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Original Research
Comparative effectiveness of macrolides and quinolones for patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) †‡
Article first published online: 9 JUN 2010
DOI: 10.1002/jhm.628
Copyright © 2010 Society of Hospital Medicine
Additional Information
How to Cite
Rothberg, M. B., Pekow, P. S., Lahti, M., Brody, O., Skiest, D. J. and Lindenauer, P. K. (2010), Comparative effectiveness of macrolides and quinolones for patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) . J. Hosp. Med., 5: 261–267. doi: 10.1002/jhm.628
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Supported by internal departmental funds. M.B.R. is the recipient of a Clinical Scientist Development Award from the Doris Duke Charitable Foundation.
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Disclosure: The authors thank Chris Craver of Premier Healthcare Informatics for his assistance with the study. All work was performed at Baystate Medical Center and the University of Massachusetts School of Public Health. M.B.R. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. M.B.R, P.K.L., O.B., and D.J.S. conceived of the study. P.K.L. acquired the data. M.B.R., P.K.L., O.B., P.S.P., and M.L. analyzed and interpreted the data. M.B.R. drafted the manuscript. P.K.L., P.S.P., M.L., and D.J.S. critically reviewed the manuscript for important intellectual content. P.S.P. and M.L. carried out the statistical analysis.
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Telephone: 413-794-3245; Fax: 413-794-4147
Publication History
- Issue published online: 9 JUN 2010
- Article first published online: 9 JUN 2010
- Manuscript Accepted: 20 SEP 2009
- Manuscript Revised: 17 SEP 2009
- Manuscript Received: 28 JUL 2009
Keywords:
- antibiotics;
- chronic obstructive;
- pulmonary disease;
- effectiveness;
- treatment
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 ≥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 of Hospital Medicine 2010;5:267–267. © 2010 Society of Hospital Medicine.