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Vol. 43. Issue 1.
Pages 22-28 (January 2007)
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Vol. 43. Issue 1.
Pages 22-28 (January 2007)
Original Articles
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Clinical Efficacy of Moxifloxacin in the Treatment of Exacerbations of Chronic Bronchitis: A Systematic Review and Meta-Analysis
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Marc Miravitllesa,
Corresponding author
marcm@clinic.ub.es

Correspondence: Dr. M. Miravitlles. Servei de Pneumologia. Institut Clínic del Tòrax. Hospital Clínic. Villarroel, 170 (UVIR, esc. 2, planta 3). 08036 Barcelona. España
, Jesús Molinab, Max Brosac
a Servei de Pneumologia, Institut Clínic del Tòrax (IDIBAPS), Hospital Clínic, Barcelona, Spain
b Centro de Salud Francia, Fuenlabrada, Madrid, Spain
c Oblikue Consulting, Barcelona, Spain
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Objective

As the research undertaken to date on the efficacy of the new antibiotics in the treatment of exacerbations of chronic bronchitis has taken the form of trials designed to demonstrate equivalence, we have no data on the advantages associated with the use of these new drugs with greater bactericidal activity. Our objective was to compare the clinical efficacy of moxifloxacin to that of the antibiotic regimens routinely used to treat such exacerbations by a systematic review of the literature and a meta-analysis.

Methods

A manual and electronic search was performed to identify all clinical trials carried out between January 1997 and July 2005 to compare moxifloxacin and the antibiotics that are currently the first line treatment for exacerbations of chronic bronchitis. Once it had been established that the designs of the trials included were acceptable, a meta-analysis of clinical outcomes was performed.

Results

Of the 45 studies identified, 9 met the inclusion criteria. Of these, 5 were double-blind randomized trials and 4 were randomized open trials. The 9 trials comprised a total of 3905 patients. The aggregate standardized mean difference in clinical success rate was 1.5% (95% confidence interval, -04% to 3.4%). Bacterial eradication rates ranged from 68.4% to 96% for the standard regimens, and from 87.7% to 96% for moxifloxacin. No intergroup differences in the percentages of patients lost to follow-up were observed in any of the studies.

Conclusions

Although the trials reviewed were designed to demonstrate equivalence, meta-analysis revealed that the clinical success rate achieved with moxifloxacin tended to be higher than that obtained in the groups that received standard antibiotic treatment.

Key words:
Moxifloxacin
Exacerbations
Chronic bronchitis
Antibiotics
Meta-analysis
Objetivo

Debido a que los ensayos clínicos de eficacia de los nuevos antibióticos en las agudizaciones de la bronquitis crónica se han diseñado para demostrar equivalencia, no co-nocemos las ventajas que pueden aportar los nuevos fárma-cos con mayor actividad bactericida. Mediante un análisis sistemático y un metaanálisis de ensayos publicados se pretende comparar la eficacia clínica del moxifloxacino con la de otros antibióticos utilizados habitualmente en esta indicación.

Métodos

Se ha realizado una búsqueda electrónica y manual de ensayos clínicos que comparen el moxifloxacino con antibióticos de referencia para las agudizaciones de la bronquitis crónica desde enero de 1997 hasta julio de 2005. Después de verificar su adecuado diseño, se ha elaborado un metaanálisis de sus resultados clínicos.

Resultados

Se identificaron 45 trabajos, de los que 9 cumplían los criterios de inclusión. Cinco eran aleatorizados y doble ciego, y 4 aleatorizados y abiertos. En total, reunie-ron a 3.905 pacientes. Globalmente, la diferencia media es-tandarizada en tasa de éxito clínico fue del 1,5% (intervalo de confianza del 95%, del -0,4 al 3,4%). La tasa de erradicación bacteriológica con comparadores osciló entre el 68,4 y el 96%, y con moxifloxacino entre el 87,7 y el 96%. No se observaron diferencias en las tasas de pérdidas entre los grupos de tratamiento en ningún estudio.

Conclusiones

A pesar de tratarse de ensayos destinados a demostrar equivalencia, el metaanálisis realizado muestra una tendencia a la superioridad en la tasa de éxito clínico con moxifloxacino respecto a los comparadores.

Palabras clave:
Moxifloxacino
Agudizaciones
Bronquitis crónica
Antibióticos
Metaanálisis
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This study was financed by Laboratorios Esteve S.A.

Copyright © 2007. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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