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Antibiotic treatment in acute exacerbation of COPD: patient outcomes with amoxicillin vs. amoxicillin/clavulanic acid—data from 43,636 outpatients

BACKGROUND: For antibiotic treatment of Acute exacerbations of COPD (AECOPD) the National guidelines in Denmark recommend either first choice amoxicillin 750 mg TID (AMX) or amoxicillin with clavulanic acid 500 mg/125 mg TID (AMC). Addition of clavulanic acid offers a broader spectrum; opposite, AMX...

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Autores principales: Bagge, Kristian, Sivapalan, Pradeesh, Eklöf, Josefin, Hertz, Frederik Böetius, Andersen, Christian Østergaard, Hansen, Ejvind Frausing, Jarløv, Jens Otto, Jensen, Jens-Ulrik Stæhr
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7789423/
https://www.ncbi.nlm.nih.gov/pubmed/33413341
http://dx.doi.org/10.1186/s12931-020-01606-7
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author Bagge, Kristian
Sivapalan, Pradeesh
Eklöf, Josefin
Hertz, Frederik Böetius
Andersen, Christian Østergaard
Hansen, Ejvind Frausing
Jarløv, Jens Otto
Jensen, Jens-Ulrik Stæhr
author_facet Bagge, Kristian
Sivapalan, Pradeesh
Eklöf, Josefin
Hertz, Frederik Böetius
Andersen, Christian Østergaard
Hansen, Ejvind Frausing
Jarløv, Jens Otto
Jensen, Jens-Ulrik Stæhr
author_sort Bagge, Kristian
collection PubMed
description BACKGROUND: For antibiotic treatment of Acute exacerbations of COPD (AECOPD) the National guidelines in Denmark recommend either first choice amoxicillin 750 mg TID (AMX) or amoxicillin with clavulanic acid 500 mg/125 mg TID (AMC). Addition of clavulanic acid offers a broader spectrum; opposite, AMX alone in a higher dose may offer more time above MIC. The aim of this study was to determine which of these regimens is associated with better outcome. METHODS: The Danish Registry of COPD (DrCOPD), a nationwide outpatient COPD registry, was crosslinked with medication data and hospital contacts. The first prescription of AMX or AMC after inclusion in DrCOPD was used as exposure variable. Adjusted Cox proportional hazards models were used to analyze the risk of hospitalization or death (combined) within 30 days and other endpoints. RESULTS: For the first treatment of AECOPD 12,915 received AMX, and 30,721 patients received AMC. AMX was associated with a decreased risk of pneumonia hospitalization or death (aHR 0.6, 95% CI 0.5–0.7; p < 0.0001) compared to AMC. CONCLUSION: In AECOPD, empirically adding clavulanic acid to amoxicillin is not associated with a better outcome; it seems safe for these patients to be treated with amoxicillin alone.
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spelling pubmed-77894232021-01-07 Antibiotic treatment in acute exacerbation of COPD: patient outcomes with amoxicillin vs. amoxicillin/clavulanic acid—data from 43,636 outpatients Bagge, Kristian Sivapalan, Pradeesh Eklöf, Josefin Hertz, Frederik Böetius Andersen, Christian Østergaard Hansen, Ejvind Frausing Jarløv, Jens Otto Jensen, Jens-Ulrik Stæhr Respir Res Research BACKGROUND: For antibiotic treatment of Acute exacerbations of COPD (AECOPD) the National guidelines in Denmark recommend either first choice amoxicillin 750 mg TID (AMX) or amoxicillin with clavulanic acid 500 mg/125 mg TID (AMC). Addition of clavulanic acid offers a broader spectrum; opposite, AMX alone in a higher dose may offer more time above MIC. The aim of this study was to determine which of these regimens is associated with better outcome. METHODS: The Danish Registry of COPD (DrCOPD), a nationwide outpatient COPD registry, was crosslinked with medication data and hospital contacts. The first prescription of AMX or AMC after inclusion in DrCOPD was used as exposure variable. Adjusted Cox proportional hazards models were used to analyze the risk of hospitalization or death (combined) within 30 days and other endpoints. RESULTS: For the first treatment of AECOPD 12,915 received AMX, and 30,721 patients received AMC. AMX was associated with a decreased risk of pneumonia hospitalization or death (aHR 0.6, 95% CI 0.5–0.7; p < 0.0001) compared to AMC. CONCLUSION: In AECOPD, empirically adding clavulanic acid to amoxicillin is not associated with a better outcome; it seems safe for these patients to be treated with amoxicillin alone. BioMed Central 2021-01-07 2021 /pmc/articles/PMC7789423/ /pubmed/33413341 http://dx.doi.org/10.1186/s12931-020-01606-7 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Bagge, Kristian
Sivapalan, Pradeesh
Eklöf, Josefin
Hertz, Frederik Böetius
Andersen, Christian Østergaard
Hansen, Ejvind Frausing
Jarløv, Jens Otto
Jensen, Jens-Ulrik Stæhr
Antibiotic treatment in acute exacerbation of COPD: patient outcomes with amoxicillin vs. amoxicillin/clavulanic acid—data from 43,636 outpatients
title Antibiotic treatment in acute exacerbation of COPD: patient outcomes with amoxicillin vs. amoxicillin/clavulanic acid—data from 43,636 outpatients
title_full Antibiotic treatment in acute exacerbation of COPD: patient outcomes with amoxicillin vs. amoxicillin/clavulanic acid—data from 43,636 outpatients
title_fullStr Antibiotic treatment in acute exacerbation of COPD: patient outcomes with amoxicillin vs. amoxicillin/clavulanic acid—data from 43,636 outpatients
title_full_unstemmed Antibiotic treatment in acute exacerbation of COPD: patient outcomes with amoxicillin vs. amoxicillin/clavulanic acid—data from 43,636 outpatients
title_short Antibiotic treatment in acute exacerbation of COPD: patient outcomes with amoxicillin vs. amoxicillin/clavulanic acid—data from 43,636 outpatients
title_sort antibiotic treatment in acute exacerbation of copd: patient outcomes with amoxicillin vs. amoxicillin/clavulanic acid—data from 43,636 outpatients
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7789423/
https://www.ncbi.nlm.nih.gov/pubmed/33413341
http://dx.doi.org/10.1186/s12931-020-01606-7
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