Abstract
In studies aimed at assessing the efficacy and safety of antibacterial agents used in treating infections of the respiratory tract, patients with exacerbations of a chronic obstructive pulmonary disease frequently are included. Both the indication for the prescription of an antibiotic and the evaluation of its effect can be difficult. As a general rule, treatment with steroids, bronchodilators and oxygen supply is indicated in cases of exacerbated pulmonary disease. These interventions will influence the clinical and bacteriological parameters usually used to evaluate the antibacterial effect. In a number of cases, non-antibacterial treatment will restore the bronchopulmonary defence sufficiently so that infection control is reached. In order to design meaningful efficacy studies, it is obligatory to understand the pathophysiological mechanisms in chronic obstructive pulmonary disease, to be aware of the pitfalls in making the diagnosis ‘bacterial bronchitis’ and to take into account the influence of co-medications on the clinical and bacteriological parameters. Some objections to comparative efficacy trials are raised.
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References
Van't Wout JW. Laboratory diagnosis of pneumonia. Pharm Weekbl [Sci] 1989;11(4):109–11.
Van den Broek PH. Antimicrobial therapy for lower respiratory tract infections. Pharm Weekbl [Sci] 1989;11(4):118–20.
Kaajan JPG. Chronic obstructive pulmonary disease and asthma. General and medical management with special attention to exacerbations. Pharm Weekbl [Sci] 1989;11(4):112–7.
Reichek N, Lewin EG, Rhoden D. Antibody responses to bacterial antigens during exacerbations of chronic bronchitis. Am Rev Respir Dis 1970;101:238–44.
Eadie MB, Stott EJ, Grist NR. Virological studies in chronic bronchitis. Br Med J 1966;2:671–3.
Graham VAL, Milton AF, Knowles GK, Davies RJ. Routine antibiotics in hospital management of acute asthma. Lancet 1982;1:418–20.
Empey DW, Laitinen LA, Jacobs L, Gold WM, Nadel JA. Mechanisms of bronchial hyperreactivity in normal subjects after upper respiratory tract infection. Am Rev Respir Dis 1976;113:131–9.
General considerations for the clinical evaluation of drugs. Publication no. FDA-77-3040. Washington: U.S. Department of Health, Education, and Welfare, 1977.
Guidelines of the clinical evaluation of anti-infective drugs (systemic) (adults and children). Publication no. FDA-77-3046. Washington: U.S. Department of Health, Education, and Welfare, 1977.
Anonymous. Guidelines for the clinical investigation of antibacterial drugs. (Report of a World Health Organization Scientific Group). Copenhagen: WHO Regional Office, 1987.
Anthonisen NR, Manfreda J, Warren CPW, Hershfield ES, Harding GKM, Nelson NA. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 1987;106:196–204.
Pines A, Raafat H, Greenfield JSB, Linsell WD, Solari ME. Antibiotic regimens in moderately ill patients with purulent exacerbations of chronic bronchitis. Br J Dis Chest 1972;66:107–15.
Stott NCH, West RR. Randomised controlled trial of antibiotics in patients with cough and purulent sputum. Br Med J 1976;2:556–9.
Manresa F, Blavia R, Martin R, Linares J, Rodriguez B, Verdaguer R. Antibiotics for exacerbations of chronic bronchitis. Lancet 1987;2:394–5.
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Wijnands, W.J.A. Antibacterial treatment in exacerbations of chronic obstructive pulmonary disease. Pharmaceutisch Weekblad Scientific Edition 11, 128–131 (1989). https://doi.org/10.1007/BF01987957
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DOI: https://doi.org/10.1007/BF01987957