Short Antibiotic Treatment Versus Duration Guided by Markers of Inflammation in the Treatment of AECOPD
Status:
Completed
Trial end date:
2019-01-31
Target enrollment:
Participant gender:
Summary
Chronic obstructive pulmonary disease (COPD) is one of the most common diseases in the world.
In a recent study, we showed that administration of levofloxacin is superior to placebo in
the treatment of decompensation of COPD; it is accompanied by a substantial reduction in
mortality and a significant reduction in the residence time in hospital.
In Tunisia, few data are available on the epidemiology of COPD decompensation. The choice of
antibiotic to be used in this situation is challenging to the clinician who must choose
between traditional antibiotics (cyclins, aminopenicillins, cotrimoxazole...) and new
antimicrobial agents. Recently, it has been emphasized the selection of patients for
treatment according to the degree of systemic inflammation (C-Reactive Protein). Indeed,
there would have a correlation between the tracheobronchial infection and elevated
inflammatory markers. As the elevation of these markers is proportional to the intensity of
the inflammatory reaction of the body, is based on the kinetics of these biomarkers in
antibiotic treatment seems logical. Thus, C-Reactive Protein allowed not only knowing when to
start antibiotics, but also through their kinetic, these markers can guide the duration of
therapy and shorten the duration of antibiotic therapy: a rate cut would ensure that the
antibiotic treatment was adopted. Available guidelines stated that antibiotic treatment
should be maintained at an average of 7 to 10 days while some studies showed no clinical
inferiority of courses as short as 3 days. Further reduction of the duration of
antibiotherapy was even suggested in order to reduce the risk of adverse events and the
pressure that drives bacterial resistance. Hence, we conducted this study using an algorithm
to comprehensively evaluate the role of CRP-guided antibiotic prescription in optimizing
treatment duration in AECOPD.