Vollenweider DJ, Frei A, Steurer, Stey CA, et al. (2018). Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Cochrane Database Systematic Rev 10: CD010257
Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease characterized by a progressive deterioration in respiratory function. COPD exacerbations (COPDE) are associated with increased morbidity and mortality, increased hospitalizations, decreased physical capacity, and increased medical costs. Antibiotic therapy (ABT) in this context remains controversial.
Does the use of ABT in case of COPDE reduce treatment failures between D7 and D30? What is its impact on mortality, disease severity and adverse events?
ABT in COPDE significantly reduces the risk of treatment failure in the ambulatory and inpatient setting, including those in intensive care units (ICU). This reduction is important in the case of mild to moderate COPDE and severe COPDE. Subgroup analysis based on the most commonly used antibiotics like penicillin, metronidazole and doxycycline does not show any significant difference. Unlike patients admitted to the ICU, there is no significant difference in mortality reduction for conventional inpatients and outpatients treated with ABT. Hospitalization times are not significantly reduced except for ICU patients. Finally, there is no significant increase in adverse events when ABT is used.
Evidence of benefit of ABT in patients with mild to moderate severe COPDE is inconclusive and justifies the conduct of further randomized controlled trials. Several sources of bias and heterogeneity complicate the interpretation of the results: additional treatments that are not always specified, the clinical severity of the underlying COPD and co-morbidities of enrolled subjects.
SMUR, CH Gonesse
Département de médecine d’urgence, CHU de Tours
Dalhousie University – QEII Health Science Centre
Nova Scotia, Canada