BACKGROUND: Short-term use of antibiotics has become a common component of the management of acute exacerbations of chronic @entity3617 (AECB), particularly in complex cases with productive cough or purulent phlegm. The @entity7646 antibiotics, particularly second-generation agents such as @entity9848 and @entity4580 , are among the antibiotic classes frequently recommended and used to treat upper and lower @entity1729 , including AECB. OBJECTIVE: This study compared the clinical efficacy and tolerability of 5-day courses of @entity9848 and @entity4580 given once daily for the treatment of acute exacerbations of @entity1030 ( @entity1030 ). METHODS: This randomized, investigator-blinded, parallel-group clinical trial was conducted at 5 centers in the United States. Eligible @entity1 were adult (age >35 years) smokers or ex-smokers (smoking history of at least 10 pack-years) with chronic @entity3617 and an acute exacerbation, defined by the occurrence of increased @entity1353 and/or productive cough and feverishness within 48 hours of enrollment. Before randomization, an attempt was made to obtain a sputum specimen from each @entity1 for Gram's staining and culture. @entity1 were randomized to receive @entity9848 500 mg QD for 5 days or @entity4580 500 mg QD on day 1 and 250 mg QD on days 2 to 5. Clinical efficacy was assessed separately by @entity1 and physicians at early (days 7-10) and late (days 25-35) posttreatment visits. RESULTS: Eighty-six @entity1 (48 @entity1 , 38 @entity1 ; mean age, 55 years) with a mean smoking history of 31 pack-years were included in the intent-to-treat analysis. Forty-six (54%) @entity1 were randomized to @entity9848 and 40 (47%) @entity1 to @entity4580 . Clinical efficacy was reported in a high proportion of @entity1 in both treatment groups, both at the early posttreatment visit (84.8% @entity9848 , 75.7% @entity4580 ; difference @entity9848 - @entity4580 , 9.1%; 95% CI, -8.2 to 26.4) and the late posttreatment visit (95.5% and 86.5%, respectively; difference @entity9848 - @entity4580 , 9.0%; 95% CI, -3.7 to 21.6). A similar proportion of @entity1 required a second course of antibiotics over the study period (20.5% @entity9848 , 27.0% @entity4580 ; difference @entity9848 - @entity4580 , -6.6%; 95% CI, -25.2 to 12.1). Only 42 (48.8%) @entity1 were able to produce a sputum sample before receiving study treatment, and of these, only 20 (47.6%) demonstrated a preponderance of neutrophils on Gram's staining. Both treatments were well tolerated. CONCLUSIONS: The results of this study suggest comparable clinical efficacy between 5-day courses of once-daily @entity9848 and @entity4580 in acute exacerbations of @entity1030 . There were insufficient data to permit meaningful comparison of the bacteriologic efficacy of these @entity7646 antibiotics.

A comparison of 5-day courses of XXXX and @entity4580 in the treatment of acute exacerbations of @entity1030 .

@entity3617 :: ('MESH:D001991', 'Disease') :: ['bronchitis'] @entity1 :: ('9606', 'Species') :: ['women', 'Patients', 'patients', 'patient', 'men'] @entity9848 :: ('MESH:C053853', 'Chemical') :: ['dirithromycin'] @entity7646 :: ('CHEBI:25106', 'Chemical') :: ['macrolide'] @entity1353 :: ('MESH:D004417', 'Disease') :: ['dyspnea'] @entity4580 :: ('MESH:D017963', 'Chemical') :: ['azithromycin'] @entity1729 :: ('MESH:D012141', 'Disease') :: ['respiratory infections'] @entity1030 :: ('MESH:D029424', 'Disease') :: ['chronic obstructive pulmonary disease', 'COPD']
@entity9848 :: (MESH:C053853,Chemical) :: ['dirithromycin']
