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

Rachida El Moussaoui ¹, Berendina M Roede ^2*, Peter Speelman ², Paul Bresser ², Jan M Prins ² and Patrick M Bossuyt ²

¹ Academical Medical Center, Netherlands
² Academic Medical Center - University of Amsterdam, Netherlands

^* To whom correspondence should be addressed. E-mail: i.roede{at}amc.uva.nl.

Accepted 16 December 2007

Abstract

Objective: To determine whether a short course of antibiotic treatment (up to 5 days) is as effective as the conventional longer treatment in acute exacerbations of chronic bronchitis and COPD.

Methods: MEDLINE, EMBASE and the Cochrane central register of controlled trials were searched to July 2006. Eligible were double-blind randomized clinical trials including adult patients 18 years of age with clinical diagnosis of exacerbation of COPD or chronic bronchitis, no antimicrobial therapy at the time of diagnosis and random assignment to antibiotic treatment up to 5 days versus longer than 5 days. Primary outcome measure was clinical cure at early follow-up, on intention to treat basis.

Results: 21 studies with a total of 10698 patients were included. The average quality of the studies was high: the mean Jadad score was 3.9 (SD 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.

Keywords: COPD, antibiotics, meta-analysis, short-course

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