Antibiotics for treatment of acute exacerbation of chronic obstructive pulmonary disease: a network meta-analysis

Zhang, Hailin; Tan, Min; Qiu, Aimin; Zhang, Tao; Wang, Changhui

doi:10.1186/s12890-017-0541-0

Cited by 30 publications

(20 citation statements)

References 60 publications

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“…It may be that better adherence to guideline recommendations not recorded in this audit, for example, NIV pressures used, ventilator asynchrony, managed agitation have made a significant contribution to impove outcomes 24–26. There have been significant improvements in processes of general COPD care between 2008 and 2014 including a higher proprotion of patients receiving antibiotics within 24 hours and the proportion of patients with controlled oxygen prescribed both which have been demonstrated elsewhere to improve outcomes 4 19 27–32. Notably, PaO 2 ABG values in the 2014 cohort were lower than in 2008 (table 1).…”

Section: Discussionmentioning

confidence: 87%

Time to NIV and mortality in AECOPD hospital admissions: an observational study into real world insights from National COPD Audits

et al. 2019

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BackgroundRandomised control trial (RCT)-derived survival figures for acute exacerbation of chronic obstructive pulmonary disease admissions managed with non-invasive ventilation (NIV) have not been replicated in UK clinical audits. Subsequent guidelines have emphasised the need for timely NIV application.MethodsData from the 2008 and 2014 national chronic obstructive pulmonary disease audits was used to analyse the association between time to NIV and mortalityResults1032 patients received NIV in 2008, and 1612 in 2014. Overall mortality rates reduced between the audits from 24.9% in 2008 to 16.8% in 2014 but time to NIV lengthened. In 2014, 20.9% of patients received NIV within 60 min versus 24.9% in 2008 (p=0.001). The proportion of patients receiving NIV between 3 and 24 hours increased from 31.3% in 2008 to 39% in 2014 (p=0.001). Patients admitted with hypercapnic acidotic respiratory failure who received NIV within 3 hours had lower in-patient mortality than those who received NIV between 3 and 24 hours, 15.9% versus 18.4%, but this did not reach statistical significance (p=0.425), but acidotic patients receiving NIV >24 hours after admission had significantly higher mortality (28.9%, p=0.002). A second cohort admitted with hypercapnia but normal range pH, who developed later acidosis, had higher mortality (24.6%), compared with those acidotic on admission (18% p≤0.001) and an extremely high mortality when NIV was given >24 hours after admission (42.6%).ConclusionSurvival rates for those treated with NIV has improved between the two audits but remains lower than reported in RCTs. Patients who developed acidosis after admission and received NIV later in the hospital stay have even higher mortality and deserve further study and clinical attention.

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Section: Discussionmentioning

confidence: 87%

Time to NIV and mortality in AECOPD hospital admissions: an observational study into real world insights from National COPD Audits

et al. 2019

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“…Furthermore, some meta-analyses have also been conducted to evaluate these findings, with the conclusion that prophylactic macrolide therapy is effective in decreasing the frequency of exacerbations in patients with COPD. 13 – 17 However, the most suitable drug, drug dose, duration of therapy, and target population remain unclear. 18 There is also no agreement on the long-term safety related to the emergence of macrolide resistance and adverse events.…”

Section: Introductionmentioning

confidence: 99%

Long-term macrolide treatment for the prevention of acute exacerbations in COPD: a systematic review and meta-analysis

Cui

Luo

et al. 2018

COPD

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BackgroundAcute exacerbation of COPD (AECOPD) is associated with an increased hospitalization and mortality. Azithromycin and erythromycin are the recommended drugs to reduce the risk of exacerbations. However, the most suitable duration of therapy and drug-related adverse events are still a matter of debate. The aim of this meta-analysis was to assess the current evidence regarding the efficacy and safety of long-term macrolide treatment for COPD.Materials and methodsWe comprehensively searched PubMed, Embase, the Cochrane Library, and the Web of Science and performed a systematic review and cumulative meta-analysis of all randomized controlled trials (RCTs) and retrospective studies.ResultsEleven RCTs and one retrospective study including a total of 2,151 cases were carried out. Long-term macrolide treatment significantly reduced the total number of cases with one or more exacerbations (OR=0.40; 95% CI=0.24–0.65; P<0.01) and the rate of exacerbations per patient per year (risk ratio [RR]=0.60; 95% CI=0.45–0.78; P<0.01). Subgroup analyses showed that the minimum duration for drug efficacy for both azithromycin and erythromycin therapy was 6 months. In addition, macrolide therapy could improve the St George Respiratory Questionnaire (SGRQ) total score (P<0.01) but did not achieve the level of clinical significance. The frequency of hospitalizations was not significantly different between the treatment and control groups (P=0.50). Moreover, chronic azithromycin treatment was more likely to increase adverse events (P<0.01).ConclusionProphylactic azithromycin or erythromycin treatment has a significant effect in reducing the frequency of AECOPD in a time-dependent manner. However, long-term macrolide treatment could increase the occurrence of adverse events and macrolide resistance. Future large-scale, well-designed RCTs with extensive follow-up are required to identify patients in whom the benefits outweigh risks.

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“…7,8 Several drugs are recommended for patients with COPD exacerbation, including bronchodilators (eg, b 2 -agonists, long-acting muscarinic antagonists, theophylline), antibiotics, and inhaled or systemic corticosteroids. [9][10][11][12][13] Systemic corticosteroids (SCS) are commonly prescribed to treat patients with respiratory conditions such as asthma and to reduce the risk of flare-ups of inflammatory conditions, including rheumatologic and autoimmune diseases, allergic reactions, and inflammatory bowel disease. Although SCS have long been used to treat patients with COPD exacerbation, there have been no head-to-head randomized controlled trials (RCTs) to directly compare the effect of different dosage regimens of SCS.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Different Doses of Systemic Corticosteroids in COPD Exacerbation

Liu

Feng

et al. 2020

Respir Care

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BACKGROUND: Although systemic corticosteroids (SCS) have long been used to treat patients with COPD exacerbation, the recommended dose remains controversial. We aimed to perform a meta-analysis and an indirect treatment comparison to investigate the efficacy and safety of different doses of SCS in subjects with COPD exacerbation. METHODS: Studies were identified by searching different databases for randomized controlled trials that investigated the efficacy and safety of SCS with placebo in subjects with exacerbation of COPD. The different doses of SCS were assigned to low-dose (ie, initial dose^40 mg prednisone equivalent/d [PE/d]), mediumdose (initial dose 5 40-100 mg PE/d, and high-dose (initial dose > 100 mg PE/d) groups. The indirect treatment comparison was performed between low-, medium-, and high-dose SCS groups. RESULTS: Twelve trials with 1,375 participates were included. Compared to placebo, the risk of treatment failure was lower in the low-dose SCS groups (risk ratio 0.61 [95% CI 0.43-0.88], P 5 .007) and high-dose SCS groups (risk ratio 0.64 [95% CI 0.48-0.85], P 5 .002); the FEV 1 was significantly improved in low-dose (mean difference 0.09 [95% CI 0.06-0.12], P < .001), medium-dose (mean difference 0.23 [95% CI 0.02-0.44], P 5 .036), and high-dose SCS groups (mean difference 0.09, [95% CI 0.03-0.15], P < .001, respectively). Regarding safety, the incidence of hyperglycemia was higher in high-dose SCS groups versus placebo (risk ratio 2.52 [95% CI 1.13-5.62], P 5 .02). The indirect comparison between low-, medium-, and high-dose SCS found that the risk of treatment failure and changes in FEV 1 were similar between these doses of SCS. CONCLUSIONS: This meta-analysis indicates that low-dose SCS (initial dose4 0 mg PE/d) was sufficient and safer for treating subjects with COPD exacerbation, and it was noninferior to higher doses of SCS (initial dose > 40 mg PE/d) in improving FEV 1 and reducing the risk of treatment failure. However, our findings need to be verified in head-to-head randomized controlled trials.

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Antibiotics for treatment of acute exacerbation of chronic obstructive pulmonary disease: a network meta-analysis

Cited by 30 publications

References 60 publications

Time to NIV and mortality in AECOPD hospital admissions: an observational study into real world insights from National COPD Audits

Time to NIV and mortality in AECOPD hospital admissions: an observational study into real world insights from National COPD Audits

Long-term macrolide treatment for the prevention of acute exacerbations in COPD: a systematic review and meta-analysis

Efficacy and Safety of Different Doses of Systemic Corticosteroids in COPD Exacerbation

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