Antibiotics enhance COPD treatment
By Lucy Piper, Senior medwireNews Reporter
18 January 2013
CHEST 2013; 143: 82–90

medwireNews: Patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease (AE-COPD) may benefit from the addition of antibiotics to systemic steroid therapy, research suggests.

The findings indicate that this addition of antibiotics is associated with a substantial reduction in the risk for hospital death and readmission.

"These findings were robust to a variety of analytic approaches and in sensitivity analyses," note Mihaela Stefan (Baystate Medical Center, Massachusetts, USA) and colleagues. "At the same time, antibiotic choice was not associated with in-hospital mortality."

The researchers compared the effectiveness of three commonly used antibiotic regimens in 53,900 patients who were admitted to hospitals in the USA for AE-COPD and treated with corticosteroids. The patients were aged 40 years or older.

In all, 85% of the participants were treated with antibiotics (quinolone, macrolides plus cephalosporin, or macrolide monotherapy) in the first 2 days of hospital admittance.

These patients had a significantly lower crude in-hospital mortality rate than those not treated with antibiotics, at 1.0% versus 1.8%.

After multivariate analysis adjusting for patient and hospital characteristics, treatments, propensity score, and diagnostic tests, receipt of antibiotics was associated with a 40% reduction in the odds for in-hospital mortality. Patients treated with antibiotics were also 13% less likely to be readmitted for AE-COPD within 30 days than those not treated with antibiotics.

"The results of our analysis do not strongly support one antibiotic over the other," the researchers note in CHEST. "Whether the antibiotic choice is important in AE-COPD is still debatable."

They also stress that their study should not be interpreted as "evidence of indiscriminate prescribing of antibiotics to any hospitalized patient with AE-COPD."

The team explains: "We did not have clinical data and could not assess when antibiotics were used inappropriately. The benefit of antibiotics should not be generalized to all subgroups of patients, and treating only certain patients is still preferable."

medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

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