Summary of article: Antibiotics for exacerbations of chronic obstructive pulmonary disease
This article is a meta-analysis and systematic review
Why I chose this? I remember learning in school to give abx for a COPD exacerbation, but I was surprised when my patient didn’t receive it. I was curious if the guidelines changed and I was also curious if it is helpful. What I have learned is that prescribing antibiotics for an acute COPD exacerbation is controversial, only about half of exacerbations are due to bacterial etiologies.
According to uptodate “Most clinical practice guidelines recommend antibiotics for patients having a moderate to severe COPD exacerbation that requires hospitalization “ They recommend antibiotics for patients who most likely have a bacterial infection or are most ill
This study aimed to assess the effects on abx on treatment failure between 7 days to 1 month for management of acute Copd exacerbqtion. It also aimed to study mortality, adverse events, length of hospital stay, time to next exacerbation.
Articles included: RCTs with patients who had acute COPD exacerbation and where either given abx or placebo. 19 trials were included and a total of 2,663 patients from outpatient, inpatient and icu.
Risk of bias from included articles: the studies included were found to have low to moderate risk of bias .
Results/Conclusion:
Meta‐analyses show that antibiotics for acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) reduced treatment failure in a statistically significant way for patients with mild to moderate AECOPDs (outpatients) and for those with very severe AECOPDs (admitted to the intensive care unit (ICU); only one trial).
There was a significant reduction in risk of mortality and length of hospital stay for ICU patients with the use of abx. There was also no statistically significant increase in risk of adverse events associated antibiotic use compared to placebo.
(Overall, antibiotics provide a strong beneficial effect for ICU patients. They provide some effects for inpatients and for outpatients, but these effects are small and inconsistent for some outcomes (treatment failure) and absent for other outcomes (mortality, length of hospital stay). It should be noted that the study including ICU patients was conducted approximately 20 years ago, and advances in the care of people admitted to the ICU have been made since that time. Therefore, these results should be interpreted and applied with caution.)
Limitation: The articles don’t clearly have a common definition for the severity of exacerbations. Additionally there was only one article that looked at ICU patients.
