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Efficacy of levofloxacin versus cefuroxime in treating acute exacerbations of chronic obstructive pulmonary disease

Authors Yoon HI, Lee CH, Kim DK, Park GM, Lee SM, Yim JJ, Kim JY, Lee JH, Lee CT, Chung HS, Kim YW, Han SK, Yoo CG

Received 17 December 2012

Accepted for publication 12 April 2013

Published 10 July 2013 Volume 2013:8 Pages 329—334

DOI https://doi.org/10.2147/COPD.S41749

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 4

Ho Il Yoon,1 Chang-Hoon Lee,2 Deog Kyeom Kim,3 Geun Min Park,4 Sang-Min Lee,2 Jae-Joon Yim,2 Jae-Yeol Kim,5 Jae Ho Lee,1 Choon-Taek Lee,1 Hee Soon Chung,3 Young Whan Kim,2 Sung Koo Han,2 Chul-Gyu Yoo2

1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea; 2Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; 3Division of Pulmonology, Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul, South Korea; 4Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Republic of Korea; 5Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea

Background: Antibiotic treatment is one of the major pharmacologic treatments for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, the choice of antibiotic depends on the local resistance pattern. A multicenter, randomized, controlled trial was done in patients with AECOPD to compare the efficacy of levofloxacin with that of cefuroxime axetil.
Methods: Patients with AECOPD and without radiographic evidence of pneumonia were enrolled and randomized to either levofloxacin 500 mg daily or cefuroxime 250 mg twice daily in the mild-moderate exacerbation group, or 500 mg twice daily in the severe exacerbation group, for seven days. Clinical efficacy and microbiologic response were evaluated 5–7 days after the last dose.
Results: Treatment was clinically successful in 90.4% of patients in the levofloxacin group, and in 90.6% of patients in the cefuroxime group (95% confidence interval -9.40 to 10.91), within a noninferiority margin of 10%. The microbiologic response appeared to be higher in the levofloxacin group, but the difference was not statistically significant. The safety profile was similar in both groups.
Conclusion: Levofloxacin is not inferior to cefuroxime with regard to clinical efficacy in treating AECOPD.

Keywords: chronic obstructive pulmonary disease, acute exacerbation, levofloxacin, cefuroxime

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