2-days course of levofloxacin good enough for controlling acute exacerbations of COPD

Tunisia: In a new study by Salma Messous and team it was found that in acute exacerbation of COPD (AECOPD), levofloxacin once daily for two days was not inferior to seven days in terms of cure rate, the requirement for further antibiotics, and hospital readmission. The findings of this study were published in Therapeutic Advances in Respiratory Disease.

Expert opinion is most usually used to determine the duration of antibiotic therapy in acute COPD exacerbations. The typical administration time is 5 to 7 days. A 2-day dose of levofloxacin had not before been evaluated. As a result, this randomized clinical trial was conducted to compare the effectiveness of 2-day versus 7-day levofloxacin therapy in individuals with AECOPD.

Patients with AECOPD were randomly assigned to either levofloxacin for 2 days and 5 days placebo (n = 155) or levofloxacin for 7 days (n = 155) treatment. For 5 days, all patients got the same dosage of intravenous prednisone. The major end measure was the cure rate, with secondary outcomes including the requirement for further antibiotics, re-exacerbation rate, ICU admission rate, mortality rate, and exacerbation-free interval (EFI) within a 1-year follow-up. The study protocol was written in conformity with the updated Helsinki Declaration for Biomedical Research Involving Human Subjects and Good Clinical Practice Guidelines.

The key findings of this study were as follows:

1. 310 individuals were randomly assigned to either a 2-day (n = 155) or a 7-day (n = 155) regimen of levofloxacin.

2. In the 2-day and 7-day groups, the cure rate was 79.3% (n = 123) and 74.2 percent (n = 115), respectively.

3. The rate of need for further antibiotics was 3.2% in the 2-day group and 1.9% in the 7-day group, respectively.

4. The ICU admission rate did not differ substantially between the two groups.

5. The one-year re-exacerbation rate in the 2-day group was 34.8% (n = 54) vs 29% (n = 45) in the 7-day group; the EFI was 121 days versus 110 days in the 2-day and 7-day treatment groups, respectively.

6. The one-year death rate did not change substantially between the two groups, with 5.2% against 7.1% in the 2-day and 7-day groups, respectively.

7. There was no discernible difference in adverse effects.

In conclusion, this study's findings would increase patient compliance while decreasing the frequency of bacterial resistance and harmful consequences.

Reference:

Messous, S., Trabelsi, I., Bel Haj Ali, K., Abdelghani, A., Ben Daya, Y., Razgallah, R., Grissa, M. H., Boukef, R., Boubaker, H., Msolli, M. A., Sekma, A., & Nouira, S. (2022). Two-day versus seven-day course of levofloxacin in acute COPD exacerbation: a randomized controlled trial. In Therapeutic Advances in Respiratory Disease (Vol. 16, p. 175346662210997). SAGE Publications. https://doi.org/10.1177/17534666221099729