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Antibiotic prophylaxis reduced exacerbations in COPD patients
Continuous antibiotic prophylaxis with a macrolide was associated with a clinically significant reduction of exacerbations in chronic obstructive pulmonary disease, according to a review of several randomized clinical trials.
Researchers examined the associations between prophylactic antibiotic use in chronic obstructive pulmonary disease (COPD) patients and lower rates of exacerbations and improved health-related quality of life (HRQOL). Of seven eligible studies, five assessed continuous antibiotic prophylaxis with a macrolide over 1 to 12 months, including azithromycin, clarithromycin and erythromycin. Two of these studies were excluded because one had missing data on the number of patients and the other was unblinded.
In the three remaining studies, prophylactic treatment with a macrolide was associated with fewer exacerbations over 6 to 12 months (OR=0.55; 95% CI, 0.39-0.77). According to the researchers, the number needed to treat to prevent one COPD patient from experiencing an exacerbation was 8 (95% CI, 5-18).
Although only one study assessed intermittent, or “pulsed,” antibiotic prophylaxis, this approach did not reduce exacerbations in COPD, the researchers said.
Both continuous and pulsed antibiotics were associated with improved HRQOL, but the associations were not clinically significant.
The researchers acknowledged the problems of antibiotic resistance stemming from long-term antibiotic use, as well as the potential for adverse events.
“This review supports cautious use of continuous macrolide prophylaxis with close monitoring for patients with frequent infective COPD exacerbations after other standard therapies have been prescribed,” they wrote.
Disclosure: One of the researchers received a grant from Boehringer Ingelheim that was unrelated to this study.