Effects of different antibiotic classes on airway bacteria in stable COPD using culture and molecular techniques: a randomised controlled trial.
Thorax
; 70(10): 930-8, 2015 Oct.
Article
in En
| MEDLINE
| ID: mdl-26179246
ABSTRACT
BACKGROUND:
Long-term antibiotic therapy is used to prevent exacerbations of COPD but there is uncertainty over whether this reduces airway bacteria. The optimum antibiotic choice remains unknown. We conducted an exploratory trial in stable patients with COPD comparing three antibiotic regimens against placebo.METHODS:
This was a single-centre, single-blind, randomised placebo-controlled trial. Patients aged ≥45â years with COPD, FEV1<80% predicted and chronic productive cough were randomised to receive either moxifloxacin 400â mg daily for 5â days every 4â weeks, doxycycline 100â mg/day, azithromycin 250â mg 3 times a week or one placebo tablet daily for 13â weeks. The primary outcome was the change in total cultured bacterial load in sputum from baseline; secondary outcomes included bacterial load by 16S quantitative PCR (qPCR), sputum inflammation and antibiotic resistance.RESULTS:
99 patients were randomised; 86 completed follow-up, were able to expectorate sputum and were analysed. After adjustment, there was a non-significant reduction in bacterial load of 0.42 log10â cfu/mL (95% CI -0.08 to 0.91, p=0.10) with moxifloxacin, 0.11 (-0.33 to 0.55, p=0.62) with doxycycline and 0.08 (-0.38 to 0.54, p=0.73) with azithromycin from placebo, respectively. There were also no significant changes in bacterial load measured by 16S qPCR or in airway inflammation. More treatment-related adverse events occurred with moxifloxacin. Of note, mean inhibitory concentrations of cultured isolates increased by at least three times over placebo in all treatment arms.CONCLUSIONS:
Total airway bacterial load did not decrease significantly after 3â months of antibiotic therapy. Large increases in antibiotic resistance were seen in all treatment groups and this has important implications for future studies. TRIAL REGISTRATION NUMBER clinicaltrials.gov (NCT01398072).Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Respiratory System
/
Doxycycline
/
Azithromycin
/
Pulmonary Disease, Chronic Obstructive
/
Fluoroquinolones
/
Anti-Bacterial Agents
Type of study:
Clinical_trials
/
Prognostic_studies
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Thorax
Year:
2015
Type:
Article
Affiliation country:
United kingdom