Clinical Briefs-By Louis Kuritzky, MD

A Comparison of Moxifloxacin and Azithromycin in the Treatment of Acute Exacerbations of Chronic Bronchitis

Optimum treatment for acute exacerbations of chronic bronchitis (AECB) remains a matter of heated debate. Because AECB are common and a substantial minority of such cases result in hospitalization, refining treatment choices may help clinicians improve outcomes.

The trial enrolled 401 patients with AECB, defined as increased sputum purulence plus increased sputum volume, cough, or dyspnea. Patients were randomized to receive a five-day course of moxifloxacin (n = 203) 400 mg qd, or azithromycin (n = 198) 500 mg day 1, then 250 mg qd ´ 4. At the test of cure visit, patient outcomes were examined including the number of days until symptom relief, days until resuming normal activity, and hours of work missed.

Both regimens were highly effective for clinical resolution. Patients in the moxifloxacin group had a slightly more rapid recovery (symptomatic relief by day 3: moxifloxacin = 40%, azithro-mycin = 27%). Kreis and associates conclude that moxifloxacin is as effective for AECB resolution and may offer more rapid return to normal activities for some individuals.

Kreis SR, et al. Journal of Clinical Outcomes Management 2000;7(12): 33-37.

Patient Preferences for Laboratory Test Results Notification

Smooth and successful functioning of clinical care depends upon appropriately informing patients of laboratory test results. In recent studies, less than one-third of physicians routinely notified patients of normal results. Perhaps surprisingly, these same data reflected that more than one-third of physicians do not always notify patients even if results of laboratory tests are abnormal. This study investigated by telephone questionnaire (n = 49) patient responses to inquiry about lipid testing as part of their hypercholesterolemia evaluation. Inquiry detailed if they had been informed of results, the method used for informing, their level of satisfaction, and their personal preference for notification.

Most patients (85%) were notified about results by phone, mail, or at a subsequent visit. A resounding concordance of patients (93.9%) indicated that they believed that patients should be informed of all results, normal or abnormal, generally preferring notification by mail (63%) or telephone (13%). Patients who did receive notification of lab results were statistically significantly more satisfied than those who did not. The increased level of satisfaction was true whether results were abnormal or not. Meza and Webster conclude that patient satisfaction may be improved by routinely informing patients of laboratory test results.

Meza JP, Webster DS. Am J Manag Care 2000;6:1297-1300.

Urine Detection of Survivin and Diagnosis of Bladder Cancer

Bladder cancer accounts for more than 10,000 deaths annually in the United States. Recently, survivin (SVN), a dysregulator of apoptosis, has been implicated in a variety of cancers, including bladder cancer. SVN prolongs apoptosis. It has been theorized that by abnormally prolonging cell life, mutation accumulation occurs. Normal tissue does not have SVN, but it is prominent in a number of cancers, and its presence is associated with worse outcome. Since SVN has been found in almost 80% of bladder cancers, its use as a screening tool for bladder cancer was the subject of this investigation.

Abnormal levels of urine SVN were found in all 46 patients with a diagnosis of new or recurrent bladder cancer. Among healthy volunteers, and persons with other urologic cancers, urinary SVN levels were normal. Dramatizing the potential case-finding value of the tool in three patients with hematuria who were urine SVN positive, one demonstrated bladder cancer by cytology, and another developed bladder cancer within six months of evidencing an elevated urinary SVN level. Urinary SVN had a sensitivity for new or recurrent bladder cancer of 100%. Smith and associates comment that the single-antibody urine test for SVN is now commercially available and may function well in a number of clinical settings for detection and monitoring of bladder cancer.

Smith SD, et al. JAMA 2001;285:324-328.