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Review
. 2009 Jan;55(1):60-7.

Penicillins vs trimethoprim-based regimens for acute bacterial exacerbations of chronic bronchitis: meta-analysis of randomized controlled trials

Ioanna P Korbila  1 , Katerina G Manta, Ilias I Siempos, George Dimopoulos, Matthew E Falagas
Affiliations
Review

Penicillins vs trimethoprim-based regimens for acute bacterial exacerbations of chronic bronchitis: meta-analysis of randomized controlled trials

Ioanna P Korbila et al. Can Fam Physician. 2009 Jan.

Abstract
in English, French

Objective: To compare the effectiveness and toxicity of semisynthetic penicillins (SSPs) (amoxicillin, ampicillin, pivampicillin) and trimethoprim-based regimens (trimethoprim, trimethoprim-sulfamethoxazole, trimethoprim-sulfadiazine) in treating acute bacterial exacerbations of chronic bronchitis (ABECB).

Data sources: We searched MEDLINE, EMBASE, Current Contents, and the Cochrane Central Register of Controlled Trials to identify and extract data from relevant randomized controlled trials (RCTs).

Study selection: Only RCTs comparing penicillins with trimethoprim-based regimens for the treatment of patients with ABECB that reported data on effectiveness, toxicity, or mortality were considered eligible for this meta-analysis.

Synthesis: Out of 134 RCTs identified in the search, 5 RCTs involving 287 patients were included in the analysis. There were no differences between patients with ABECB treated with SSPs and those treated with trimethoprim, alone or in combination with a sulfonamide, in treatment success (intention-to-treat patients: n = 262, odds ratio [OR] 1.68, 95% confidence interval [CI] 0.91-3.09; clinically evaluable patients: n = 246, OR 1.59, 95% CI 0.79-3.20) or number of drug-related adverse events in general (n = 186 patients, OR 0.37, 95% CI 0.11-1.24), frequency of diarrhea or skin rashes, or number of withdrawals due to adverse events (n = 179 patients, OR 0.27, 95% CI 0.07-1.03).

Conclusion: Based on limited evidence leading to wide CIs of the estimated treatment effects, SSPs and trimethoprim-based regimens seem to be equivalent in terms of effectiveness and toxicity for ABECB.

OBJECTIF: Comparer l’efficacité et la toxicité des pénicillines semi-synthétiques (PSS) (amoxicilline, ampicilline, pivampicilline) à celles des préparations à base de triméthoprime (TMP) (triméthoprime, triméthoprime-sulfaméthoxazole, triméthoprime-sulfadiazine) pour traiter les exacerbations bactériennes aiguës de la bronchite chronique (EBABC).

SOURCES DES DONNÉES: On a consulté MEDLINE, EMBASE, Currents Contents et le Cochrane Central Register of Controled Trials afin d’identifier et d’extraire les données d’essais cliniques randomisés (ECR) pertinents.

CHOIX DES ÉTUDES: Seuls les ECR comparant les pénicillines aux préparations contenant du triméthoprime dans le traitement des EBABC et comportant des données sur l’efficacité, la toxicité ou la mortalité ont été retenus pour cette méta-analyse.

SYNTHÈSE: Sur les 134 ECR identifiés lors de la recherche, 5 regroupant 287 patients ont été inclus dans l’analyse. On n’a observé aucune différence entre les patients présentant une EBABC traités par des PSS et ceux traités par le TMP avec ou sans sulfamide, en termes de succès du traitement (nombre de patients à traiter: n=262, rapport de cotes [RC] 1,68, intervalle de confiance [IC] à 95% 0,91–3,09; patients cliniquement évaluables: n=246, RC 1,59, IC à 95% 0,79–3,20), ou du nombre d’effets indésirables attribuables aux médicaments en général (n=186 patients, RC 0,37, IC à 95% 0,11–1,24), ou de la fréquence des diarrhées ou des éruptions cutanées, ou du nombre de retraits du médicament à cause d’effets indésirables (n=179 patients, RC 0,27, IC à 95% 0,07–1,03).

CONCLUSION: À partir de données probantes limitées entraînant de larges IC concernant les effets des traitements, il semble que les PSS et les préparations à base de TMP ont une efficacité et une toxicité équivalentes pour le traitement des EBABC.

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Figures

Figure 1
Figure 1
Study selection
Figure 2
Figure 2. Odds ratios of treatment success in patients with acute bacterial exacerbations of chronic bronchitis in randomized controlled trials comparing broad-spectrum semisynthetic penicillins with trimethoprim alone or in combination with a sulfonamide
A) intention-to-treat patients; B) clinically evaluable patients.*
See this image and copyright information in PMC

Comment in

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