Macrolides, quinolones, and amoxicillin/clavulanate for chronic bronchitis: a meta-analysis

¹ Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece
² Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece; and Intensive Care Unit, "Attikon" University Hospital, Athens, Greece
³ Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece; Dept of Medicine, Henry Dunant Hospital, Athens, Greece; and Dept of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA

	Abstract

We evaluated the comparative effectiveness and safety of macrolides, quinolones, and amoxicillin/clavulanic acid (A/C) for the treatment of patients with acute bacterial exacerbation of chronic bronchitis (ABECB).

PubMed, Current Contents, and the Cochrane Central Register of Controlled Trials were searched to identify relevant randomized controlled trials (RCTs).

Nineteen RCTs (20 comparisons) were included. There was no difference regarding treatment success in intention-to-treat and clinically evaluable patients between macrolides and quinolones, A/C and quinolones or A/C and macrolides. The treatment success in microbiologically evaluable patients was lower for macrolides compared with quinolones (OR=0.47, 95% CI 0.31-0.69). Less quinolone-recipients experienced a recurrence of ABECB after resolution of the initial episode compared with macrolide-recipients during the 26-week period after therapy. Adverse effects in general were similar between macrolides and quinolones. Administration of A/C was associated with more adverse effects (mainly diarrhea) than quinolones (OR=1.36, 95% CI 1.01-1.85).

Macrolides, quinolones, and A/C may be considered equivalent for the treatment of patients with ABECB in terms of short-term effectiveness. Quinolones are associated with better microbiological success and fewer recurrence of ABECB than macrolides, while A/C with more adverse effects than both comparators.

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