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Patients who are admitted for acute exacerbations of chronic obstructive pulmonary disease (COPD) often receive antibiotics, although roughly half of exacerbations are attributable to viral infections. Most randomized studies supporting antibiotic use are small and old.
Researchers used a U.S. healthcare quality database to conduct a retrospective cohort study of nearly 85,000 patients admitted for COPD exacerbations. About 10% required mechanical ventilation, died, or were readmitted for COPD within 30 days. Nearly 80% received at least 2 days of antibiotic therapy (most commonly with quinolones, cephalosporins, or macrolides). Treated patients were significantly less likely than untreated patients to receive mechanical ventilation (1.1% vs. 1.8%), die (1.0% vs. 1.6%), or to be readmitted for COPD (7.9% vs. 8.8%). However, treated patients also had a higher rate of readmission for Clostridium difficile infections than untreated patients (0.2% vs. 0.1%). In an analysis adjusted for a wide range of clinical and demographic factors, composite risk for treatment failure was 13% lower in the treated group.
Rothberg MB et al. Antibiotic therapy and treatment failure in patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease. JAMA 2010 May 26; 303:2035.
Comment
A retrospective study cannot account for all potential sources of bias, but, in this case, treated patients were actually sicker and had more comorbidities. A randomized trial might be useful but might not be considered to be ethical because of the results of this and prior studies. In some recent studies, investigators have focused on using novel inflammatory markers, such as procalcitonin, to identify patients with bacterial infections who would benefit from antibiotics. In the meantime, antibiotic use appears to be appropriate for all hospitalized patients with COPD exacerbations.