Short-course antibiotic treatment in acute exacerbations of chronic bronchitis and COPD: a meta-analysis of double-blind studies

Abstract

Background: A study was undertaken to determine whether a short course of antibiotic treatment ((5 days) is as effective as the conventional longer treatment in acute exacerbations of chronic bronchitis and chronic obstructive pulmonary disease (COPD). Methods: MEDLINE, EMBASE and the Cochrane central register of controlled trials were searched to July 2006. Studies considered eligible were double-blind randomised clinical trials including adult patients >18 years of age with a clinical diagnosis of exacerbation of COPD or chronic bronchitis, no antimicrobial therapy at the time of diagnosis and random assignment to antibiotic treatment for (5 days versus .5 days. The primary outcome measure was clinical cure at early follow-up on an intention-to-treat basis.Results: 21 studies with a total of 10 698 patients were included. The average quality of the studies was high: the mean (SD) Jadad score was 3.9 (0.9). At early follow-up (,25 days), the summary odds ratio (OR) for clinical cure with short treatment versus conventional treatment was 0.99 (95% CI 0.90 to 1.08). At late follow-up the summary OR was 1.0 (95% CI 0.91 to 1.10) and the summary OR for bacteriological cure was 1.05 (95% CI 0.87 to 1.26). Similar summary ORs were observed for early cure in trials with the same antibiotic in both arms and in studies grouped by the antibiotic class used in the short-course arm. Conclusions: A short course of antibiotic treatment is as effective as the traditional longer treatment in patients with mild to moderate exacerbations of chronic bronchitis and COPD.

Diagnosis and Management of Chronic Obstructive Pulmonary Disease: The Swiss Guidelines

“…The determination of serum procalcitonin was shown to reduce the use of antibiotics in COPD exacerbations and may be of value in the decision to use antibiotics (Evidence A) [124]. If antibiotics are deemed needed, a short treatment course of ≤5 days is preferred, as these have an outcome equal to a conventional treatment with antibiotics of 7–10 days (Evidence C) [125]. Longer courses of antibiotics should be considered for patients with more severe exacerbations requiring a hospital admission or ICU stay and those with proven colonization or infection with Gram-negative rods.…”

Diagnosis, Prevention and Treatment of Stable COPD and Acute Exacerbations of COPD: The Swiss Recommendations 2018

“…In nonfebrile exacerbations, antibiotics do not reduce treatment failure at 28 days [97] do not prolong the exacerbationfree time [98]. Antibiotic treatment should not exceed 5-7 days during an AECOPD [12,99]. A serum procalcitonin-guided approach can reduce use and exposure to antibiotics without impacting clinical outcomes such as re-exacerbation, need for hospitalization or mortality (Evidence A) [100,101].…”

Zalecenia Polskiego Towarzystwa Chorób Płuc Dotyczące Rozpoznawania i Leczenia Przewlekłej Obturacyjnej Choroby Płuc

“…U chorych z umiarkowanym i ciężkim zaostrzeniem POChP skuteczna i wystarczająca okazała się krótka (5-dniowa) antybiotykoterapia [192].…”