Amoxicillin alone is better than combined antibiotics in the treatment of acute exacerbations of COPD

A Danish study showed that for patients with acute exacerbations of chronic obstructive pulmonary disease (COPD), amoxicillin alone has better results than amoxicillin combined with another antibiotic, clavulanic acid.
The study titled "Antibiotic Therapy in Acute Exacerbations of COPD: Patient Outcomes of Amoxicillin and Amoxicillin/Clavulanic Acid-Data from 43,636 Outpatients" was published in the Journal of Respiratory Research.
An acute exacerbation of COPD is an event in which the patient's symptoms suddenly worsen. Since these exacerbations are usually related to bacterial infections, treatment with antibiotics (drugs that kill bacteria) is part of the standard of care.
In Denmark, there are two commonly used antibiotic regimens that can be used to treat such exacerbations. One is 750 mg amoxicillin three times a day, and the other is 500 mg amoxicillin plus 125 mg clavulanic acid, also three times a day.
Amoxicillin and clavulanic acid are both beta-lactams, which are antibiotics that work by interfering with the production of bacterial cell walls, thereby killing bacteria.
The basic principle of combining these two antibiotics is that clavulanic acid is effective against more different types of bacteria. However, treatment with amoxicillin alone means that a single antibiotic can be given at a higher dose, which may eventually kill bacteria more effectively.
Now, a group of Danish researchers directly compared the results of these two regimens for the treatment of acute exacerbations of COPD.
The researchers used data from the Danish COPD registry, combined with data from other national registries, to identify 43,639 patients with aggravated conditions who had received one of the two options analyzed. Specifically, 12,915 people took amoxicillin alone and 30,721 people took combination medications. It is worth noting that none of the patients analyzed was hospitalized due to COPD exacerbation, which indicates that the attack was not serious.
Compared with the combination of amoxicillin and clavulanic acid, treatment with amoxicillin alone can reduce the risk of pneumonia-related hospitalization or all-cause death by 40% after 30 days. Amoxicillin alone is also associated with a 10% reduction in the risk of non-pneumonia hospitalization or death and a 20% reduction in the risk of all-cause hospitalization or death.
For all these measures, the difference between the two treatments is statistically significant. Additional statistical analysis will usually find consistent results.
The researchers wrote: "We found that compared with AMC [amoxicillin plus clavulanic acid], AECOPD [COPD exacerbation] outpatients treated with AMX [amoxicillin alone] are at risk of hospitalization or death with pneumonia within 30 days Significantly lower."
The team speculates that one possible reason for this result is the difference in dosage between the two antibiotic regimens.
"When administered at the same dose, AMC [combination] is unlikely to be lower than AMX [amoxicillin alone]," they wrote.
Overall, the analysis “supports the use of AMX as the preferred antibiotic treatment for outpatients with AECOPD,” the researchers concluded because “the addition of clavulanic acid to amoxicillin has nothing to do with better results.”
According to the researchers, the main limitation of the study is the risk of confusion due to indications-in other words, people who are already in poor condition may be more likely to receive combination therapy. Although the researchers' statistical analysis attempts to explain this factor, it is still possible that the pre-treatment differences explained some of the results.
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Post time: Aug-23-2021