Antibiotics used in the ambulatory management of acute COPD exacerbations

Abstract

Study objectives: This study was conducted to describe the different antibiotics that are used in the home management of chronic obstructive pulmonary disease (COPD) exacerbations and to estimate the failure rates following the initiation of the antibiotic. Methods: A cohort study was conducted. Patients enrolled in a COPD home management program were included in the analysis. Failure rates were defi ned as an additional prescription of an antibiotic, an emergency room visit, or a hospitalization for a COPD exacerbation in the 30 days following the initiation of the antibiotic. Results: A total of 1180 episodes of antibiotic treatment were analyzed. Overall, 348 episodes led to a failure (29.5%). The most frequently used antibiotics were cefuroxime (45.9%) and ciprofl oxacin (21.1%). Conclusion:This project demonstrates that a wide range of antibiotics were prescribed to our population of COPD patients with a moderate to severe form of the disease. Many treatment failures (about 30%) occurred in the 30-day period following the initiation of the home therapy with an antibiotic. Clinicians should be aware of this high failure rate when managing mild exacerbations of COPD at home.

Terms and Definitions Used to Describe Recurrence, Treatment Failure and Recovery of Acute Exacerbations of COPD: A Systematic Review of Observational Studies

“…Treatment failure was a term used by 12 articles and was defined as a composite of absence of symptom resolution (n = 2), antibiotic or oral corticosteroid prescription or change in medication (n = 3), hospital readmission (n = 7), increased mechanical ventilator support (n = 5), and/or death (n = 7). 51–62 One study defined treatment failure as failure to return to baseline or need for a new treatment medication. 57 Treatment failure was a term only used for moderate or severe exacerbations.…”

“…The timeframe for observing treatment failure ranged from two days from hospital admission 60 to ninety days from hospital discharge. 54 The proportion of patients with treatment failure ranged from 14.5% at/before seven days 51 to 36.8% at/before 90 days. 54 By 30 days (the most common timeframe), the proportion experiencing treatment failure ranged from 7.4% to 34.8% 55 – suggesting heterogeneity in the studies, potentially due to a range of definitions for treatment failure between studies.…”

Antibiotics Use among Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in the Department of Internal Medicine of a Tertiary Care Centre: A Descriptive Cross-sectional Study

“… 12 , 13 , 16 However, the Penicillin group of antibiotics was least used in two settings. 15 , 17 The Macrolides and Cephalosporin groups were among the antibiotics to be used as an alternative to penicillin in most of the studies. 15 , 17 , 18 Based on the GOLD-2021 and European Respiratory Society (ERS) guidelines, Co-amoxiclav is the preferred empirical antibiotic for AECOPD.…”

Prediction of exacerbation frequency of AECOPD based on next-generation sequencing and its relationship with imbalance of lung and gut microbiota: a protocol of a prospective cohort study

“…As the growth of some parasitic bacteria and yeasts in the intestine (such as Candida albicans ) is inhibited, the number of bacteria (such as Proteus , Staphylococcus and Clostridium difficile ) would increase. 38 The use of broad-spectrum antibiotics causes collateral damage, including overgrowth of potentially pathogenic intestinal flora, which can impact the inflammatory immune responses. Patients with AECOPD frequently receive antibiotic treatment and are often subjected to mechanical ventilation, which may induce local and systemic inflammatory responses.…”