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JAC Advance Access originally published online on May 8, 2008
Journal of Antimicrobial Chemotherapy 2008 62(3):442-450; doi:10.1093/jac/dkn201
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Systematic review

Short- versus long-duration antimicrobial treatment for exacerbations of chronic bronchitis: a meta-analysis

Matthew E. Falagas1,2,3,*, Sofia G. Avgeri1, Dimitrios K. Matthaiou1, George Dimopoulos1,4 and Ilias I. Siempos1

1 Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece 2 Department of Medicine, Tufts University School of Medicine, Boston, MA, USA 3 Department of Medicine, Henry Dunant Hospital, Athens, Greece 4 Intensive Care Unit, ‘Attikon’ University Hospital, Athens, Greece

Received 11 February 2008; returned 10 March 2008; revised 28 March 2008; accepted 13 April 2008

* Correspondence address. Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23 Marousi, Greece. Tel: +30-210-683-9604; Fax: +30-210-683-9605; E-mail: m.falagas{at}aibs.gr

Objectives: The aim of this study was to evaluate the comparative effectiveness and safety of short (5 days) and long (7 or 10 days) duration antimicrobial treatment of patients with acute exacerbations of chronic bronchitis (AECB).

Methods: We performed a meta-analysis of randomized controlled trials (RCTs) comparing regimens of the same antibiotic (same dosage and same route of administration) administered for a different time period. We searched PubMed, the Cochrane Central Register of Controlled Trials and reference lists from publications, with no language restrictions.

Results: Of the 1031 reports retrieved initially, seven RCTs, enrolling 3083 patients with AECB, met our inclusion criteria. The antimicrobials studied in these seven RCTs were quinolones, cefixime and clarithromycin. There was no difference between the short- and long-duration therapies with regard to treatment success in intention-to-treat [relative risk (RR) = 0.99, 95% confidence interval (CI) 0.95–1.03], clinically evaluable (RR = 0.99, 95% CI 0.96–1.02) or microbiologically evaluable (RR = 0.98, 95% CI 0.93–1.02) patients. Short-duration treatment, when compared with long, was associated with fewer adverse events (RR = 0.84, 95% CI 0.72–0.97).

Conclusions: Short-duration treatment seems to be as effective as and safer than long-duration antimicrobial treatment of patients with AECB. Additional research is required to clarify the long-term outcomes (namely the exacerbation-free interval after the resolution of an initial episode) of the compared regimens.

Keywords: chronic obstructive pulmonary disease , Streptococcus pneumoniae , quinolones , macrolides , β-lactams


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