No benefit of retreatment with ciprofloxacin for incompletely resolved COPD exacerbations
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An additional course of ciprofloxacin 14 days after an unresolved COPD exacerbation did not benefit time to next event, compared with placebo, in patients with persistent symptoms and elevated C-reactive protein, according to recent data.
“COPD exacerbations are prone to nonrecovery, but there are no data about the effectiveness of retreatment for these prolonged events,” Andrew I. Ritchie, MD, clinical research fellow at the National Heart and Lung Institute at Imperial College, London, and colleagues wrote in the American Journal of Respiratory and Critical Care Medicine. “We examined whether further therapy with 7 days of ciprofloxacin in patients with COPD exacerbations and ongoing symptoms or inflammation would delay a subsequent exacerbation.”
Researchers conducted a multicenter, randomized, double-blind, placebo-controlled trial to assess whether additional treatment with ciprofloxacin 500 mg twice daily (n = 72) compared with placebo (n = 72) would benefit patients with incompletely recovered COPD exacerbations. The study enrolled 144 patients with COPD and persistent symptoms and/or serum C-reactive protein (> 8 mg/L) 14 days after a COPD exacerbation. The mean age was 69 years and more than 60% were men.
Primary endpoint was time to next COPD exacerbation within 90 days.
During 90 days of follow-up 57% of patients assigned ciprofloxacin experienced one or more exacerbations compared with 53% of patients assigned placebo. Median time to next COPD exacerbation 34 days in the ciprofloxacin group compared with 32.5 days in the placebo group (aHR = 1.07; 95% CI, 0.68-1.68; P = .76).
Researchers observed no significant difference in quality-of-life scores, lung function, duration of symptoms after COPD exacerbation or C-reactive protein between the two treatment groups.
According to the researchers, ciprofloxacin was well tolerated, with no significant differences in the frequency of adverse events compared with placebo.
“This suggests that nonrecovered exacerbations are not driven by ongoing bacterial infection and maypotentially be targeted with anti-inflammatory therapy,” Ritchie and colleagues wrote.