Medicine by the Numbers

A Collaboration of TheNNT.com and AFP

Antibiotics for Exacerbations of Chronic Obstructive Pulmonary Disease

 

Am Fam Physician. 2020 Feb 1;101(3):online.

image

 Enlarge     Print

ANTIBIOTICS FOR EXACERBATIONS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

BenefitsHarms

1 in 12 prevented outpatient treatment failure

No difference in adverse effects

No lives were saved

No difference in length of hospital stay

ANTIBIOTICS FOR EXACERBATIONS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

BenefitsHarms

1 in 12 prevented outpatient treatment failure

No difference in adverse effects

No lives were saved

No difference in length of hospital stay

Details for This Review

Study Population: Patients older than 40 years with mild to very severe exacerbations of chronic obstructive pulmonary disease (COPD)

Efficacy End Points: Treatment failure measured between seven days and one month, length of hospital stay, and mortality

Harm End Points: Diarrhea

Narrative: Prescription of antibiotics for treatment of COPD exacerbations is controversial because of the variety of etiologies that induce a flare-up, including viral, bacterial, and environmental causes.1 Approximately one-half of exacerbations are thought to be bacterial in origin.2 Antibiotics continue to be widely prescribed.3 Adverse effects are often minor, and benefits may appear to outweigh harms. However, the most important argument against antibiotic use is antibiotic overuse and the emergence of multidrug-resistant bacteria.4

This Cochrane review included 19 randomized controlled trials with 2,663 patients.5 Eleven trials evaluated outpatients, seven trials evaluated inpatients, and one trial evaluated patients in the intensive care unit (ICU). In the outpatient setting, low-quality evidence showed that antibiotics statistically and significantly reduced the risk of treatment failure with a number needed to treat (NNT) of 12 (95% CI, 0.53 to 0.90). When restricted to the seven trials that included currently used antibiotics, low-quality evidence suggested a similar effect with an NNT of 12 (95% CI, 0.56 to 0.94). There was no mortality benefit.

In the general inpatient setting, antibiotics did not have a statistically significant effect on preventing treatment failure, decreasing the length of stay, or preventing mo

Author disclosure: No relevant financial affiliations.

References

show all references

1. Labaki WW, Han MK. Antibiotics for COPD exacerbations. Lancet Respir Med. 2017;5(6):461–462....

2. Sethi S. Bacteria in exacerbations of chronic obstructive pulmonary disease: phenomenon or epiphenomenon? Proc Am Thorac Soc. 2004;1(2):109–114.

3. Pretto JJ, McDonald VM, Wark PA, et al. Multicentre audit of inpatient management of acute exacerbations of chronic obstructive pulmonary disease: comparison with clinical guidelines. Intern Med J. 2012;42(4):380–387.

4. World Health Organization. Antimicrobial resistance. Accessed August 6, 2019. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance

5. Vollenweider DJ, Frei A, Steurer-Stey CA, et al. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2018;(10):CD010257.

 

 

Copyright © 2020 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

More in Pubmed

MOST RECENT ISSUE


Sep 15, 2020

Access the latest issue of American Family Physician

Read the Issue


Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article