426 Prophylactic antibiotics effective for chronic obstructive pulmonary disease

July 02, 2014

PEARLS 426, March 2014, written by Brian R McAvoy

Clinical question
How effective are prophylactic antibiotics for patients with chronic obstructive pulmonary disease (COPD)?

Bottom line
Use of continuous prophylactic macrolide antibiotics for a period of up to 12 months reduced the number of patients with exacerbations (NNT = 8),* exacerbation frequency and the median time to first exacerbation. There was also a significant improvement seen in health-related quality of life, though the improvement may be too small to be clinically significant. The impact of pulsed antibiotics was uncertain. Neither pulsed nor continuous antibiotics showed a significant effect on the secondary outcomes of frequency of hospital admissions, change in lung function, serious adverse events or all-cause mortality. The trials lasted from 3 months to 3 years.
*NNT= number needed to treat to benefit 1 individual.

Caveat
All trials of continuous antibiotics used macrolides. The trials included patients who had frequent exacerbations and needed treatment with antibiotics or systemic steroids, or who were on supplemental oxygen. It is not clear from the studies the extent to which participants had other treatments for their COPD optimised (eg, smoking cessation programmes, pulmonary rehabilitation, vaccination).

Context
People with COPD may have exacerbations that usually occur after respiratory infections. These may lead to further irreversible loss of lung function with days off work, hospital admission, reduction in quality of life and even death.

Cochrane Systematic Review
Herath SC, Poole P. Prophylactic antibiotic therapy for chronic obstructive pulmonary disease (COPD). Cochrane Reviews, 2013, Issue 11. Art. No.: CD009764.DOI: 10.1002/14651858. CD009764.pub2. This review contains 7 studies involving 3170 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.