Antibiotic treatment in acute exacerbation of COPD: patient outcomes with amoxicillin vs. amoxicillin/clavulanic acid—data from 43,636 outpatients
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Antibiotic treatment in acute exacerbation of COPD : patient outcomes with amoxicillin vs. amoxicillin/clavulanic acid—data from 43,636 outpatients. / Bagge, Kristian; Sivapalan, Pradeesh; Eklöf, Josefin; Hertz, Frederik Böetius; Andersen, Christian Østergaard; Hansen, Ejvind Frausing; Jarløv, Jens Otto; Jensen, Jens Ulrik Stæhr.
In: Respiratory research, Vol. 22, No. 1, 11, 2021.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Antibiotic treatment in acute exacerbation of COPD
T2 - patient outcomes with amoxicillin vs. amoxicillin/clavulanic acid—data from 43,636 outpatients
AU - Bagge, Kristian
AU - Sivapalan, Pradeesh
AU - Eklöf, Josefin
AU - Hertz, Frederik Böetius
AU - Andersen, Christian Østergaard
AU - Hansen, Ejvind Frausing
AU - Jarløv, Jens Otto
AU - Jensen, Jens Ulrik Stæhr
PY - 2021
Y1 - 2021
N2 - Background: For antibiotic treatment of Acute exacerbations of COPD (AECOPD) the National guidelines in Denmark recommend either first choice amoxicillin 750 mg TID (AMX) or amoxicillin with clavulanic acid 500 mg/125 mg TID (AMC). Addition of clavulanic acid offers a broader spectrum; opposite, AMX alone in a higher dose may offer more time above MIC. The aim of this study was to determine which of these regimens is associated with better outcome. Methods: The Danish Registry of COPD (DrCOPD), a nationwide outpatient COPD registry, was crosslinked with medication data and hospital contacts. The first prescription of AMX or AMC after inclusion in DrCOPD was used as exposure variable. Adjusted Cox proportional hazards models were used to analyze the risk of hospitalization or death (combined) within 30 days and other endpoints. Results: For the first treatment of AECOPD 12,915 received AMX, and 30,721 patients received AMC. AMX was associated with a decreased risk of pneumonia hospitalization or death (aHR 0.6, 95% CI 0.5–0.7; p < 0.0001) compared to AMC. Conclusion: In AECOPD, empirically adding clavulanic acid to amoxicillin is not associated with a better outcome; it seems safe for these patients to be treated with amoxicillin alone.
AB - Background: For antibiotic treatment of Acute exacerbations of COPD (AECOPD) the National guidelines in Denmark recommend either first choice amoxicillin 750 mg TID (AMX) or amoxicillin with clavulanic acid 500 mg/125 mg TID (AMC). Addition of clavulanic acid offers a broader spectrum; opposite, AMX alone in a higher dose may offer more time above MIC. The aim of this study was to determine which of these regimens is associated with better outcome. Methods: The Danish Registry of COPD (DrCOPD), a nationwide outpatient COPD registry, was crosslinked with medication data and hospital contacts. The first prescription of AMX or AMC after inclusion in DrCOPD was used as exposure variable. Adjusted Cox proportional hazards models were used to analyze the risk of hospitalization or death (combined) within 30 days and other endpoints. Results: For the first treatment of AECOPD 12,915 received AMX, and 30,721 patients received AMC. AMX was associated with a decreased risk of pneumonia hospitalization or death (aHR 0.6, 95% CI 0.5–0.7; p < 0.0001) compared to AMC. Conclusion: In AECOPD, empirically adding clavulanic acid to amoxicillin is not associated with a better outcome; it seems safe for these patients to be treated with amoxicillin alone.
U2 - 10.1186/s12931-020-01606-7
DO - 10.1186/s12931-020-01606-7
M3 - Journal article
C2 - 33413341
AN - SCOPUS:85098855409
VL - 22
JO - Respiratory Research (Print)
JF - Respiratory Research (Print)
SN - 1465-9921
IS - 1
M1 - 11
ER -
ID: 255351561