Systemic antibiotics, corticosteroids effective in mild to moderate exacerbations of COPD

Chronic obstructive pulmonary disease (COPD) is characterized by frequent exacerbations.The researchers conducted a study to evaluate the comparative effectiveness and adverse events (AEs) of pharmacologic interventions for adults with exacerbation of COPD.

It was found that antibiotics and systemic corticosteroids reduce treatment failure in adults with mild to severe exacerbation of chronic obstructive pulmonary disease (COPD). The systematic review with meta-analysis is published in Annals of Internal Medicine.

COPD is characterized by frequent exacerbations that are often treated with antibiotics, systemic corticosteroids, and short-acting bronchodilators. Whether all patients, especially those with mild exacerbations treated as outpatients, benefit from these treatments is uncertain.

To compare the effectiveness of these treatments, researchers from the Mayo Clinic analyzed 68 randomized controlled trials that enrolled adults with COPD exacerbation treated in outpatient or inpatient settings other than intensive care. They compared drug therapies with placebo, "usual care," or other drug interventions. They found that compared with placebo or management without antibiotics, antibiotics given for 3 to 14 days were associated with improvement of exacerbation at the end of the intervention and less treatment failure at the end of the intervention, independent of severity of exacerbations in outpatients and inpatients. Compared with placebo in outpatients and inpatients, systemic corticosteroids given for nine to 56 days were associated with less treatment failure at the end of the intervention but also with a higher number of total and endocrine-related adverse events.

The limitations was scant evidence for many interventions; several studies had unclear or high risk of bias and inadequate reporting of AEs.

The researchers concluded that antibiotics and systemic corticosteroids reduce treatment failure in adults with mild to severe exacerbation of COPD.

Evidence for other interventions — such as aminophyllines, magnesium sulfate, anti-inflammatory agents, inhaled corticosteroids, and short-acting bronchodilators — was insufficient

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DOI: 10.7326/M19-3007