Cochrane review azithromycin copd exacerbation treatment

review treatment cochrane exacerbation azithromycin copd

Acute exacerbation of chronic obstructive pulmonary disease AECOPD is the most common reason for azithromycin copd exacerbation hospitalization and death of pulmonary patients. The major outcome variables were clinical cure rate and adverse effects. The microbiological response rate, relapse of exacerbation, and mortality were "azithromycin copd exacerbation" analysed. A random-effect network was used to assess the effectiveness and tolerance of each antibiotic used for AECOPD treatment.

The cluster ranking showed that dirithromycin had a high clinical cure rate with a low rate of adverse effects. Ofloxacin, ciprofloxacin, and trimethoprim-sulfamethoxazole had high clinical cure rates with median rates of adverse effects. In terms of the microbiological response rate, only doxycycline was significantly better orlistat low carb diet placebo odds ratio OR3. There were no other significant results with respect to the frequency of recurrence or mortality.

Our study indicated that dirithromycin is adequate for improving the clinical cure rate of patients with AECOPD with few "cochrane review" effects. Ofloxacin, ciprofloxacin, and trimethoprim-sulfamethoxazole are also recommended for disease treatment. The online version of this article doi: Chronic obstructive pulmonary disease COPD is characterised by neutrophilic airway inflammation and incomplete reversible airflow restriction.

COPD is also the fourth-leading cause of death causing about 2. The severity of impaired lung treatment can vary depending on the type of pathogenic bacteria and the degree of infection [ 6 ]. Bronchodilators, mainly beta-2 receptor agonists, anti-cholinergic drugs, and theophylline, are the most commonly used agents in the treatment of AECOPD [ 7 ]. Systemic treatment inhaled corticosteroids and antimicrobial therapy are also important adjuvant therapies [ 8 ]. Other therapies, such as supplemental oxygen and mechanical ventilation, are also used clinically.

Once the infectious bacteria are identified, specific antibiotics treatment those pathogens are used mixing xanax and acid treatment. However, at the onset of AECOPD, the physician may not be able to determine whether a patient has a bacterial infection, the type of bacteria, or the severity of infection; therefore, the type of antibiotic to be used for AECOPD treatment remains a matter of debate [ 1011 ].

It was found that moxifloxacin is a safe and effective empirical agent for treatment, but this study only included will klonopin make me sleep small treatment of AECOPD patients [ 12 ]. Another study showed that prophylactic antibiotics could effectively reduce the frequency of exacerbation; however, long-term use might increase bacterial resistance and increase the risk of adverse effects [ 13 ].

Therefore, our research systematically analysed the effect and tolerance of antibiotics for the treatment of patients with AECOPD, and a network meta-analysis was performed to directly and indirectly compare different antibiotics. This network meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews guidelines [ 14 ]. We systematically searched the PubMed, EmBase, and the Cochrane Central Register of Controlled Trials databases using the following keywords for results published through September in the English language: The references of relevant reviews were also checked to ensure that no relevant review cochrane were omitted.

The literature search was undertaken independently treatment 2 authors and any inconsistencies were settled by group discussion until a consensus was reached. A study was eligible for inclusion if it met the following criteria: The exclusion criteria included the following: Review articles, conference presentations, secondary research reports, letters, editorials, and basic research articles were also excluded.

We extracted the first author, publication year, country, sample size, gender ratio, experimental intervention, comparison intervention, outcome assessment, and treatment data. We also assessed the methodological quality of the included trials using a risk how to detox your body from lexapro bias approach, as described by the Cochrane Collaboration [ 15 ].

In our analysis, the major efficacy outcome was clinical cure success rate and the major tolerance outcome was the rate of adverse effects. Secondary outcomes included microbiological response rate, relapse of exacerbations, and mortality. For the efficacy outcome analysis, we used data with the intention of treating a population comprised of randomized patients who received a study agent. In our analysis, we performed a pairwise meta-analysis using a random-effect model.

We also used a random effects network meta-analysis for mixed multiple treatment comparisons [ 16 ]. To rank the treatments for each outcome, we used surface under the cumulative ranking SUCRA probabilities [ 17 ]. The how much clonazepam is safe cure and adverse effect rates of each treatment are displayed as cluster-ranking plots. Comparison-adjusted funnel plots were used to determine whether small-study effects were present in our analysis [ 18 ].

All tests were two-tailed, and a P value of less than 0. In our study, exacerbation treatment were identified after duplications were removed. After screening the titles and abstracts, of over the counter drugs like adipex articles were excluded. The full-text of the remaining 57 articles were assessed and the following articles were excluded: Ultimately, 19 articles, published between andthat assessed patients were collected for our systematic review Fig.

One of the included trials contained four intervention arms [ 36 ]. In the included studies, the most common research region was Europe. Studies were also conducted in Asia, North America, and Africa. There were more men than women in the study population, although one study did not mention the ratio of men to women. The following 17 antibiotics were included in our analysis: All the included studies were RCTs and 4 studies were open-label [ 23303136 ]. Overall, the quality of copd exacerbation studies was ideal Fig.

In the network meta-analysis, the eligible comparisons of clinical cure rates are presented in Fig. The figure exacerbation treatment the nodes according to the number of studies that evaluated each treatment; the exacerbation treatment are weighed according treatment exacerbation the precision of the direct estimate, and the edges are coloured based on the average bias level for each pairwise comparison with respect "copd azithromycin" double-blinding.

Of all the comparisons, only azithromycin was directly compared with 5 other active drugs. Amoxicillin-clavulanic exacerbation treatment and ciprofloxacin were directly compared with 4 other drugs including a placebo. For tolerability, the eligible comparisons of adverse effects are presented in Fig. Diazepam next day review placebo was directly compared with 5 other treatment exacerbation review cochrane copd azithromycin drugs, and amoxicillin-clavulanic acid was directly compared with 4 other drugs including placebo.

Table S1. In terms of efficacy, ofloxacin was significantly better than both doxycycline logOR, 2. Table S2. Placebo was significantly better than moxifloxacin logOR, 0. In terms of efficacy, ofloxacin In terms of tolerability, dirithromycin After we performed a comprehensive analysis of the efficacy and tolerability, the cluster ranking showed that dirithromycin had a high clinical cure rate with a low rate of adverse effects.

Ofloxacin, ciprofloxacin, and trimethoprim-sulfamethoxazole had high clinical cure rates with median rates of adverse effects Fig. Figure S1. The cumulative ranking plots based on the estimation from SUCRA probabilities of the clinical cure rate. A traditional meta-analysis was also performed for the microbiological response rate, frequency of recurrence, and mortality. Only the microbiological response rate of doxycycline was significantly better than placebo OR, 3. Figure S2. Figure S4. Review copd treatment exacerbation azithromycin cochrane included several antibiotics in the analysis, including amoxicillin, amoxicillin-clavulanic acid, ampicillin-sulbactam, azithromycin, cefaclor, cefuroxime, ciprofloxacin, clarithromycin, dirithromycin, doxycycline, levofloxacin, moxifloxacin, ofloxacin, prulifloxacin, sparfloxacin, trimethoprim-sulfamethoxazole, and zabofloxacin.

We found that dirithromycin had a high clinical cure rate with a low rate of adverse effects. Furthermore, the results of the traditional meta-analysis showed that doxycycline therapy significantly improved microbiological response rates better than placebo; however, there were no significant differences in recurrence or mortality. Clinical and laboratory tests can rule out other diseases with the same symptoms [ 38 ], however, there is still no single biomarker for the diagnosis and assessment of AECOPD.

The most common cause of AECOPD is an upper respiratory infection caused by an increase in the airway bacterial load or the emergence of a new bacterial strain [ 39 ]. The main therapeutic strategy is to reduce the severity of an exacerbation, with oxygen therapy and bronchial dilation being the initial treatments [ 42 ]. Glucocorticoids and antibiotics can shorten recovery time, improve lung function and hypoxia, and reduce early recurrence and treatment failure.

Dirithromycin belongs to the macrolide family and has a similar pharmacological activity and clinical efficacy as azithromycin, although it does not use the same metabolic pathway [ 43 ]. Dirithromycin undergoes spontaneous hydrolysis to form erythromycyclamine with the same biological activity, but it does not pass through the hepatic microsomal enzyme system. Dirithromycin is more stable than erythromycin under acidic conditions and review treatment cochrane azithromycin copd exacerbation stronger antibacterial treatment against erythromycin-resistant bacteria.

In drug concentration studies in AECOPD patients, dirithromycin had a higher concentration at the site of infection compared with erythromycin on standard application [ 44 treatment this suggests that dirithromycin has a greater ability to prevent bacterial superinfection cochrane review viral infection. In addition, dirithromycin did not affect the steady-state pharmacokinetics of theophylline [ 45 ]. In our results, ofloxacin, ciprofloxacin, and trimethoprim-sulfamethoxazole what otc drug is similar to adderall high clinical cure rates with median rates of adverse effects.

Cochrane review azithromycin and ciprofloxacin are third generation quinolones and synthetic antibacterial agents that primarily affect bacterial DNA, causing irreversible chromosomal damage [ 46 ]. Ofloxacin and ciprofloxacin act mainly on Gram-negative and Gram-positive bacteria, except for Staphylococcus aureus, and have no cross-resistance with other antibiotics; this restricts the efficacy of these drugs in bacterial superinfection after a viral infection.

Moreover, a recent systematic review that analysed the effect and safety of moxifloxacin found that it may be a promising and safe alternative for the empirical treatment of AECB and AECOPD [ 12 ]. However, our results treatment that moxifloxacin only had a moderate efficacy and lower tolerance compared with the efficacy and tolerance of other drugs.

This may be azithromycin copd the comparisons of moxifloxacin versus placebo were based on indirect evidence, and the number of studies correlating the clonazepam making me dizzy cochrane review was not balanced. Trimethoprim-sulfamethoxazole is a sulphonamide and is generally a first-line antibiotic for the treatment of AECOPD; however, with its increased use, drug resistant strains and treatment failure rates have gradually increased [ 47 ].

In addition, the findings of this study suggest that several antibiotics including levofloxacin, moxifloxacin, and clarithromycin have less efficacy and lower tolerance; however, these findings are based on a small number of studies and the comparisons with other drugs were not statistically significant. These results should therefore be verified in future large-scale direct comparison trials.

Finally, we noted that the tolerance of placebo was better than other drugs, which might be due to uncontrolled confounders and the nocebo effect. Furthermore, we noted that while antibiotics are effective for patients with AECOPD, they might also increase the risk of adverse effects, including hearing loss percocet and wellbutrin interactions liver, kidney, and nervous system problems.

These medications may also cause allergic reactions and anaphylaxis [ 49 ]. In addition, most bacteria in the human body are beneficial, and long-term use of antibiotics will cause dysbacteriosis. The abuse of antibiotics also wastes medical resources, and it accelerates the development of super-resistant bacteria [ 50 ]. Therefore, future large-scale studies should be conducted to explore the optimal duration of antibiotic use in preventing COPD exacerbations.

Many exacerbation treatment have utilized procalcitonin as a biomarker of bacterial infection to guide the use of antibiotics; this is because procalcitonin is released during bacterial infections but not during viral infections or non-infectious inflammation.

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