Podcast 298: COPD exacerbations — 7 days of antibiotics versus 2

A VIDEO RECORDING OF THIS INTERVIEW IS AVAILABLE AT THIS LINK.

In treating most exacerbations of chronic obstructive pulmonary disease (COPD) the usual regimen consists of prednisone plus 5- to 7-days of antibiotics. But what if a shorter course of antibiotic therapy would do? That would be both convenient for patients and less likely to promote antibiotic resistance.

A recent paper in Therapeutic Advances in Respiratory Disease describes just such a strategy: patients received prednisone plus either 2 or 7 days of levofloxacin. There was no substantive difference in clinical results between the groups. Summarized in NEJM Journal Watch General Medicine as “practice changing,” this research seems worth a closer look.

To that end we’ve invited two of the researchers and the Journal Watch editor who wrote the summary to discuss the issues raised.

Have a listen to this 14-minute Clinical Conversation.

(A note of no great consequence: We’ve called this “Podcast 298” because, while numbering the titles, your host negligently skipped from 297 to 299 in his haste to achieve 300 episodes.)

Therapeutic Advances in Respiratory Disease paper

Journal Watch summary

TRANSCRIPT

Joe Elia:

A recent summary in NEJM Journal Watch Journal General Medicine labeled a study about treating acute exacerbations of chronic obstructive pulmonary disease — or COPD — as practice changing, so it seems important to spread the news.

To do that, we’ve got Dr. Daniel Dressler, the summarizer of the study, Dr. Salma Messous, the study’s first author, and Dr. Semir Nouira, a senior author, to discuss it with us.

Dr. Dressler is a professor of medicine at Emory University in Atlanta. He is also deputy editor of NEJM Journal Watch General Medicine. Dr. Messous and Dr. Nouira are in the Emergency Department and the Department of Laboratory Research at Monastir University in Tunisia. Welcome to you both.

Dr. Semir Nouira: 

Thank you very much. Welcome.

Dr. Salma Messous:

Thank you very much.

Dr. Daniel Dressler: 

Thank you so much, Joe. Welcome, again, to Dr. Messous and Dr. Nouira.

I’ll just jump in and ask you if you would agree with this thumbnail description of your work: You randomized approximately 300 patients with acute exacerbation of COPD to one of two antibiotic regimens, either a two-day course of levofloxacin — or a seven-day course, which is the usual care, so I’ll ask you if that’s correct and if you can tell us briefly why you undertook this study, and essentially what you found.

Dr. Semir Nouira:

Thank you, Dan, for your choice of our study. I’m very proud to be here and to be with you to explain the background of our study and the results of our study.

Our study is probably the first that compares a short course of antibiotic — as short as two days — compared to seven days’ conventional duration. We found that there are similar results, and that the two-day is as effective as seven days.

You know, actually the objective of the study is not to show or to demonstrate the similarity between short course and conventional course of antibiotics, this was clearly shown many years ago — I can say at least since 2008, since the publication of the first analyses comparing the efficacy between short and a conventional course. So years ago it was shown, this evidence.</