Evidence map›Paper›PMID 26179246›Full record

Trial reportThorax2015

Effects of different antibiotic classes on airway bacteria in stable COPD using culture and molecular techniques: a randomised controlled trial.

Simon E Brill, Martin Law, Ethaar El-Emir, James P Allinson, Phillip James, Victoria Maddox, Gavin C Donaldson, Timothy D McHugh, William O Cookson, Miriam F Moffatt and 5 more

Registry-linked trialOpen access · hybridAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Thorax, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01398072 (A Phase III Single-blind, Randomised Placebo Controlled Trial of Long Term Therapy in Patients With Stable COPD Using Moxifloxacin, Azithromycin and Doxycycline), which is not on this map. Cited by 49 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
49citing papers in PubMed, 6 pooled it
10.9field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01398072 phase3unknown statusnot on this map

A Phase III Single-blind, Randomised Placebo Controlled Trial of Long Term Therapy in Patients With Stable COPD Using Moxifloxacin, Azithromycin and Doxycycline: a Bayesian Decision Analysis, Including Other Criteria, Will be Used to Distinguish the Optimal Antibiotic Treatment

TypeinterventionalSponsorUniversity College, LondonRan2011 to 2013Enrolled200ConditionsChronic Obstructive Pulmonary Disease (COPD).ArmsMoxifloxacin, Azithromycin, Doxycycline, Placebo
3 · Its place in the literature

Who cites it

49 citing papers in PubMed, 6 syntheses or guidelines pooled it, 76 citations in OpenAlex.

  1. Macrolides versus placebo for chronic asthma.The Cochrane database of systematic reviews · 2021
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  19. Looking Beyond the Lower Airways for Microbes Affecting Pulmonary Fibrosis.American journal of respiratory and critical care medicine · 2024
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 5 institutions in 1 country.

Simon E BrillNational Heart and Lung Institute, Imperial College London, London, UK.
Martin LawMedical Research Council Biostatistics Unit Hub for Trials Methodology Research, Cambridge, UK.
Ethaar El-EmirNational Heart and Lung Institute, Imperial College London, London, UK.
James P AllinsonNational Heart and Lung Institute, Imperial College London, London, UK.
Phillip JamesNational Heart and Lung Institute, Imperial College London, London, UK.
Victoria MaddoxCentre for Clinical Microbiology, University College London, London, UK.
Gavin C DonaldsonNational Heart and Lung Institute, Imperial College London, London, UK.
Timothy D McHughCentre for Clinical Microbiology, University College London, London, UK.
William O CooksonNational Heart and Lung Institute, Imperial College London, London, UK.
Miriam F MoffattNational Heart and Lung Institute, Imperial College London, London, UK.
Irwin NazarethDepartment of Primary Care and Population Sciences, University College London, London, UK.
John R HurstCentre for Respiratory Medicine, University College London, London, UK.
Peter M A CalverleySchool of Aging and Chronic Disease, University of Liverpool, Liverpool, UK.
Michael J SweetingDepartment of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Jadwiga A WedzichaNational Heart and Lung Institute, Imperial College London, London, UK.
Imperial College London · GBUniversity College London · GBMedical Research Council · GBUniversity of Cambridge · GBUniversity of Liverpool · GB

Funding

British Heart Foundation RG/08/014/24067Department of Health RP-PG-0109-10056Medical Research Council G0800860Medical Research Council G1000758Medical Research Council MR/L003120/1Wellcome Trust 097117
6 · The paper itself

Abstract

backgroundLong-term antibiotic therapy is used to prevent exacerbations of COPD but there is uncertainty over whether this reduces airway bacteria. The optimum antibiotic choice remains unknown. We conducted an exploratory trial in stable patients with COPD comparing three antibiotic regimens against placebo.

methodsThis was a single-centre, single-blind, randomised placebo-controlled trial. Patients aged ≥45 years with COPD, FEV1<80% predicted and chronic productive cough were randomised to receive either moxifloxacin 400 mg daily for 5 days every 4 weeks, doxycycline 100 mg/day, azithromycin 250 mg 3 times a week or one placebo tablet daily for 13 weeks. The primary outcome was the change in total cultured bacterial load in sputum from baseline; secondary outcomes included bacterial load by 16S quantitative PCR (qPCR), sputum inflammation and antibiotic resistance.

results99 patients were randomised; 86 completed follow-up, were able to expectorate sputum and were analysed. After adjustment, there was a non-significant reduction in bacterial load of 0.42 log10 cfu/mL (95% CI -0.08 to 0.91, p=0.10) with moxifloxacin, 0.11 (-0.33 to 0.55, p=0.62) with doxycycline and 0.08 (-0.38 to 0.54, p=0.73) with azithromycin from placebo, respectively. There were also no significant changes in bacterial load measured by 16S qPCR or in airway inflammation. More treatment-related adverse events occurred with moxifloxacin. Of note, mean inhibitory concentrations of cultured isolates increased by at least three times over placebo in all treatment arms.

conclusionsTotal airway bacterial load did not decrease significantly after 3 months of antibiotic therapy. Large increases in antibiotic resistance were seen in all treatment groups and this has important implications for future studies. TRIAL REGISTRATION NUMBER: clinicaltrials.gov (NCT01398072).

Indexed as

AgedAnti-Bacterial AgentsAzithromycinBacterial LoadDoxycyclineFemaleFluoroquinolonesHumansMaleMiddle AgedMoxifloxacinOutcome Assessment, Health CarePulmonary Disease, Chronic ObstructiveRespiratory SystemSingle-Blind MethodSputumAnti-Bacterial AgentsAzithromycinDoxycyclineFluoroquinolonesMoxifloxacinCOPD ExacerbationsCOPD PathologyRespiratory Infection

Identifiers

PMID26179246
PMCPMC4602260
OpenAlexW2172046332

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.