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Speed of Recovery from Acute Exacerbations of Chronic Obstructive Pulmonary Disease after Treatment with Antimicrobials

Results of a Two-Year Study

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Abstract

Objective: We performed a multicentre study under a 2-year observational protocol that included data on time to recovery from acute exacerbations of chronic obstructive pulmonary disease (AE-COPD) in patients receiving moxifloxacin and comparator antimicrobials.

Patients and methods: Outpatients with moderate or severe COPD were recruited from respiratory clinics throughout Spain. Moxifloxacin was available in year 2, and was to be prescribed to 50% of patients in that period in a non-randomised allocation. Time to recovery was compared in successfully treated AE-COPD; cross-sectionally for all AE-COPD over 2 years, first AE-COPD and all AE-COPD in year 2, and longitudinally in patients receiving comparator antimicrobials for AE-COPD in year 1 and moxifloxacin in year 2.

Results: 614 AE-COPD were treated in 441 patients over 2 years (mean age 66.7 ± 8.3 years, 98% males, mean forced expiratory volume in 1 second [FEV1] 35.9 ± 8.8%). Mean time to recovery overall was 4.6 days (SD 3.3) with moxifloxacin 400 mg/day for 5 days, and 5.8 days (SD 4.6) with comparators (p < 0.01), which were most frequently amoxicillin/clavulanic acid 500/125mg/8h, clarithromycin 500mg/12h and cefuroxime axetil 500mg/12h for 7–10 days. Longitudinal analysis showed that 27 patients treated with moxifloxacin in the second year of the study recovered in a mean of 3.7 days (SD 3.1), and the same patients treated with comparator antimicrobials in year one recovered in a mean of 6.8 days (SD 4.6) [p = 0.02]. In contrast, in 66 patients treated with comparator antimicrobials in both years, mean time to recovery was 7.4 days (SD 7.3) in year one and 5.5 days (SD 3.5) in year two (p = 0.24). All subgroup analyses showed a statistically significant reduction of 18–25% in time to recovery with moxifloxacin compared with other antibiotics.

Conclusions:Moxifloxacin significantly reduced time to recovery from AE-COPD in patients with moderate to severe disease by approximately 20% (>1 day) compared with other antimicrobials. Faster recovery should result in earlier return to work or normal activities, and to social and economic savings.

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Acknowledgements

The IMPAC Study was funded by an unrestricted grant from QF Bayer Spain. The authors greatly appreciate the assistance in the data management by Angels Pont from the Health Services Research Unit, Institut Municipal d’Investigació Mèdica, Barcelona.

Investigators of the IMPAC Study Group: Carlos Escudero, H. de Asturias (Oviedo); Carlos Sanjuas, H. Del Mar (Barcelona); José Joaquín Cebrián, H. Carlos Haya (Málaga); Francisco Álvarez-Gutiérrez, H Virgen del Rocío (Sevilla); Félix del Campo, H. Río Ortega (Valladolid); Juan M. Hernández-Valle, H. San Pedro de Alcátara (Cáceres); Francisco Casas, H. Clínico San Cecilio (Granada); Sara Vilá, C. De la Roza, H. General Vall d´Hebron (Barcelona); Marina Blanco, H. Juan Canalejo (La Coruña); Gregorio Pérez Peñate, H. General de Gran Canaria Dr. Negrín (Las Palmas); José J. Blanco, H. Cristal-Piñor (Ourense); Antonio León, H. Puerta del Mar (Cádiz); Julia Tárrega, H. De la Santa Creu i Sant Pau (Barcelona); Francisco J. Domínguez del Valle, H. de Navarra (Navarra); Luis A. Ruíz-Iturraga, H. De San Eloy (Vizcaya); José Ma Echave-Sustaeta, H. 12 de Octubre (Madrid); Julio Palop, Rafael Blanquer. H. Dr. Peset (Valencia); Olga Perelló, Carlos A. Jiménez, H. De la Princesa (Madrid); José Franco, H. Alcira (Valencia); Javier Garrapiz, Luis Borderías, H. San Jorge (Huesca); José A. Hermida, HGetafe (Madrid); Asunción Perpiñá, H. Severo Ochoa (Madrid); Francisco Conget, H. Clínico Universitario de Zaragoza (Zaragoza); Germán Peces-Barba, Fundación Jiménez Díaz (Madrid); Néstor Soler, H. Clínic i Provincial (Barcelona); M. Carmen Abellán, H. General Universitario de Murcia (Murcia); M. José Mejuto, H. Arquitecto Marcide (La Coruña); Mariano Arévalo, H. General de Albacete (Albacete); Cristina Estirado, H. Txagorritxu (Vitoria); Feliu Renom, H. Joan March (Baleares); Myriam Calle, H. Clínico Universitario San Carlos (Madrid); Enric Prats, H. Bellvitge (Barcelona); Milagros Iriberri, H. Cruces (Vizcaya); Montserrat Vendrell, H. Josep Trueta (Girona); Tomás Lloret, H. General de Valencia (Valencia); Ma Sol Prats, H. Germans Trias i Pujol (Barcelona); Nuria Roger, H. Vic (Barcelona); José L. Izquierdo, H. Guadalajara (Guadalajara); Ana Bustamante, H. Sierrallana (Cantabria).

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Authors and Affiliations

  1. Servei de Pneumologia, Institut Clínic de Pneumologia i Cirurgia Toràcica (IDIBAPS), Hospital Clínic i Provincial, Villarroel 170 (UVIR, esc 2, planta 3), Barcelona, E-08036, Spain

    Marc Miravitlles

  2. Unidad de Patología Respiratoria, Hospital de Cruces, Baracaldo, Vizcaya, Spain

    Rafael Zalacain

  3. Unitat de Pneumologia, Hospital General de Catalunya, Barcelona, Spain

    Cristina Murio

  4. Health Services Research Unit, Institut Municipal d’Investigació Mèdica, Barcelona, Spain

    Montserrat Ferrer

  5. Servicio de Neumología, Hospital Clínico San Carlos, Madrid, Spain

    José L. Alvarez-Sala

  6. Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres, Spain

    Juan F. Masa

  7. Servicio de Neumología, Hospital Juan Canalejo, La Coruña, Spain

    Héctor Verea

  8. R+D Department, QF Bayer, Barcelona, Spain

    Fernando Ros

  9. Servei de Pneumologia, Hospital General Vall d’Hebron, Barcelona, Spain

    Rafael Vidal

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  1. Marc Miravitlles
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Correspondence to Marc Miravitlles.

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Miravitlles, M., Zalacain, R., Murio, C. et al. Speed of Recovery from Acute Exacerbations of Chronic Obstructive Pulmonary Disease after Treatment with Antimicrobials. Clin. Drug Investig. 23, 439–450 (2003). https://doi.org/10.2165/00044011-200323070-00003

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