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IntroductionDuration of antibiotic treatment in acute exacerbation of COPD (AECOPD) is most commonly based on expert opinion. Biomarker guided strategy is increasingly recommended to limit unnecessary antibiotic use. We performed a randomized controlled study to evaluate the efficacy of 2-day versus C-reactive protein (CRP)-guided treatment with levofloxacin in patients with AECOPD.MethodsPatients with AECOPD were randomized to receive oral levofloxacin daily for 7 days unless the serum CRP level decreased by at least 50% from the baseline value or levofloxacin for two days; thereafter, oral placebo tablet was prescribed according to the CRP. The primary outcome measure was cure rate, and secondary outcome included need for additional antibiotics, intensive care unit (ICU) admission, exacerbation rates and exacerbation free interval (EFI) within one-year follow-up.ResultsIn intention to treat (ITT) analysis, cure rate was 76.1% (n = 118) and 79.3% (n = 123) respectively in 2-day and CRP-guided groups. In per protocol (PP) analysis, cure rate was 73% (n = 92) and 70.4% (n = 88) respectively in 2-day and CRP-guided groups. The difference between the two groups was not significant. The need for additional antibiotics and ICU admission rates were not significantly different between the two groups. One-year exacerbation rate was 27% (n = 42) in 2-day group versus 30.3% (n = 47) in CRP-guided group (p = 0.53); the EFI was 125 days (interquartile range, 100-151) versus 100 days (interquartile range, 78-123) in 2-day and CRP-guided groups respectively (p = 0.45). No difference in adverse effects was detected.ConclusionLevofloxacin once daily for 2 days had similar efficacy compared to CRP-guided in AECOPD. This short course treatment decreased antibiotic consumption which would improve patient compliance and reduce adverse effects.

Lemon balm (Melissa officinalis L.) is one of the rare medicinal plants in Tunisia. It was found only in two sites in the north of Tunisia with a small number of plants. The study of germination under the NaCl and PEG effect showed that Tunisian lemon balm seeds were sensitive to saline and osmotic stress. Morphological and biochemical characterizations of Tunisian M. officinalis were performed. Results showed that the Tunisian populations presented plants with long, broad leaves and weak branching. The major constituent in leaf essential oil was germacrene-D with a percentage ranging from 29.17 to 24.6%, and the major fatty acids were polyunsaturated fatty acids, linoleic acid, ranging from 73.93 to 66.74%. The phenolic content of M. officinalis extract varied significantly among origins which could explain the high variation in antiradical scavenging activity. The evaluation of allelopathic activities showed that the extract of the lemon balm leaves presented an allelopathic effect with the majority of the tested seeds. [ABSTRACT FROM AUTHOR]