@article{Brill:2015:10.1136/thoraxjnl-2015-207194,
author = {Brill, S and Law, M and El-Emir, E and Allinson, JP and James, PL and Maddox, V and Donaldson, GC and McHugh, TD and Cookson, WO and Moffatt, MF and Nazareth, I and Hurst, JR and Calverley, PMA and Sweeting, MJ and Wedzicha, JA},
doi = {10.1136/thoraxjnl-2015-207194},
journal = {Thorax},
pages = {930--938},
title = {Effects of different antibiotic classes on airwaybacteria in stable COPD using culture and molecularQ1 techniques: a randomised controlled trial},
url = {http://dx.doi.org/10.1136/thoraxjnl-2015-207194},
volume = {70},
year = {2015}
}

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TY  - JOUR
AB  - BackgroundLong term antibiotic therapy is used to prevent exacerbations of chronic obstructive pulmonary disease (COPD) but there is uncertainty over whether this reduces airway bacteria. The optimum antibiotic choice remains unknown. We conducted an exploratory trial in stable patients with COPD comparing three antibiotic regimens against placebo.  MethodsThis was a single-centre, single-blind, randomised placebo-controlled trial (clinicaltrials.gov number NCT01398072). Patients ≥45 years with COPD, FEV1<80% predicted and chronic productive cough were randomised to receive either moxifloxacin 400mg daily for 5 days/4 weeks, doxycycline 100mg/day, azithromycin 250mg 3x/week or one placebo tablet daily for 13 weeks. The primary outcome was the change in total cultured bacterial load in sputum from baseline; secondary outcomes included bacterial load by 16S qPCR, sputum inflammation and antibiotic resistance. Results99 patients were randomised; 86 completed follow-up, were able to expectorate sputum and were analysed. After adjustment, there was a mean reduction in bacterial load of 0.42 log10 cfu/ml (95% CI -0.08, 0.91, p=0.10) with moxifloxacin, 0.11 (-0.33, 0.55, p=0.62) with doxycycline, and 0.08 (-0.38, 0.54, p=0.73) with azithromycin from placebo, respectively. There were also no significant changes in bacterial load measured by 16S qPCR or in airway inflammation. More treatment-related adverse events occurred with moxifloxacin. Of note, mean inhibitory concentrations of cultured isolates increased by at least 3 times over placebo in all treatment arms.ConclusionsTotal airway bacterial load did not decrease significantly after three months of antibiotic therapy. Large increases in antibiotic resistance were seen in all treatment groups and this has important implications for future studies.
AU  - Brill,S
AU  - Law,M
AU  - El-Emir,E
AU  - Allinson,JP
AU  - James,PL
AU  - Maddox,V
AU  - Donaldson,GC
AU  - McHugh,TD
AU  - Cookson,WO
AU  - Moffatt,MF
AU  - Nazareth,I
AU  - Hurst,JR
AU  - Calverley,PMA
AU  - Sweeting,MJ
AU  - Wedzicha,JA
DO  - 10.1136/thoraxjnl-2015-207194
EP  - 938
PY  - 2015///
SN  - 1468-3296
SP  - 930
TI  - Effects of different antibiotic classes on airwaybacteria in stable COPD using culture and molecularQ1 techniques: a randomised controlled trial
T2  - Thorax
UR  - http://dx.doi.org/10.1136/thoraxjnl-2015-207194
UR  - http://hdl.handle.net/10044/1/23886
VL  - 70
ER  - 

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