CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Short-course antibiotic treatment in acute exacerbations of chronic bronchitis and COPD: a meta-analysis of double-blind studies

R El Moussaoui¹, B M Roede¹, P Speelman¹, P Bresser², J M Prins¹, P M M Bossuyt³

¹ Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS and Center for Infection and Immunity Amsterdam (CINIMA), Amsterdam, The Netherlands
² Department of Pulmonology, Academic Medical Center, Amsterdam, The Netherlands
³ Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands

Dr B M Roede, Academic Medical Center, University of Amsterdam, Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Room F4-217, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; i.roede{at}amc.uva.nl

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

Results: 21 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 to 1.08). At late follow-up the summary OR was 1.0 (95% CI 0.91 to 1.10) and the summary OR for bacteriological cure was 1.05 (95% CI 0.87 to 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.

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