Antibiotic treatment of exacerbations of COPD in general practice: long-term impact on healthrelated quality of life
Marc Miravitlles1, Carles Llor2, Jesús Molina3, Karlos Naberan4, Josep M Cots5, Fernando Ros6 on behalf of the EVOCA Study Group
1Fundació Clínic. Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain; 2Primary Health Care Center ‘Jaume I’, Societat Catalana de Medicina Familiar i Comunitària, Universitat Rovira i Virgili, Tarragona, Spain; 3Primary Health Care Center ‘Francia’, Grupo de Respiratorio de la Sociedad Madrileña de Medicina Familiar y Comunitaria, Madrid, Spain; 4Primary Health Care Center ‘Fuentes de Ebro’, Grupo de Investigación del Instituto Aragonés Ciencias de la Salud (IACS), Zaragoza, Spain; 5Primary Health Care Center ‘La Marina’, Societat Catalana de Medicina Familiar i Comunitària, Facultat de Medicina, Barcelona, Spain; 6Medical Department, Bayer Healthcare, Barcelona, Spain
Objective: To investigate the impact of exacerbations in health-related quality of life (HRQL) of patients with COPD and to compare the effect of treatment of COPD exacerbations with moxifloxacin (400 mg/day for 5 days) and amoxicillin/clavulanate (500/125 mg 3 times a day for 10 days) on HRQL.
Methods: 229 outpatients with stable COPD (mean age 68.2 years; mean FEV1 % predicted 49.3%) participated in a prospective, observational study of 2 years’ duration. The St George’s Respiratory Questionnaire (SGRQ) was completed at baseline and every 6 months thereafter.
Results: COPD exacerbations (mean 2.7 episodes/patient) occurred in 136 patients (124 patients received the study medications [amoxicillin/clavulanate 54, moxifloxacin 70]). Differences between baseline and the final visit were higher for moxifloxacin compared with amoxicillin/clavulanate for total SGRQ score (-2.60 [13.1] vs 4.21 [16.2], P = 0.05) and “Symptoms” subscale (-5.64 [16.7] vs 8.27 , P = 0.02). The same findings were observed in patients with two or more exacerbations.
Conclusions: In COPD outpatients, treatment of exacerbations with moxifloxacin had a more favorable long-term effect on quality of life than amoxicillin/clavulanate.
Keywords: COPD, exacerbations, moxifloxacin, amoxicillin/clavulanate, quality of life, SGRQ
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