Are shorter courses of antibiotics adequate in exacerbations of COPD?

Background

A study was undertaken to determine whether a short course of antibiotic treatment (< or=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 > or=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<or=5 days versus >5 days. The primary outcome measure was clinical cure at early follow-up on an intention-to-treat basis.

Results

Twenty-one 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 0.90–1.08). At late follow-up the summary OR was 1.0 (95% CI 0.91–1.10) and the summary OR for bacteriological cure was 1.05 (95% CI 0.87–1.26). 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.

Reproduced with permission from the BMJ Publishing Group.