Randomized comparative study of three-day azithromycin treatment versus 10-day cefuroxime treatment in the exacerbations of patients with chronic obstructive pulmonary disease.

BACKGROUND: The aim of this study was to prospectively evaluate the clinica l and gasometric evolution and the side effects of two treatment schedules in the exacerbations of patients with chronic obstructive pulmonary disease (COPD): 500 mg/24 h of azithromycin (AZM) for three days versus 500 mg/12 h of acetyl cefuroxime (ACF) for 10 days. PATIENTS AND METHODS: Patients were randomized included into each therapeut ic schedule. The patients were seen three times (days 1 and 4, and at 15-21 days) to evaluate clinical symptoms scores. Forced spirometry and arterial gasometry were performed the first and the last time the patients were see n. The number of patients requiring admission during follow up and the seco ndary effects of each antibiotic were quantified. RESULTS: A total de 50 patients were treated with AZM and 51 with ACF. The evolution of the symptoms was similar although with a trend to greater impr ovement in those treated with AZM. This improvement was significant for the characteristics of expectoration (p < 0.05). Functional and gasometric evo lution was similar in the two schedules. Three patients treated with AZM re quired hospital admission, as did 5 treated with ACF. A greater number of s econdary effects were observed in patients treated with ACF (18%) than in t hose receiving AZM (10%), with gastrointestinal side effects being the most commonly observed. CONCLUSIONS: Treatment with short schedule of AZM may have the same activit y as longer schedule of ACF, with fewer secondary effects thereby suggestin g that AZM may be an effective alternative in the treatment of exacerbation s in patients with COPD.