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2-Day versus C-reactive protein guided antibiotherapy with levofloxacin in acute COPD exacerbation: A randomized controlled trial

INTRODUCTION: Duration of antibiotic treatment in acute exacerbation of COPD (AECOPD) is most commonly based on expert opinion. Biomarker guided strategy is increasingly recommended to limit unnecessary antibiotic use. We performed a randomized controlled study to evaluate the efficacy of 2-day vers...

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Autores principales: Mohamed Amine, Msolli, Selma, Messous, Adel, Sekma, Khaoula, Bel haj ali, Mohamed Hassene, Khalil, Imen, Trabelsi, Ahmed, Abdelghani, Nadia, Ben Brahim, Yosra, Ben Dhaya, Rabie, Razgallah, Mohamed Habib, Grissa, Kaouthar, Beltaief, Mehdi, Methamem, Asma, Belguith, Wahid, Bouida, Riadh, Boukef, Hamdi, Boubaker, Semir, Nouira
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136675/
https://www.ncbi.nlm.nih.gov/pubmed/34015041
http://dx.doi.org/10.1371/journal.pone.0251716
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author Mohamed Amine, Msolli
Selma, Messous
Adel, Sekma
Khaoula, Bel haj ali
Mohamed Hassene, Khalil
Imen, Trabelsi
Ahmed, Abdelghani
Nadia, Ben Brahim
Yosra, Ben Dhaya
Rabie, Razgallah
Mohamed Habib, Grissa
Kaouthar, Beltaief
Mehdi, Methamem
Asma, Belguith
Wahid, Bouida
Riadh, Boukef
Hamdi, Boubaker
Semir, Nouira
author_facet Mohamed Amine, Msolli
Selma, Messous
Adel, Sekma
Khaoula, Bel haj ali
Mohamed Hassene, Khalil
Imen, Trabelsi
Ahmed, Abdelghani
Nadia, Ben Brahim
Yosra, Ben Dhaya
Rabie, Razgallah
Mohamed Habib, Grissa
Kaouthar, Beltaief
Mehdi, Methamem
Asma, Belguith
Wahid, Bouida
Riadh, Boukef
Hamdi, Boubaker
Semir, Nouira
author_sort Mohamed Amine, Msolli
collection PubMed
description INTRODUCTION: Duration of antibiotic treatment in acute exacerbation of COPD (AECOPD) is most commonly based on expert opinion. Biomarker guided strategy is increasingly recommended to limit unnecessary antibiotic use. We performed a randomized controlled study to evaluate the efficacy of 2-day versus C-reactive protein (CRP)-guided treatment with levofloxacin in patients with AECOPD. METHODS: Patients with AECOPD were randomized to receive oral levofloxacin daily for 7 days unless the serum CRP level decreased by at least 50% from the baseline value or levofloxacin for two days; thereafter, oral placebo tablet was prescribed according to the CRP. The primary outcome measure was cure rate, and secondary outcome included need for additional antibiotics, intensive care unit (ICU) admission, exacerbation rates and exacerbation free interval (EFI) within one-year follow-up. RESULTS: In intention to treat (ITT) analysis, cure rate was 76.1% (n = 118) and 79.3% (n = 123) respectively in 2-day and CRP-guided groups. In per protocol (PP) analysis, cure rate was 73% (n = 92) and 70.4% (n = 88) respectively in 2-day and CRP-guided groups. The difference between the two groups was not significant. The need for additional antibiotics and ICU admission rates were not significantly different between the two groups. One-year exacerbation rate was 27% (n = 42) in 2-day group versus 30.3% (n = 47) in CRP-guided group (p = 0.53); the EFI was 125 days (interquartile range, 100–151) versus 100 days (interquartile range, 78–123) in 2-day and CRP-guided groups respectively (p = 0.45). No difference in adverse effects was detected. CONCLUSION: Levofloxacin once daily for 2 days had similar efficacy compared to CRP-guided in AECOPD. This short course treatment decreased antibiotic consumption which would improve patient compliance and reduce adverse effects.
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spelling pubmed-81366752021-06-11 2-Day versus C-reactive protein guided antibiotherapy with levofloxacin in acute COPD exacerbation: A randomized controlled trial Mohamed Amine, Msolli Selma, Messous Adel, Sekma Khaoula, Bel haj ali Mohamed Hassene, Khalil Imen, Trabelsi Ahmed, Abdelghani Nadia, Ben Brahim Yosra, Ben Dhaya Rabie, Razgallah Mohamed Habib, Grissa Kaouthar, Beltaief Mehdi, Methamem Asma, Belguith Wahid, Bouida Riadh, Boukef Hamdi, Boubaker Semir, Nouira PLoS One Research Article INTRODUCTION: Duration of antibiotic treatment in acute exacerbation of COPD (AECOPD) is most commonly based on expert opinion. Biomarker guided strategy is increasingly recommended to limit unnecessary antibiotic use. We performed a randomized controlled study to evaluate the efficacy of 2-day versus C-reactive protein (CRP)-guided treatment with levofloxacin in patients with AECOPD. METHODS: Patients with AECOPD were randomized to receive oral levofloxacin daily for 7 days unless the serum CRP level decreased by at least 50% from the baseline value or levofloxacin for two days; thereafter, oral placebo tablet was prescribed according to the CRP. The primary outcome measure was cure rate, and secondary outcome included need for additional antibiotics, intensive care unit (ICU) admission, exacerbation rates and exacerbation free interval (EFI) within one-year follow-up. RESULTS: In intention to treat (ITT) analysis, cure rate was 76.1% (n = 118) and 79.3% (n = 123) respectively in 2-day and CRP-guided groups. In per protocol (PP) analysis, cure rate was 73% (n = 92) and 70.4% (n = 88) respectively in 2-day and CRP-guided groups. The difference between the two groups was not significant. The need for additional antibiotics and ICU admission rates were not significantly different between the two groups. One-year exacerbation rate was 27% (n = 42) in 2-day group versus 30.3% (n = 47) in CRP-guided group (p = 0.53); the EFI was 125 days (interquartile range, 100–151) versus 100 days (interquartile range, 78–123) in 2-day and CRP-guided groups respectively (p = 0.45). No difference in adverse effects was detected. CONCLUSION: Levofloxacin once daily for 2 days had similar efficacy compared to CRP-guided in AECOPD. This short course treatment decreased antibiotic consumption which would improve patient compliance and reduce adverse effects. Public Library of Science 2021-05-20 /pmc/articles/PMC8136675/ /pubmed/34015041 http://dx.doi.org/10.1371/journal.pone.0251716 Text en © 2021 Mohamed Amine et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Mohamed Amine, Msolli
Selma, Messous
Adel, Sekma
Khaoula, Bel haj ali
Mohamed Hassene, Khalil
Imen, Trabelsi
Ahmed, Abdelghani
Nadia, Ben Brahim
Yosra, Ben Dhaya
Rabie, Razgallah
Mohamed Habib, Grissa
Kaouthar, Beltaief
Mehdi, Methamem
Asma, Belguith
Wahid, Bouida
Riadh, Boukef
Hamdi, Boubaker
Semir, Nouira
2-Day versus C-reactive protein guided antibiotherapy with levofloxacin in acute COPD exacerbation: A randomized controlled trial
title 2-Day versus C-reactive protein guided antibiotherapy with levofloxacin in acute COPD exacerbation: A randomized controlled trial
title_full 2-Day versus C-reactive protein guided antibiotherapy with levofloxacin in acute COPD exacerbation: A randomized controlled trial
title_fullStr 2-Day versus C-reactive protein guided antibiotherapy with levofloxacin in acute COPD exacerbation: A randomized controlled trial
title_full_unstemmed 2-Day versus C-reactive protein guided antibiotherapy with levofloxacin in acute COPD exacerbation: A randomized controlled trial
title_short 2-Day versus C-reactive protein guided antibiotherapy with levofloxacin in acute COPD exacerbation: A randomized controlled trial
title_sort 2-day versus c-reactive protein guided antibiotherapy with levofloxacin in acute copd exacerbation: a randomized controlled trial
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136675/
https://www.ncbi.nlm.nih.gov/pubmed/34015041
http://dx.doi.org/10.1371/journal.pone.0251716
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