What are the uses of the five-day antibiotic azithromycin? What are the potential side effects? Is this treatment safe? Get the answers to your questions about this common antibacterial medication.

Understanding Azithromycin: The Five-Day Antibiotic

Azithromycin is an antibiotic medication that is often prescribed for a variety of bacterial infections. One common treatment regimen is the five-day dose pack, which provides a short but effective course of this medication. But what exactly is azithromycin, and how does the five-day treatment work?

Uses of Azithromycin Five-Day Dose Pack

The five-day azithromycin treatment is primarily used to treat community-acquired bacterial pneumonia. This type of pneumonia is caused by bacteria that are commonly found in the community, rather than more severe, hospital-acquired pneumonia. Azithromycin can effectively treat the bacterial infection and help patients recover.

In addition to pneumonia, the five-day azithromycin dose pack may also be prescribed for other bacterial infections, such as:

• Bronchitis
• Sinusitis
• Certain skin and soft tissue infections
• Sexually transmitted diseases like chlamydia

How Does the Five-Day Regimen Work?

Azithromycin is an antibiotic that works by interfering with the ability of bacteria to produce proteins, which they need to survive and replicate. The five-day dosing schedule is designed to provide an effective treatment while minimizing the duration of antibiotic exposure.

Typically, the five-day azithromycin regimen involves taking a higher initial dose on the first day, followed by lower doses on the remaining four days. This allows the medication to build up to therapeutic levels quickly, while the tapered dosing over the subsequent days helps to fully treat the infection.

Potential Side Effects of Azithromycin

Like any medication, azithromycin can cause side effects in some patients. The most common side effects associated with the five-day azithromycin dose pack include:

• Gastrointestinal issues such as nausea, vomiting, diarrhea, or abdominal pain
• Headache
• Dizziness
• Rash

These side effects are usually mild and tend to resolve on their own as the treatment progresses. Inform your healthcare provider if any side effects become severe or persistent.

Safety Considerations for Azithromycin

While the five-day azithromycin regimen is generally considered safe, there are some important safety considerations to be aware of:

Drug Interactions

Azithromycin can interact with certain other medications, including:

• Blood thinners like warfarin
• Certain heart rhythm medications
• Some antifungal drugs

Be sure to inform your healthcare provider about all medications you are taking to avoid potentially dangerous interactions.

Cardiac Risks

In rare cases, azithromycin has been associated with an increased risk of heart rhythm problems, particularly in patients with existing heart conditions or those taking certain other medications. Your healthcare provider will assess your individual risk factors before prescribing azithromycin.

Allergic Reactions

As with any medication, there is a small risk of allergic reactions to azithromycin. Seek immediate medical attention if you experience symptoms like difficulty breathing, swelling, or a severe rash.

Maximizing the Benefits of Azithromycin

To get the most out of your five-day azithromycin treatment, be sure to:

• Take the medication exactly as prescribed, including completing the full course
• Avoid skipping or missing doses
• Notify your healthcare provider of any side effects or concerns
• Inform your provider about all other medications you are taking

By following these guidelines and working closely with your healthcare team, you can help ensure that the five-day azithromycin treatment is safe and effective for your needs.

Conclusion

The five-day azithromycin dose pack is a common and effective treatment for community-acquired bacterial infections like pneumonia. While it is generally well-tolerated, it’s important to be aware of potential side effects and safety considerations. By taking the medication as directed and communicating with your healthcare provider, you can help maximize the benefits of this antibiotic therapy.

Five-day antibiotic treatment for community-acquired bacterial pneumonia: A systematic review and meta-analysis of randomized controlled trials

Save citation to file

Format:

Summary (text)PubMedPMIDAbstract (text)CSV

Add to Collections

• Create a new collection
• Add to an existing collection

Name your collection:

Name must be less than 100 characters

Choose a collection:

Unable to load your collection due to an error
Please try again

Add to My Bibliography

• My Bibliography

Unable to load your delegates due to an error
Please try again

Your saved search

Name of saved search:

Search terms:

Test search terms

Email:

(change)

Which day?

The first SundayThe first MondayThe first TuesdayThe first WednesdayThe first ThursdayThe first FridayThe first SaturdayThe first dayThe first weekday

Which day?

SundayMondayTuesdayWednesdayThursdayFridaySaturday

Report format:

SummarySummary (text)AbstractAbstract (text)PubMed

Send at most:

1 item5 items10 items20 items50 items100 items200 items

Send even when there aren’t any new results

Optional text in email:

Create a file for external citation management software

Full text links

Elsevier Science

Full text links

Meta-Analysis

. 2020 Dec;23:94-99.

doi: 10.1016/j.jgar.2020.08.005.

Epub 2020 Aug 28.

Shao-Huan Lan 
¹
, Chih-Cheng Lai 
²
, Shen-Peng Chang 
³
, Li-Chin Lu 
⁴
, Shun-Hsing Hung 
⁵
, Wei-Ting Lin 
⁶

Affiliations

Affiliations

• ¹ School of Pharmaceutical Sciences and Medical Technology, Putian University, Putian 351100, China.
• ² Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan, Taiwan.
• ³ Yijia Pharmacy, Tainan 70846, Taiwan.
• ⁴ School of Management, Putian University, Putian 351100, China.
• ⁵ Division of Urology, Department of Surgery, Chi-Mei Hospital, Chia Li, Tainan, Taiwan. Electronic address: [email protected].
• ⁶ Department of Orthopedic, Chi Mei Medical Center, Tainan 71004, Taiwan. Electronic address: [email protected].

• PMID:

  32866643

• DOI:

  10.1016/j.jgar.2020.08.005

Free article

Meta-Analysis

Shao-Huan Lan et al.

J Glob Antimicrob Resist.

2020 Dec.

Free article

. 2020 Dec;23:94-99.

doi: 10.1016/j.jgar.2020.08.005.

Epub 2020 Aug 28.

Authors

Shao-Huan Lan 
¹
, Chih-Cheng Lai 
²
, Shen-Peng Chang 
³
, Li-Chin Lu 
⁴
, Shun-Hsing Hung 
⁵
, Wei-Ting Lin 
⁶

Affiliations

• ¹ School of Pharmaceutical Sciences and Medical Technology, Putian University, Putian 351100, China.
• ² Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan, Taiwan.
• ³ Yijia Pharmacy, Tainan 70846, Taiwan.
• ⁴ School of Management, Putian University, Putian 351100, China.
• ⁵ Division of Urology, Department of Surgery, Chi-Mei Hospital, Chia Li, Tainan, Taiwan. Electronic address: [email protected].
• ⁶ Department of Orthopedic, Chi Mei Medical Center, Tainan 71004, Taiwan. Electronic address: [email protected].

• PMID:

  32866643

• DOI:

  10.1016/j.jgar.2020.08.005

Abstract

Objectives:

This systematic review and meta-analysis of randomized controlled trials (RCTs) investigated whether the clinical efficacy of a 5-day antibiotic course is comparable to that of a longer (≥7 d) course for treating adults with community-acquired bacterial pneumonia (CABP).

Methods:

The PubMed, Web of Science, Cochrane Library, Ovid MEDLINE, and Embase. were searched before January 18, 2020. RCTs comparing the efficacy of a 5-day antibiotic course with a longer course (≥7 d) for CABP treatment were included. Primary outcomes included the clinical response, microbiological response, and risk of adverse events (AEs).

Results:

In this meta-analysis, 7 RCTs were included, and the 5-day antibiotic courses group, and a longer course group comprised 1499 and 1522 patients, respectively. The difference in the overall clinical response rates between the 5-day and longer courses (88.3% vs 88.8%, odds ratio [OR], 0.95, 95% confidence interval [CI], 0.70-1.28, I² = 19%) was nonsignificant. Additionally, the microbiological eradication rates did not differ significantly between the groups, at 94.8% and 95. 8% in the 5-day and longer courses groups, respectively (OR, 0.84, 95% CI, 0.38-1.87, I² = 0%). Finally, all-cause mortality did not differ between the 2 groups (OR, 0.91, 95% CI, 0.31-2.66, I² = 0%).

Conclusions:

Five-day treatment and longer antibiotic courses for CABP yield similar clinical and microbiological responses and exhibit similar safety profiles.

Keywords:

Antibiotic; Bacterial Pneumonia; Community-acquired; Outcome; Short course.

Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Cited by

• Shorter versus longer durations of antibiotic treatment for patients with community-acquired pneumonia: a protocol for a systematic review and meta-analysis.

  Agarwal A, Gao Y, Colunga Lozano LE, Asif S, Bakaa L, Ghadimi M, Basmaji J, Das A, Loeb M, Guyatt G.

  Agarwal A, et al.
  BMJ Open. 2022 Jun 24;12(6):e062428. doi: 10.1136/bmjopen-2022-062428.
  BMJ Open. 2022.

  PMID: 35750458
  Free PMC article.

• Legionnaires’ Disease: Update on Diagnosis and Treatment.

  Viasus D, Gaia V, Manzur-Barbur C, Carratalà J.

  Viasus D, et al.
  Infect Dis Ther. 2022 Jun;11(3):973-986. doi: 10.1007/s40121-022-00635-7. Epub 2022 May 3.
  Infect Dis Ther. 2022.

  PMID: 35505000
  Free PMC article.

  Review.

Publication types

MeSH terms

Substances

Full text links

Elsevier Science

Cite

Format:

AMA

APA

MLA

NLM

Send To

Comparison of three-day and five-day courses of azithromycin in the treatment of atypical pneumonia

Clinical Trial

. 1991 Oct;10(10):877-80.

doi: 10.1007/BF01975847.

S Schönwald 
¹
, V Skerk, I Petricevic, V Car, L Majerus-Misic, M Gunjaca

Affiliations

Affiliation

• ¹ University Hospital of Infectious Diseases, Zagreb, Yugoslavia.

• PMID:

  1662637

• DOI:

  10.1007/BF01975847

Clinical Trial

S Schönwald et al.

Eur J Clin Microbiol Infect Dis.

1991 Oct.

. 1991 Oct;10(10):877-80.

doi: 10.1007/BF01975847.

Authors

S Schönwald 
¹
, V Skerk, I Petricevic, V Car, L Majerus-Misic, M Gunjaca

Affiliation

• ¹ University Hospital of Infectious Diseases, Zagreb, Yugoslavia.

• PMID:

  1662637

• DOI:

  10.1007/BF01975847

Abstract

This open, randomised clinical study, conducted from June 1988 to December 1989, included 84 patients with clinical and radiological findings of atypical pneumonia. All patients were treated with a total dose of 1.5 g azithromycin, a new azalide antibiotic. In Group I, azithromycin was administered for three days (500 mg once daily). In Group II, azithromycin was administered for five days (250 mg b.i.d. on day 1, followed by 250 mg once daily on days 2 to 5). Causative pathogens were identified by serological methods. Of the 41 patients in Group I, Mycoplasma pneumoniae, Chlamydia psittaci and Coxiella burnetti were identified in 19, 4 and 3 patients, respectively. In Group II there were 43 patients; Mycoplasma pneumoniae was identified in 24, Chlamydia psittaci in 4 and Coxiella burnetti in 3. Only patients with known causative pathogens were included in the evaluation of clinical efficacy. All patients were clinically cured by day 5; most of the patients became afebrile within 48 h of starting treatment. Side effects were observed in one patient in Group I and in one patient in Group II. The results suggest that a 1.5 g total dose of azithromycin is equally effective when administered as a three- or five-day regimen for the treatment of atypical pneumonia.

Similar articles

• Three-day azithromycin compared with ten-day roxithromycin treatment of atypical pneumonia.

  Schönwald S, Barsić B, Klinar I, Gunjaca M.

  Schönwald S, et al.
  Scand J Infect Dis. 1994;26(6):706-10. doi: 10.3109/00365549409008639.
  Scand J Infect Dis. 1994.

  PMID: 7747094

  Clinical Trial.

• Comparison of azithromycin and erythromycin in the treatment of atypical pneumonias.

  Schönwald S, Gunjaca M, Kolacny-Babić L, Car V, Gosev M.

  Schönwald S, et al.
  J Antimicrob Chemother. 1990 Jan;25 Suppl A:123-6. doi: 10.1093/jac/25.suppl_a.123.
  J Antimicrob Chemother. 1990.

  PMID: 2154431

  Clinical Trial.

• Safety and efficacy of azithromycin in the treatment of community-acquired pneumonia in children.

  Harris JA, Kolokathis A, Campbell M, Cassell GH, Hammerschlag MR.

  Harris JA, et al.
  Pediatr Infect Dis J. 1998 Oct;17(10):865-71. doi: 10.1097/00006454-199810000-00004.
  Pediatr Infect Dis J. 1998.

  PMID: 9802626

  Clinical Trial.

• Atypical pneumonia.

  Martin RE, Bates JH.

  Martin RE, et al.
  Infect Dis Clin North Am. 1991 Sep;5(3):585-601.
  Infect Dis Clin North Am. 1991.

  PMID: 1955701

  Review.

• Azithromycin in the treatment of uncomplicated genital chlamydial infections.

  Stamm WE.

  Stamm WE.
  Am J Med. 1991 Sep 12;91(3A):19S-22S. doi: 10.1016/0002-9343(91)90396-f.
  Am J Med. 1991.

  PMID: 1656737

  Review.

See all similar articles

Cited by

• Clinical Characteristics of Macrolide-Refractory Mycoplasma pneumoniae Pneumonia in Korean Children: A Multicenter Retrospective Study.

  Choi YJ, Chung EH, Lee E, Kim CH, Lee YJ, Kim HB, Kim BS, Kim HY, Cho Y, Seo JH, Sol IS, Sung M, Song DJ, Ahn YM, Oh HL, Yu J, Jung S, Lee KS, Lee JS, Jang GC, Jang YY, Chung HL, Choi SM, Han MY, Shim JY, Kim JT, Kim CK, Yang HJ, Suh DI.

  Choi YJ, et al.
  J Clin Med. 2022 Jan 8;11(2):306. doi: 10.3390/jcm11020306.
  J Clin Med. 2022.

  PMID: 35054002
  Free PMC article.

• Short- vs long-course antibiotic therapy for pneumonia: a comparison of systematic reviews and guidelines for the SIMI Choosing Wisely Campaign.

  Furlan L, Erba L, Trombetta L, Sacco R, Colombo G, Casazza G, Solbiati M, Montano N, Marta C, Sbrojavacca R, Perticone F, Corazza GR, Costantino G.

  Furlan L, et al.
  Intern Emerg Med. 2019 Apr;14(3):377-394. doi: 10.1007/s11739-018-1955-2. Epub 2018 Oct 8.
  Intern Emerg Med. 2019.

  PMID: 30298412

• Rapid Detection of the Macrolide Sensitivity of Pneumonia-Causing Mycoplasma pneumoniae Using Quenching Probe Polymerase Chain Reaction (GENECUBE^®).

  Ito Y, Iwashima S, Hayano S, Nishio T, Shiozawa R, Yata S, Kubota T, Kubota A, Uemura K.

  Ito Y, et al.
  Mol Diagn Ther. 2018 Dec;22(6):737-747. doi: 10.1007/s40291-018-0360-x.
  Mol Diagn Ther. 2018.

  PMID: 30259422

• Guideline for Antibiotic Use in Adults with Community-acquired Pneumonia.

  Lee MS, Oh JY, Kang CI, Kim ES, Park S, Rhee CK, Jung JY, Jo KW, Heo EY, Park DA, Suh GY, Kiem S.

  Lee MS, et al.
  Infect Chemother. 2018 Jun;50(2):160-198. doi: 10.3947/ic.2018.50.2.160.
  Infect Chemother. 2018.

  PMID: 29968985
  Free PMC article.

  Review.

• From Erythromycin to Azithromycin and New Potential Ribosome-Binding Antimicrobials.

  Jelić D, Antolović R.

  Jelić D, et al.
  Antibiotics (Basel). 2016 Sep 1;5(3):29. doi: 10.3390/antibiotics5030029.
  Antibiotics (Basel). 2016.

  PMID: 27598215
  Free PMC article.

  Review.

See all “Cited by” articles

References

1. 1. Antimicrob Agents Chemother. 1987 Dec;31(12):1939-47

      –

      PubMed

2. 1. Med Clin North Am. 1987 Nov;71(6):1147-54

      –

      PubMed

3. 1. J Antimicrob Chemother. 1990 Jan;25 Suppl A:123-6

      –

      PubMed

4. 1. J Antimicrob Chemother. 1988 Jul;22 Suppl B:145-53

      –

      PubMed

5. 1. J Antimicrob Chemother. 1990 Jan;25 Suppl A:73-82

      –

      PubMed

Publication types

MeSH terms

Substances

Acute and chronic bronchitis: antibacterial therapy tactics

00:00

Oksana Mikhailovna Drapkina , professor, doctor of medical sciences:

– I would like to offer the floor to professor Avdeev Sergey Nikolaevi chu, which will tell us about acute and chronic bronchitis and talk about the tactics of antibiotic therapy.

Sergey Nikolaevich Avdeev , professor, doctor of medical sciences:

– Dear friends, good evening.

We are talking about bronchitis. I’ll start with a definition.

Bronchitis is a well-known disease. There is probably not a single medical specialty that would not come into contact with this pathology. In fact, this is an inflammation of the bronchial mucosa. Clinically, this is expressed in the form of sputum production and cough.

Bronchitis can be divided into two groups: acute (conditional division up to 30 days) and chronic. We refer to it as cough and sputum production for at least three months of the year for two consecutive years. These definitions have not changed for one and a half to two decades.

We start with acute bronchitis. I am a representative of pulmonology, so I am talking about adult patients. From an epidemiological point of view, bronchitis is a very common disease. If we take all people, then 4-5% every year have this disease. About 90% seek some form of medical attention to manage acute bronchitis.

It is believed that the most common cause of acute bronchitis is a viral infection (more than 80%). Approximately 40% of all patients develop bronchial obstruction during acute bronchitis.

The main reason is viruses. Whether antibiotic therapy is necessary here. The question is very difficult. Moreover, we are all well aware that antibiotics for viral infections are absolutely useless. However, this problem has been repeatedly studied in many clinical trials (CTs).

I present one of the famous meta-analyses from the Cochrane Library. 9 studies, 550 patients. It turns out that antibiotics have a small beneficial effect. Approximately half a day earlier, there is a decrease in symptoms in the form of a decrease in cough, sputum production, and general malaise.

In order to obtain a clinical effect, it is necessary to treat 14 patients. On the other hand, those patients who receive antibiotics for acute bronchitis have more adverse reactions.

If you look at modern data, it turns out that everything is not so simple. I draw your attention to one of the largest analyzes that has ever been published in the literature. Study (inaudible, 02:40) published in the British Medical Journal.

02:45

3.5 million people. The development of respiratory infection in all age groups. Pneumonia in people of the older age group (over 64 years old) develops about one and a half times less often. Where patients received antibiotics for acute bronchitis.

Why. If we look at the modern structure that studies the etiological structure of pathogens, it turns out that not only viruses, but also bacteria (although less often) are the culprits of acute respiratory bronchitis. This is still the same respiratory group of pathogens: pneumococcus, Haemophilus influenzae, Moraxella catarrhalis (moraxella catarrhalis).

For these cases we need antibiotics.

Let’s decide when antibiotics are needed for acute bronchitis. Alas, we do not have a unanimous consensus today. But there are certain recommendations in modern literature. They say that in situations where patients have purulent sputum, there are disorders of C-reactive protein levels above 10 mg / l, in sick smokers, in elderly patients, we can prescribe antibiotics, suggesting the bacterial nature of their acute bronchitis.

Among these antibiotics, we are primarily talking about the use of modern macrolides “Azithromycin” (“Azithrtomycin”) and “Clarithromycin” (“Clarithromycin”). And also about the use of beta-lactams. “Amoxicillin” (“Amoxicilin”) protected by “Amoxicillin” clavulanic acid and “Cefuroxime” (“Cefuroxime”).

The problem of chronic bronchitis. Today, we often discuss this topic in the framework of chronic obstructive pulmonary disease (COPD), that is, where there is bronchial obstruction, a more severe disease both in terms of prognosis and in terms of modern therapy. If we are talking today about the epidemiology of COPD, then the problem is extremely common. In the modern adult population, from 10% to 20% of individuals.

COPD is a disease where exacerbations occur in almost everyone. On average, each patient suffers 1-2 exacerbations per year. Mortality in exacerbations of COPD, in contrast to acute bronchitis, is very high. If we are talking about hospitalized patients, then this is up to 8%. And among patients who are in the intensive care unit (the more severe the disease, the more likely they are to get there), the mortality rate is higher than 25%.

05:15

Modern interpretations of the definition are also ambiguous. Today there are many documents. The definition varies. One of the most famous definitions today is from the “GOLD” document.

COPD is an exacerbation of natural events. It is characterized by an increase in symptoms, shortness of breath, sputum. This event is acute and requires additional therapy.

Some authors add that this exacerbation is associated with increased inflammation in the airways and systemic inflammation.

There is another approach, the criteria-based approach. We believe that there is an exacerbation of COPD and chronic bronchitis when three cardinal signs appear: increased dyspnea, increased sputum volume, and increased purulent sputum. These are the Winnipeg criteria, as they were proposed by a Canadian author who lives in the city of Winnipeg.

In terms of these criteria, exacerbations of COPD can be classified according to severity. If there are all three signs – this is the first type – the most severe exacerbation. Two signs – the second type – less severe. One of the signs is a milder exacerbation.

In terms of etiology, it may or may not be treated with antibiotics. Modern studies that use very rigorous methodological approaches to identify all possible causes (including DNA-based approaches) tell us that at least 50 to 55% of patients with exacerbations of COPD have a bacterial infection as the cause.

Thus, such patients can be treated with antibiotics.

(Slide show).

One of the first famous studies that showed the usefulness of antibiotics in such patients was the Antonison study (the one that proposed the Winnipeg criteria). Here we see the distribution of patients with exacerbations of COPD into three groups according to these large Winnipeg criteria.

07:24

The first type is the most severe exacerbation. If we look at these patients, we see that the biggest gap between treated and untreated patients with antibiotics is in severe patients of the first group. If we look at the entire group, the success of antibiotic therapy is 68%.

Placebo also does not look so bad against this background – 55%. Explained simply. An infection such as an exacerbation of chronic bronchitis or COPD is localized within the mucosa of the respiratory tract. There is a good chance that the infection may end on its own. But this chance is reduced in the most severe patients. The more severe the disease, the greater the need for therapy of such patients.

From the point of view of evidence, I present more recent data. According to the latest meta-analysis of the Cochrane Library, if we are talking about a severe exacerbation of COPD, then today there is data that confirms that antibiotics reduce mortality by 77%, the risk of therapy failure by 53%, the risk of having or having purulent sputum consistency by 44%.

A very difficult question today is when to prescribe antibiotics. Why. Not all exacerbations of COPD are bacterial. From the point of view of today’s data, it is recommended to prescribe antibiotics when we are dealing with an exacerbation of the first type according to Antonison. If all three cardinal signs are present. Where there is purulent sputum, and it appeared precisely during the exacerbation. And also with a very severe exacerbation, when there is acute respiratory failure, there are indications for non-invasive ventilation of the lungs and for invasive mechanical ventilation.

One of the modern trends is the use of markers to determine the timing of antibiotic therapy. A domestic study shows that such a simple and accessible biomarker as C-reactive protein (CRP) makes it possible to stratify patients with COPD exacerbation by groups.

Where there is mucoid sputum, that is, a non-bacterial exacerbation, CRP is slightly increased. Where there is purulent sputum, it is increased more significantly – here is a bacterial exacerbation. Where there is pneumonia, there is a very high rise.

According to this study, if CRP is above 15 mg/l, antibiotics are prescribed.

09:58

What pathogens. A typical trinity is Haemophilus influenzae, pneumococcus, moraxella catarrhalis. Gram-negative enterobacteria also play a significant role in the etiology of exacerbations of chronic bronchitis. Especially when it comes to severe bronchial obstruction. For example, FEV1 is less than 35%.

In order to prescribe antibiotics, we have good trump cards today. There are studies that show that the pathogen that causes an exacerbation of COPD is very closely related to the severity of the underlying disease. It turns out that in patients with a milder course, the most common pathogens are pneumococcus and gram-positive cocci. In patients with a severe course, the most common pathogens are gram-negative enterobacteria, including Pseudomonas aeruginosa.

Haemophilus influenzae and moraxella are evenly present in all groups.

(Slide show).

This scheme is one of the last schemes to comply with the “GOLD” recommendations. It shows the modern strategy of prescribing antibiotics in patients with COPD exacerbation.

A mild exacerbation – where there is only one of the three signs – may not require any antibiotics at all. Here, as a rule, it is recommended to increase the regimen of concomitant or basic therapy, increase (inaudible, 11:25) and so on.

But in a situation where there are two of the three signs, we must prescribe antibiotics. Such an exacerbation can be uncomplicated and complicated. Complicated exacerbation – where there are no risk factors. The patient suffers less than three exacerbations per year. He has a good breathing function. FEV1 more than 50%. Age less than 65 years and no heart disease.

11:51

Complicated exacerbation – everything is much more difficult. Three or more exacerbations. Age over 65 years. FEV1 less than 50. Heart disease is present.

In the first case, with a complicated exacerbation, we can prescribe modern macrolides – Azithromycin and Clarithromycin, cephalosporins such as Cefuroxin.

In a situation where there is a complicated exacerbation, the choice is between two groups of drugs. These are new modern fluoroquinolones – “Moxilevofloxacin” (“Levofloxacin”) or “Amoxicillin clavulanate”.

In terms of antibiotic therapy, with more severe symptoms, that is, with a more pronounced exacerbation of COPD, all of the listed antibiotics work in the same way. This was first noticed about 15 years ago.

(Slide show).

The group shown in green is the third-line antibiotics, that is, the most modern ones. Among them are “Amoxicillin clavulanate” and “Azithromycin”. The risk of therapeutic failure is lowest with these antibiotics.

Essentially, the point is that an effective antibiotic should lead to maximum eradication of the causative agent. One of the domestic studies compares “Amoxicillin clavulanate” and macrolides in exacerbation of COPD associated with Haemophilus influenzae.

Amoxicillin clavulanate is the most effective antibiotic for the eradication of this pathogen. If we observe patients for a year, it turns out that where the maximum eradication was performed (that is, patients during the exacerbation period received Amoxicillin clavulanate), there will be a smaller number of exacerbations in the future.

A modern study, which is also carried out in our country, shows how the drug “Amoxicillin clavulanate” retains its role. The study of the Smolensk group shows that, for example, during exacerbation of COPD, the effectiveness of two antibiotics, which belong to different manufacturing companies, had 100%.

Among these patients there were no patients at risk of Pseudomonas aeruginosa.

11:58

It is especially important that among this group of patients…

Patients with COPD are a rather vulnerable group of patients. Elderly patients, comorbidities. We also need to talk about the safety issues of antimicrobial therapy. Modern preparations that are made in the form of dispersible tablets, such as “Flemoclav” (“Flemoclav”), have some advantages in terms of the number of side effects over traditional forms.

Fewer side effects, including those from the gastrointestinal tract.

A recent study compared two antibiotics directly. This is the largest study to date. It will be discussed over the coming years. Here is a completely new non-traditional study design. The end point is referred to the end of the second month. This effect or end point is assessed as failure of therapy.

Two modern antibiotics were compared, Moxifloxacin (a new fluoroquinolone) and Amoxicillin clavulanate. It turned out that in terms of the primary point, in terms of the number of failures, absolutely no differences were found in this study.

The last question I would like to answer. How long to treat patients with exacerbation of COPD, chronic bronchitis. We see different recommendations from different countries, different societies. Accordingly, completely different answers. Somewhere there are no answers at all. Somewhere – 3, 10 days, somewhere – 5-7 days. What do we need to get closer to today?

In fact, there are studies today that compare shorter courses of antibiotics with longer courses.

(Slide show).

This is a fairly large meta-analysis of over 3,000 patients. On the left side there is information on the clinical cure of patients. On the right side is information on side effects.

According to this meta-analysis, shorter courses of antibiotic therapy for five days are no worse in clinical and bacteriological effects than extended courses. In terms of side effects, there are benefits here.

Approximately 16% fewer side effects.

The latest real-world study to support this position. With exacerbation of COPD, chronic bronchitis, the most used regimens in the world today in terms of duration are five-day courses (about 40%) and seven-day courses (about 37%).

Thus, 5-7 days is quite sufficient time for the treatment of patients with exacerbation of COPD.

Adsorbents can help protect the microbiome from the negative effects of antibiotics

New York (Reuters Health) – An experimental activated charcoal product may help protect the microbiome from the negative effects of antibiotics, a phase 1 randomized trial suggests.

“DAV132 was highly effective in protecting the gut microbiome of healthy volunteers when using moxafloxacin and could represent a clinical breakthrough in preventing adverse health effects from a wide range of antibiotics,” said Dr. Jean de Gunzburg and colleagues from Da Volterra, a biotech company in Paris, which is developing DAV132, in the Journal of Infectious Diseases online Nov. 23.

“By reaching the caecum and colon, oral antibiotics cause dysbiosis, promoting the spread of Clostridium difficile, diarrhea, and the growth of antibiotic-resistant bacteria,” said Dr. Gunzburg and colleagues. They developed DAV132, which delivers a non-specific activated charcoal adsorbent to the distal ileum. In an experimental study, this drug showed that treatment with it does not affect the plasma pharmacokinetics of a single dose of amoxicillin.

In a new study, 28 healthy volunteers who received a five-day course of moxoflaxacin were randomized to receive either DAV132 or placebo three times a day. Dr. Gunzburg and colleagues also included two control groups of eight people each who received DAV132 alone or a placebo.

The free moxafloxacin peak in the placebo group was 136.2 micrograms/gram on day six and was not detectable on day 16. In patients treated with DAV132, faecal free moxaflaxacin ranged from 1 to 14 micrograms/gram each day until the sixth day of the study.

On the first and fifth days, the plasma concentration of moxafloxacin was the same in both groups. There was one case of a side effect of vulvovaginal fungal infection, which the authors attributed to moxafloxation rather than DAV132.

In subjects not treated with DAV132, microbial concentrations decreased to 54.6% of baseline by day 6 and did not return to baseline by day 37 of the study. In patients taking DAV132 together with moxafloxation, on the 6th day, the microbial concentration was 97.8% of baseline, similar to control patients who did not receive moxofloxacin. In the DAV132 group, microbial concentration returned to baseline levels 11 days after the end of treatment.

One third of the 252 metagenomic species identified in the guts of study participants were altered in patients who did not receive DAV132. Administration of DAV132 protected 81% of metagenomic species that were affected by moxafloxacin, and 12% were partially protected. All 34 metagenomic species characterizing microbiome diversity were protected.

In ex-vivo studies of DAV132 with 14 commonly used antibiotics, 13 were adsorbed by at least 95% and amoxicillin was adsorbed by 92%.

“The results of this phase 1 study look promising: DAV132 could be a breakthrough in preventing short-term and long-term adverse effects of antibiotics,” write Dr.