Do antibiotics improve outcomes in hospitalized patients with COPD exacerbations?

January 01, 0001

Do antibiotics improve outcomes in hospitalized patients with COPD exacerbations?

Guidelines include use of antibiotics in treatment of COPD exacerbations. However, the data supporting their use is comparatively weak and is based off of small trials. These US researchers performed a prospective cohort of hospitalized patients in the US to see whether antibiotic use in the first two days of admission had an affect compared with later use or no use at all. They uses a composite measure of treatment failure, which was defined as the initiation of mechanical ventilation after the second hospital day, mortality, or readmission. They also examined length of stay, and hospital costs.

The researchers found: "Of 84,621 patients, 79 percent received at least 2 consecutive days of antibiotic treatment. Treated patients were less likely than nontreated patients to receive mechanical ventilation after the second hospital day (1.07 percent vs 1.80 percent), had lower rates of inpatient mortality (1.04 percent vs 1.59 percent), and had lower rates of readmission for acute exacerbations of COPD (7.91 percent vs 8.79 percent). Patients treated with antibiotic agents had a higher rate of readmissions for Clostridium difficile (0.19 percent) than those who were not treated (0.09 percent). After multivariable adjustment, including the propensity for antibiotic treatment, the risk of treatment failure was lower in antibiotic- treated patients (odds ratio, 0.87). A grouped treatment approach and hierarchical modeling to account for potential confounding of hospital effects yielded similar results. Analysis stratified by risk of treatment failure found similar magnitudes of benefit across all subgroups."

The researchers concluded: "Early antibiotic administration was associated with improved outcomes among patients hospitalized for acute exacerbations of COPD regardless of the risk of treatment failure."

This study suggests that the prompt use of antibiotics in patients hospitalized during COPD exacerbations is associated with better outcomes.

For the full abstract, click here.

JAMA 303(20):2035-2042, 26 May 2010 © 2010 the American Medical Association
Antibiotic Therapy and Treatment Failure in Patients Hospitalized for Acute Exacerbations of Chronic Obstructive Pulmonary Disease. Michael B. Rothberg, Penelope S. Pekow, Maureen Lahti, Oren Brody, Daniel J. Skiest, and Peter K. Lindenauer.

Category: R. Respiratory. Keywords: COPD exacerbation, hospitalized patients, antibiotic use, mortality, mechanical ventilation, prospective cohort study, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 18 June 2010

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