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Comparative effectiveness of macrolides and quinolones for patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease (AECOPD).

Abstract：

BACKGROUND:Meta-analyses of randomized trials have found that antibiotics are effective in acute exacerbations of chronic obstructive pulmonary disease (AECOPD), but there is insufficient evidence to guide antibiotic selection. Current guidelines offer conflicting recommendations. OBJECTIVE:To compare the effectiveness of macrolides and quinolones for AECOPD DESIGN: Retrospective cohort study using logistic regression, propensity score-matching, and grouped treatment models. SETTING:A total of 375 acute care hospitals throughout the United States. PATIENTS:Age > or =40 years and hospitalized for AECOPD. INTERVENTION:Macrolide or quinolone antibiotic begun in the first 2 hospital days. MEASUREMENTS:Treatment failure (defined as the initiation of mechanical ventilation after hospital day 2, inpatient mortality, or readmission for AECOPD within 30 days), length of stay, and hospital costs. RESULTS:Of the 19,608 patients who met the inclusion criteria, 6139 (31%) were treated initially with a macrolide and 13,469 (69%) with a quinolone. Compared to patients treated initially with a quinolone, those who received macrolides had a lower risk of treatment failure (6.8% vs. 8.1%; P < 0.01), a finding that was attenuated after multivariable adjustment (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.78-1.01), and disappeared in a grouped-treatment analysis (OR, 1.01; 95% CI, 0.75-1.35). There were no differences in adjusted length of stay (ratio, 0.98; 95% CI, 0.97-1.00) or adjusted cost (ratio, 1.00; 95% CI, 0.99-1.02). After propensity score-matching, antibiotic-associated diarrhea was more common with quinolones (1.2% vs. 0.6%; P < 0.001). CONCLUSIONS:Macrolide and quinolone antibiotics are associated with similar rates of treatment failure in AECOPD; however, macrolides are less frequently associated with diarrhea.

journal_name

J Hosp Med

journal_title

Journal of hospital medicine

authors

Rothberg MB,Pekow PS,Lahti M,Brody O,Skiest DJ,Lindenauer PK

doi

10.1002/jhm.628

subject

Has Abstract

pub_date

2010-05-01 00:00:00

pages

261-7

issue

eissn

1553-5592

issn

1553-5606

journal_volume

pub_type

杂志文章,多中心研究

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Comparative effectiveness of macrolides and quinolones for patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease (AECOPD).