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The role of antibiotics in treating acute exacerbations of chronic obstructive pulmonary disease (AECOPD) remains controversial; the relevant trials were conducted before the benefits of systemic steroids were known.
In a recent industry-supported, placebo-controlled trial, researchers reexamined this issue among adults admitted for AECOPD to two medical centers in the Netherlands (223 patients; 265 exacerbations). Per inclusion criteria, none of the patients had fever (temperature ≥38.5°C), recent antibiotic treatment for ≥24 hours, or radiographic evidence of pneumonia. For each exacerbation, participants received a fixed tapering dose of intravenous and oral prednisolone as well as nebulized bronchodilator therapy. Patients were randomize…