December 14, 2018
Antibiotics for acute exacerbations of chronic obstructive pulmonary disease (COPD) offer strong benefit for patients in the intensive care unit but just small effects for other inpatients as well as outpatients, according to a recent systematic review for the Cochrane Database of Systematic Reviews.
“Many patients with an exacerbation of COPD are treated with antibiotics,” researchers wrote. “However, the value of antibiotics remains uncertain, as systematic reviews and clinical trials have shown conflicting results.”
Researchers reviewed evidence from 19 randomized controlled trials with 2663 participants.
Just a single study involved patients in the intensive care unit (ICU). However, data showed antibiotics reduced treatment failures from 565 to 107 per 1000 treated participants. Antibiotics also had a statistically significant effect or mortality and length of hospital stay in the ICU population, researchers reported.
The effect of antibiotic treatment on inpatients and outpatients in studies was small and, for outcomes such as treatment failure, inconsistent. For mortality and length-of-hospital-stay outcomes among patients not in intensive care, antibiotics had no effect, according to the review.
Data was limited regarding the effect of antibiotics on health-related quality of life and other patient-reported symptoms. Compared with placebo, antibiotics did not significantly raise the risk of adverse events, the review found.
“These inconsistent effects call for research into clinical signs and biomarkers that can help identify patients who would benefit from antibiotics,” researchers concluded, “while sparing antibiotics for patients who are unlikely to experience benefit and for whom downsides of antibiotics (side effects, costs, and multi-resistance) should be avoided.”
Vollenweider DJ, Frei A, Steurer-Stey CA, Garcia-Aymerich J, Puhan MA. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews. 2018;10:CD010257.
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