The Pharmaceutical Journal
Vol 273 No 7309 p108
24 July 2004

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Moxifloxacin more effective than alternatives in exacerbations of chronic bronchitis

POEM series

Clinical question Is moxifloxacin more effective than alternatives for acute exacerbation of chronic bronchitis?

Bottom line Moxifloxacin (Avelox) offers a small advantage over the alternatives (amoxicillin, clarithromycin, or cefuroxime axetil) for the treatment of acute exacerbation of chronic bronchitis in terms of complete clinical cure one week after the end of treatment, but no advantage in terms of overall clinical success. Since the much less expensive and better tolerated amoxicillin offered a similar overall clinical success rate (83.0 per cent for amoxicillin vs 87.6 per cent for moxifloxacin), it should remain the first choice for most patients.

Synopsis Adults older than 45 years with chronic bronchitis, at least 20 pack-years of smoking (ie, have smoked at least a pack of cigarettes a day for 20 years), at least two previous acute exacerbations of chronic bronchitis, and an FEV₁ less than 85 per cent of the predicted value were studied. They were randomised (allocation concealed) at the time of a new acute exacerbation, defined as increased dyspnoea, increased sputum volume and purulent sputum. If randomised to the treatment group, the patients received moxifloxacin 400mg orally once a day for five days. Patients in the control group received either amoxicillin 500mg orally three times a day for seven days (n=88), clarithromycin 500mg orally twice a day for seven days (n=114), or cefuroxime-axetil 250mg orally twice a day for seven days (n=174) at their physician's discretion. Patients were contacted by telephone approximately one week after randomisation, and examined seven to 10 days after the end of treatment. Analysis was by intention to treat, and groups were similar at baseline. The primary patient-oriented outcome was clinical success seven to 10 days after the end of treatment, defined as the percentage of patients who were cured or improved to the point that no additional antimicrobial therapy was needed. This outcome was achieved in 87.6 per cent of the moxifloxacin group, 83.0 per cent of the amoxicillin group, 84.2 per cent of the clarithromycin group, and 82.2 per cent of the cefuroxime-axetil group (P=non significant). The rate of complete clinical cure was slightly higher for the moxifloxacin group than for the combined comparison groups (70.9 per cent vs 62.8 per cent, number needed to treat = 12.5). Adverse events were more common in the moxifloxacin group (7.1 per cent vs 4.8 per cent, statistical significance not reported).

Level of evidence 1b (individual randomised controlled trial with narrow confidence interval).

Reference Wilson R, Allegra L, Huchon G, et al. Short-term and long-term outcomes of moxifloxacin compared to standard antibiotic treatment in acute exacerbations of chronic bronchitis. Chest 2004;125:953–64.

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