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Uncertainty over - give antibiotics in exacerbations of COPD


People with chronic obstructive pulmonary disease often experience short term worsening and aggravation of their symptoms. To date, there has been conflicting evidence as to whether these exacerbations should be treated with antibiotic therapy. A new systematic review to be published in The Cochrane Library, Issue 2, 2006 now concludes that they should be used. The researchers found that antibiotics reduce the risk of dying from the attack by 77%, decreases the risk of treatment failure by 53% and decrease the risk of developing pussy sputum by 44%. There is, however, a small increase in the risk of developing diarrhoea.

Many people question whether antibiotics should be used to combat exacerbations of COPD. The uncertainty stems from the growing desire to use antibiotics only when necessary, combined with the recognition that up to one third of exacerbations of COPD have are not caused by infections, and some others are due to viral infections.

A large number of trials have been conducted to try and address this situation, but a simple comparison suggests that the data is contradictory.

To clarify the situation the Cochrane Review Authors performed a systematic review of available data, and identified 11 trials involving 917 patients.

"The review showed clearly that antibiotic therapy, regardless of which antibiotic was used, reduced the risks involved in an exacerbation, and as might be expected, the effects is greatest in patients with more severe disease," says lead Review Author Dr Felix Ram, Senior Lecturer in Respiratory Medicine & Clinical Pharmacology in the School of Health Sciences, at Massey University in Auckland, New Zealand.

"The controversy over whether antibiotics should be prescribed to patients with acute exacerbations of COPD has been very highly debated and unsolved for many years in the respiratory field and this review will help to finally resolve this long outstanding issue in the management of our COPD patients," adds Dr Ram.


Review Title: Ram FSF et. al. Antibiotics for exacerbations of chronic obstructive pulmonary disease. The Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD004403.pub2. DOI: 10.1002/14651858.CD004403.pub2.

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