Division of General Medicine, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts 01199, USA.
J Hosp Med. 2010 May-Jun;5(5):261-7. doi: 10.1002/jhm.628.
Meta-analyses of randomized trials have found that antibiotics are effective in acute exacerbations of chronic obstructive pulmonary disease (AECOPD), but there is insufficient evidence to guide antibiotic selection. Current guidelines offer conflicting recommendations.
To compare the effectiveness of macrolides and quinolones for AECOPD DESIGN: Retrospective cohort study using logistic regression, propensity score-matching, and grouped treatment models.
A total of 375 acute care hospitals throughout the United States.
Age > or =40 years and hospitalized for AECOPD.
Macrolide or quinolone antibiotic begun in the first 2 hospital days.
Treatment failure (defined as the initiation of mechanical ventilation after hospital day 2, inpatient mortality, or readmission for AECOPD within 30 days), length of stay, and hospital costs.
Of the 19,608 patients who met the inclusion criteria, 6139 (31%) were treated initially with a macrolide and 13,469 (69%) with a quinolone. Compared to patients treated initially with a quinolone, those who received macrolides had a lower risk of treatment failure (6.8% vs. 8.1%; P < 0.01), a finding that was attenuated after multivariable adjustment (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.78-1.01), and disappeared in a grouped-treatment analysis (OR, 1.01; 95% CI, 0.75-1.35). There were no differences in adjusted length of stay (ratio, 0.98; 95% CI, 0.97-1.00) or adjusted cost (ratio, 1.00; 95% CI, 0.99-1.02). After propensity score-matching, antibiotic-associated diarrhea was more common with quinolones (1.2% vs. 0.6%; P < 0.001).
Macrolide and quinolone antibiotics are associated with similar rates of treatment failure in AECOPD; however, macrolides are less frequently associated with diarrhea.
荟萃分析的随机试验发现抗生素在慢性阻塞性肺疾病急性加重（AECOPD）中是有效的，但没有足够的证据来指导抗生素的选择。目前的指南提供了相互矛盾的建议。
比较大环内酯类和喹诺酮类药物治疗 AECOPD 的疗效。
使用逻辑回归、倾向评分匹配和分组治疗模型进行回顾性队列研究。
美国各地的 375 家急性护理医院。
年龄≥40 岁，因 AECOPD 住院。
大环内酯类或喹诺酮类抗生素在入院后 2 天内开始使用。
治疗失败（定义为入院后第 2 天开始使用机械通气、住院死亡率或 30 天内因 AECOPD 再次入院）、住院时间和住院费用。
在符合纳入标准的 19608 名患者中，6139 名（31%）最初接受大环内酯类药物治疗，13469 名（69%）最初接受喹诺酮类药物治疗。与最初接受喹诺酮类药物治疗的患者相比，接受大环内酯类药物治疗的患者治疗失败的风险较低（6.8%比 8.1%；P < 0.01），多变量调整后风险降低（比值比[OR]，0.89；95%置信区间[CI]，0.78-1.01），在分组治疗分析中消失（OR，1.01；95%CI，0.75-1.35）。调整后的住院时间（比值，0.98；95%CI，0.97-1.00）或调整后的成本（比值，1.00；95%CI，0.99-1.02）无差异。在倾向评分匹配后，喹诺酮类药物相关腹泻更为常见（1.2%比 0.6%；P < 0.001）。
大环内酯类和喹诺酮类抗生素治疗 AECOPD 的疗效相似；然而，大环内酯类药物相关腹泻的发生率较低。
