Source: Annual Congress 2006 - COPD and inflammation
Disease area: Airway diseases

Abstract

The true efficacy of antibiotic use in the treatment of exacerbations of chronic obstructive pulmonary disease (COPD) remains controversial. Most patients are treated with a broad-spectrum antibiotic during an exacerbation, and a number of controlled trials have shown their beneficial effects. However, some trials have shown a lack of positive effect with antibiotic therapy. Despite clinical trials and guidelines the role of antibiotics in the management of exacerbations of COPD remains a matter of debate.
We conducted a systematic review with meta-analysis of all available high quality randomised controlled trials. Studies were searched for on the Cochrane trials database, MEDLINE, EMBASE, CINAHL, Web of Science and key respiratory journal web sites.
Eleven trials with 917 patients with moderate-to-severe COPD exacerbations were included in the review. Antibiotic therapy reduced relative risk (RR) of mortality by 77% (RR 0.23; 95%CI 0.10, 0.52), treatment failure by 53 (RR 0.47; 95%CI 0.36, 0.62) and sputum purulence by 44% (RR 0.56; 95%CI 0.41, 0.77). The number of patients required to be treated with antibiotics to save one life was 8 (95%CI 6, 17) to avoid one treatment failure was 3 (95%CI 2, 4) and to avoid one patient having purulent sputum 8 (95%CI 5, 14). There was an increased risk of diarrhoea with antibiotic use (RR 2.86; 95%CI 1.06, 7.76).
This review has shown that in moderate-to-severe exacerbations of COPD, antibiotic therapy regardless of antibiotic choice, is efficacious in decreasing the risk of mortality, treatment failure and sputum purulence. This review supports the use of antibiotics for patients with exacerbations of COPD who are moderately or severely ill.

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F. S. F. Ram, R. Rodriguez-Roisin, A. Granados-Navarrete, J. Garcia-Aymerich, N. C. Barnes (Auckland, New Zealand; Barcelona, Spain; London, United Kingdom). Role of antibiotics in exacerbations of chronic obstructive pulmonary disease: a Cochrane review. Eur Respir J 2006; 28: Suppl. 50, 2001

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