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• Filed under: Clinical, Cover Story

• Keywords: clincal trial, cost, macrolide, JHM, length of stay, quinolones

New Research Target

From: The eWire, 6/16/2010

by Richard Quinn

A report in this month’s Journal of Hospital Medicine shows macrolide and quinolone antibiotics are associated with similar rates of treatment failure in acute exacerbation of chronic pulmonary disease (AECOPD). The lead author says the study could be a precursor to, say, an intrepid HM researcher working on a randomized trial of the antibiotics’ effectiveness.

“It’s a perfect thing for hospitalists to study because they’re the ones treating it,” says Michael Rothberg, MD, MPH, associate professor of medicine at Tufts University School of Medicine in Boston, and lead author of "Comparative Effectiveness of Macrolides and Quinolones for Patients Hospitalized with Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD)."

The retrospective cohort review reported that out of nearly 20,000 patients, 6,139 (31%) were treated initially with a macrolide and 13,469 (69%) with a quinolone. “Those who received macrolides had a lower risk of treatment failure (6.8% vs. 8.1%, p<0.01), a finding that was attenuated after multivariable adjustment (OR=0.89, 95% CI 0.78-1.01), and disappeared in a grouped-treatment analysis (OR=1.01, 95% CI 0.75-1.35),” the authors wrote. The study found no differences in adjusted length of stay or cost. However, antibiotic-associated diarrhea was more common with quinolones (1.2% vs. 0.6%, p<0.001).

Dr. Rothberg, who is affiliated with the Center for Quality of Care Research at Baystate Medical Center in Springfield, Mass., says the data, while a point in the right direction, should be viewed as a first step in doing more search to determine the best treatment for AECOPD.

“If you look at the guidelines, the recommendations are all over the map,” Dr. Rothberg says. “This is really because there are no randomized trials in COPD patients. … There are so many unanswered questions. There’s been so much focus on pneumonia, heart failure, and acute myocardial infarction. COPD kind of has a dearth of research.”

Dr. Rothberg hopes to further that research via the COPD Outcomes-Based Network for Clinical Effectiveness & Research Translation (CONCERT), a team of physicians and researchers from centers around the country who are advocating for improvements to COPD treatment. Baystate is one of CONCERT’s outposts.