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Penicillins vs trimethoprim-based regimens for acute bacterial exacerbations of chronic bronchitis

Meta-analysis of randomized controlled trials

George Dimopoulos, MD FCCP
Works for the Department of Medicine at Tufts University School of Medicine in Boston, Mass

Matthew E. Falagas, MD MSc DSc
Staff at the Intensive Care Unit of Attikon University Hospital in Athens

Correspondence: Dr Matthew E. Falagas, Alfa Institute of Biomedical Sciences, 9 Neapoleos St, 151 23 Marousi, Greece; telephone 30 694 611-0000; fax 30 210 683-9605; e-mailm.falagas{at}aibs.gr

OBJECTIVE To compare the effectiveness and toxicity of semisynthetic penicillins (SSPs) (amoxicillin, ampicillin, pivampicillin) and trimethoprim-based regimens (trimethoprim, trimethoprim-sulfamethoxazole, trimethoprim-sulfadiazine) in treating acute bacterial exacerbations of chronic bronchitis (ABECB).

DATA SOURCES We searched MEDLINE, EMBASE, Current Contents, and the Cochrane Central Register of Controlled Trials to identify and extract data from relevant randomized controlled trials (RCTs).

STUDY SELECTION Only RCTs comparing penicillins with trimethoprim-based regimens for the treatment of patients with ABECB that reported data on effectiveness, toxicity, or mortality were considered eligible for this meta-analysis.

SYNTHESIS Out of 134 RCTs identified in the search, 5 RCTs involving 287 patients were included in the analysis. There were no differences between patients with ABECB treated with SSPs and those treated with trimethoprim, alone or in combination with a sulfonamide, in treatment success (intention-to-treat patients: n = 262, odds ratio [OR] 1.68, 95% confidence interval [CI] 0.91–3.09; clinically evaluable patients: n = 246, OR 1.59, 95% CI 0.79–3.20) or number of drug-related adverse events in general (n = 186 patients, OR 0.37, 95% CI 0.11–1.24), frequency of diarrhea or skin rashes, or number of withdrawals due to adverse events (n = 179 patients, OR 0.27, 95% CI 0.07–1.03).

CONCLUSION Based on limited evidence leading to wide CIs of the estimated treatment effects, SSPs and trimethoprim-based regimens seem to be equivalent in terms of effectiveness and toxicity for ABECB.

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