Short-course antibiotic treatment in acute exacerbations of chronic bronchitis and COPD: a meta-analysis of double-blind studies
- 1Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS and Center for Infection and Immunity Amsterdam (CINIMA), Amsterdam, The Netherlands
- 2Department of Pulmonology, Academic Medical Center, Amsterdam, The Netherlands
- 3Department 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;
- Received 14 September 2007
- Accepted 16 December 2007
- Published Online First 30 January 2008
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.
The sponsors of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.
Competing interests: Healthcare Insurance Board, Amstelveen, The Netherlands (grant OG99-038).