Newer fluoroquinolones in the treatment of acute exacerbations of COPD

Figures & data

Table 1 Summary of major respiratory society guidelines

Society and classification	Symptoms	Antibiotic treatment
BritishThoracic Society	No increase in sputum purulence or radiographic changes consistent with pneumonia	Nil
	Increased sputum purulence	Aminopenicillin, macrolide, or tetracycline as first-line treatment
American Thoracic Society/European Respiratory Society	Increase in sputum volume or purulence	Amoxycillin–ampicillin, cephalosporins, doxycycline, or macrolides
	Increase in sputum volume or purulence and failed prior antibiotic treatment	Consider amoxicillin–clavulanate or fluoroquinolones as first-line antibiotics
Canadian Respiratory Society
Group 0	Cough with sputum production in patient with no underlying lung disease	Likely caused by virus therefore no antibiotic unless protracted course
Group 1	Chronic bronchitis with mild to moderate impairment of lung function and less than 4 exacerbations a year	Aminopenicillins, doxycycline, or trimethoprim– sulphamethoxazole although may be better to use second-/third-generation cephalosporins or macrolides
Group 2	Significant airway obstruction and other co-morbidities for example cardiac disease	Direct treatment at resistant organisms using for example amoxicillin–clavulanate or fluoroquinolones
Group 3	Chronic bronchial suppuration with continuous purulent sputum production	Treatment as with Group 2 patients but note more at risk of Pseudomonas aeruginosa

Table 2 Limitations of older antibiotic study design in acute exacerbations of COPD

Small number of enrolled patients limits study power

Enrollment of patients with mild COPD or normal lung function with high rates of recovery diminishes perceived efficacy of antibiotics

No assessment of speed of recovery

Use of end points 3 weeks post treatment when spontaneous recovery may have occurred

Lack of long-term follow up and therefore no assessment of time to next exacerbation

No evaluation of concurrent medication likely to affect clinical outcome, allowing potential bias