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document
Standard versus newer antibacterial agents in the treatment of severe acute exacerbation of chronic obstructive pulmonary disease : a randomized trial of trimethoprim-sulfamethoxazole versus ciprofloxacin . BACKGROUND . Although the use of antibiotics in the treatment of acute exacerbation of chronic obstructive pulmonary disease ( COPD ) is largely accepted , controversy remains regarding whether the choice of antibiotic has any impact on outcome . Our aim was to compare the effects of the combination of trimethoprim and sulfamethoxazole and ciprofloxacin in patients treated for severe COPD exacerbation requiring mechanical ventilation . METHODS . In a randomized , double-blind trial , we included 170 patients with an acute exacerbation of COPD requiring mechanical ventilation . Enrolled patients received trimethoprim-sulfamethoxazole ( n = 85 ) or ciprofloxacin ( n = 85 ) for 10 days . Main outcomes were hospital death and need for an additional course of antibiotics . Secondary outcomes were duration of mechanical ventilation , length of hospital stay , and exacerbation-free interval . RESULTS . Combined hospital death and additional antibiotic prescription rates were similar in the 2 groups ( 16.4 % vs 15.3 % for trimethoprim-sulfamethoxazole group vs ciprofloxacin group ; difference , 1.1 % ; 95 % confidence interval [ CI ] -9.8 % to 12.0 % ; P = .832 ) . Hospital death occurred in 7 patients ( 8.2 % ) receiving trimethoprim-sulfamethoxazole and 8 patients ( 9.4 % ) receiving ciprofloxacin ( difference , -1.2 % ; 95 % CI , -9.7 to 7.3 ; P = .90 ) . The need for an additional antibiotic course was observed in 8 patients in the trimethoprim-sulfamethoxazole group and 5 patients in the ciprofloxacin group ( difference , 2.3 % ; 95 % CI , -5.4 to 10.0 ; P = .549 ) . The mean exacerbation-free interval ( +/- standard deviation ) was similar in both treatment groups ( 83 +/- 25 vs 79 +/- 22 for the trimethoprim-sulfamethoxazole group vs ciprofloxacin group ; difference , 4 days ; 95 % CI , -15 to 19 days ; P = .41 ) . Duration of mechanical ventilation and hospital stay was not significantly different between the 2 groups . CONCLUSIONS . In patients with acute exacerbation of COPD requiring mechanical ventilation , efficacy of trimethoprim-sulfamethoxazole was not inferior to ciprofloxacin . Trial registration . ClinicalTrials.gov identifier : NCT00791505 .
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Intervention_Pharmacological
trimethoprim-sulfamethoxazole
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Intervention_Pharmacological
trimethoprim and sulfamethoxazole
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Intervention_Pharmacological
trimethoprim-sulfamethoxazole
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Intervention_Pharmacological
ciprofloxacin
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Intervention_Pharmacological
trimethoprim-sulfamethoxazole
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Intervention_Pharmacological
trimethoprim-sulfamethoxazole
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Intervention_Pharmacological
trimethoprim-sulfamethoxazole
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Intervention_Pharmacological
trimethoprim-sulfamethoxazole
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Outcome_Mortality
hospital death
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Outcome_Other
need for an additional course of antibiotics
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Outcome_Other
duration of mechanical ventilation
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Outcome_Other
length of hospital stay
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Outcome_Other
exacerbation-free interval
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Outcome_Mortality
hospital death
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Outcome_Other
additional antibiotic prescription rates
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Outcome_Mortality
Hospital death
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Outcome_Other
need for an additional antibiotic course
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Outcome_Other
mean exacerbation-free interval
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Outcome_Other
Duration of mechanical ventilation
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Outcome_Other
hospital stay
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Outcome_Other
efficacy
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Participant_Condition
severe acute exacerbation of chronic obstructive pulmonary disease :
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Participant_Condition
chronic obstructive pulmonary disease ( COPD
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Participant_Condition
patients treated for severe COPD exacerbation requiring mechanical ventilation
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Participant_Sample-size
170
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Participant_Condition
acute exacerbation of COPD requiring mechanical ventilation
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Participant_Condition
COPD