Reassement of the Lille consensus on treatment of chronic bronchitis exacerbation

Objective - The authors had for aim to assess the treatment of chronic bron chitis exacerbation, considering the recommendations or guidelines, clinica l studies, and the evolution of bacterial resistance since 1991. The assess ment was performed on antibiotics put on the market since 1991, considering their efficacy treatment duration, the bacteriological impact, and the cos t-effectiveness ratio. Method - Research was performed on Medline and on references quoted in vari ous papers when needed, from 1991 to 1999. We selected randomized studies o nly whether open or blind, and various items were collected such as the num ber of patients involved, selection and exclusion criteria, judgement crite ria, statistical analysis, methodology. Results - For the seven recommendations or guidelines, the first choice tre atment usually concerned old and low price molecules. 34 equivalence, rando mized studies were selected (fluoroquinolones (12), macrolides (14), and be talactams (8)). No difference was demonstrated with the comparators. The ec ological impact was not analyzed on an individual basis. The shortest durat ion treatment was as effective as the longest. The cost-effectiveness analy sis was made in 2 retrospective studies, and seemed to be in favor of the n ew drugs. Conclusion - we cannot prove the superiority of new molecules. the clinical assessment were not meant for that but to assess equivalence. So, these ne w antibiotics cannot be recommended as the first line treatment despite a s uperior intrinsic activity as shown by their spectrum, and their efficacy r ate, superior to that generally shown with first line antibiotics. More stu dies are needed to assess economical and ecological impact. (C) 2001 Editio ns scientifiques et medicales Elsevier SAS.