antimicrob Agents Chemother 1997; 41: 292–297.
 
11. Doern GV, Brueggemann AB, Pierce G, et al. Prevalence of antimicrobial resistance among 723 outpatient clinical isolates of Moraxella catarrhalis in the United States in 1994 and 1995: Results of a 30-center national surveillance study. Antimicrob Agents Chemother 1996; 40: 2884–2886.
 
12. Doern GV, Brueggemann A, Holley HP Jr, et al. Antimicrobial resistance of Streptococcus pneumoniae recovered from outpatients in the United States during the winter months of 1994 to 1995: Results of a 30-center national surveillance study. Antimicrob Agents Chemother 1996; 40: 1208–1213.
 
13. Grossman RF. Cost-effective therapy for acute exacerbations of chronic bronchitis. Semin Respir Infect 2000; 15: 71–81.
 
14. Niederman MS. Antibiotic therapy of exacerbations of chronic bronchitis. Semin Respir Infect 2000; 15: 59–70.
 
15. Peng CC, Aspinall SL, Good CB. Update in pulmonary disease. Ann Intern Med 2001; 135: 301(letter).