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The therapeutic efficacy of a 2-day levofloxacin course is comparable to that of a 7-day treatment course for acute COPD exacerbation.

The typical period of administration of antibiotics for treating acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is approximately 5–7 days. Previous studies have not assessed the administration of a 2-day course of levofloxacin for AECOPD. This randomized clinical trial, published in the Therapeutic Advances in Respiratory Disease, assessed the therapeutic efficacy of 2-day and 7-day levofloxacin treatments for patients who presented with AECOPD.

A total of 310 study participants were randomized to a 2-day or 7-day levofloxacin course. All of the patients were administered intravenous prednisone each day for 5 days. The cure rate was the primary outcome measure. Secondary outcomes of the study included ICU admission rate, death rate, exacerbation-free interval, the requirement for additional antibiotics, and re-exacerbation rate.

The analysis of the study results revealed that the cure rate was 74.2% in the 7-day group and 79.3% in the 2-day group. The rate for the requirement of additional antibiotics was 1.9% for the 7-day group and 3.2% for the 2-day group. The re-exacerbation rate was 29% and 38.4% in the 7-day and 2-day groups, respectively. The exacerbation-free interval was 121 days for the 2-day group and 110 days for the 7-day group. The ICU admission and 1-year death rates were not significantly different between the two groups. Similarly, there were no differences between the 2-day and 7-day treatment groups in the context of adverse events.

In summary, a 2-day course with levofloxacin is not inferior to a 7-day course of levofloxacin in terms of cure rate, the requirement for additional antibiotics, and the length of hospital stay in patients with AECOPD. The study findings may contribute to improved patient compliance, the reduced onset of adverse outcomes, and a lesser incidence of bacterial resistance.


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Messous, S., Trabelsi, I., Bel Haj Ali, K., Abdelghani, A., Ben Daya, Y., Razgallah, R., Grissa, M. H., Beltaief, K., Mezgar, Z., Belguith, A., Bouida, W., Boukef, R., Boubaker, H., Msolli, M. A., Sekma, A., & Nouira, S. (2022). Two-day versus seven-day course of levofloxacin in acute COPD exacerbation: a randomized controlled trial. Therapeutic Advances in Respiratory Disease, 16, 17534666221099729. https://doi.org/10.1177/17534666221099729