Moxifloxacin for the treatment of acute exacerbations of chronic obstructive pulmonary disease.
OBJECTIVE
The significant impact of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is now recognized. This recognition has led to increased efforts to provide evidence-based, appropriate treatment of AECOPD, to minimize its negative impact. This article reviews the bacterial etiology of AECOPD and clinical trials (both placebo-controlled and antibiotic comparison trials) that support the use of antibiotics for AECOPD, with an emphasis on the role of newer fluoroquinolones for the treatment of patients with this condition. A discussion of patient stratification that permits identification of those who require initial aggressive antibiotic therapy is presented.


RESULTS
Among the treatment modalities for exacerbations, the role and choice of antibiotics is hotly debated. Current evidence supports the use of antibiotics in the treatment of AECOPD, because bacterial pathogens cause approximately half the exacerbations, and because empirical antibiotics have a significant benefit in most exacerbations. Several recent investigations have aided in the development of a rational antibiotic strategy for AECOPD. These include outcome studies that have identified patients who are likely to have a poor outcome of their exacerbation and, therefore, are candidates for aggressive initial antibiotic therapy. Studies of the new fluoroquinolone agents have shown superior short- and long-term clinical results among patients with AECOPD who are at risk of a poor outcome.


CONCLUSIONS
Theoretical concerns about the emergence of resistance to the fluoroquinolones dictate not only the appropriate use of these drugs but, also, the use of the most-potent agents available in this class, to sustain their usefulness over time. Such selected use of the new fluoroquinolones balances individual benefit with societal concerns regarding the use of these agents for the treatment of AECOPD.
Sethi
Sanjay
S
Division of Pulmonary, Critical Care and Sleep Medicine, State University of New York, and Department of Veterans Affairs, Western New York Healthcare System, Buffalo, New York, USA. ssethi@buffalo.edu
D000328:Adult; D001372:Aza Compounds / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D016993:Chlamydophila pneumoniae / Q000302:isolation & purification; D018849:Controlled Clinical Trials as Topic; D024841:Fluoroquinolones; D006801:Humans; D000077266:Moxifloxacin; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000382:microbiology; D011804:Quinolines / Q000008:administration & dosage*
D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D000077266:Moxifloxacin