• Choice of antibiotic therapy in acute exacerbation of COPD

    November 3, 2014

    According to the latest guidelines of GOLD (Global Initiative for Chronic Obstructive Lung Disease), the antibiotic treatment has a good effect on lung function and is recommended for acute exacerbation of chronic obstructive pulmonary disease (COPD) in patients whose progressive dyspnea and cough are accompanied by increased expectoration and purulent sputum.

    The exacerbations (episodes of acute worsening of the respiratory symptoms) in COPD have an inflammatory genesis, most often with an infectious etiology (bacterial or viral infection).

    Viral infections also play an important role in the pathogenesis and exacerbations of COPD and are a major cause of morbidity, mortality and hospitalization of these patients. The respiratory viral infections, particularly with rhinoviruses, are associated with 50% of these exacerbations.

    The results of a recent study comparing levofloxacin and cefuroxime for the treatment of exacerbations of COPD showed that both antibiotics have similar efficacy.

    The study was prospective, multicenter, randomized and was conducted in seven hospitals in South Korea and 141 patients over 18 years with acute exacerbation of COPD were included. It has been defined as recently increased cough or dyspnea, change in the color or amount of the sputum in spirometrically demonstrated COPD and in the absence of radiographic evidence of pneumonia.

    The patients were randomized to receive either levofloxacin 500 mg daily or cefuroxime 250 mg twice daily (in mild to moderate exacerbation) or cefuroxime 500 mg twice daily in severe exacerbation. The treatment lasted seven days; the clinical efficacy and microbiological response were recorded 5-7 days after the last dose.

    The treatment had clinical success in 90.4% of patients treated with levofloxacin and 90.6% of those on cefuroxime. The microbiological response was better in the levofloxacin group; the difference was not statistically significant. The safety profile was similar for both antibiotics.

    The effectiveness of levofloxacin can be explained by its excellent pharmacokinetic and pharmacodynamic characteristics. The medicine is absorbed completely in the gastrointestinal tract; its bioavailability was approximately 99% after oral administration. This contrasts with 40-50% bioavailability of beta-lactams and macrolides.

    After oral administration of 500 mg levofloxacin the peak concentration in the serum, bronchial secretions and the alveolar macrophages is achieved.

    Following administration of levofloxacin, the concentrations at the site of infection are high enough to ensure the elimination of the causative agent. Levofloxacin has excellent activity against S. pneumoniae.

    The good pharmacokinetic and pharmacodynamic characteristics of levofloxacin provide its high efficiency and prevent the development of antimicrobial resistance.

    Tchaikapharma High Quality Medicines provides on the Bulgarian market antibiotics with the following trade names:

    JF 509 Lifurox (Cefuroxime) 500 mg x 10 tabl.

    JF 499 Levor (Levofloxacin) 500 mg x 10 tabl.

    JF 491 Climox (Amoxicillin/Clavulanic acid ) 875 mg / 125 mg x 14 tabl.

    JF 400 Klacar (Clarithromycin) 500 mg x 14 tabl.

    JF 515 Klacar XL (Clarithromycin) 500 mg x 7 tabl.

    The price of all these antibiotics is BGN 14.99