Some COPD exacerbations need antibiotic treatment
John Cole/Science Photo Library
Patients admitted to hospital benefit most from antibotic treatment |
Exacerbations of chronic obstructive pulmonary disease associated with
increased cough and sputum purulence should be treated with antibiotics,
according to a review published
online in The Cochrane Database of Systematic Reviews (19
April 2006).
There is conflicting evidence as to whether acute COPD exacerbations
should be treated with antibiotics, say the reviewers. They conducted
a systematic review of 11 trials with 917 patients to estimate the value
of antibiotics in the management of acute COPD exacerbations.
The reviewers found that, regardless of choice, antibiotics reduced the
risk of death by 77 per cent (relative risk 0.23, 95 per cent confidence
interval 0.10–0.52); decreased the risk of treatment failure by
53 per cent (RR 0.47, 95 per cent CI 0.36–0.62); and reduced the
risk of sputum remaining purulent by 44 per cent (RR 0.56, 95 per cent
CI 0.41–0.77). However, antibiotics also increased the risk of
diarrhoea (RR 2.86, 95 per cent CI 1.06–7.76).
“This effect is greatest in the severe group of patients who are
admitted to hospital. Analysis restricted to community-based studies
did not find
differences between antibiotic and placebo,” say the reviewers
The results should be interpreted with caution owing to differences in
patient selection, choice of antibiotic and the small number of trials
included, they add. “Nevertheless, this review supports the use
of antibiotics for most patients with increased cough and sputum purulence
with exacerbations of COPD who are moderately or severely ill.” |
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